Trends of Odontogenic Sinusitis Incidence During the COVID-19 Pandemic.

OBJECTIVES: The COVID-19 pandemic affected the epidemiology of several diseases. This study aims to compare the incidence of surgically treated odontogenic sinusitis (ODS) before and during the COVID-19 pandemic and identify unique features. METHODS: A retrospective chart review of patients who underwent at least maxillary antrostomy at a tertiary referral center was performed. The patients were divided into two cohorts: "pre-COVID" (March 2018 to February 2020) and "COVID" (March 2020 to February 2022). Data on demographics, comorbidities, and treatment interventions were collected and analyzed. RESULTS: Of the 734 patients who underwent maxillary antrostomy, 370 (50.4%) were operated on during the COVID period, with a mean age of 53.1 ± 15.7 years. ODS was found as the etiology of 22 (6%) and 45 (12.2%) of the pre-COVID and COVID cases, respectively (p = 0.006). Although no difference was found in the incidence of diabetes (p = 0.9) or obesity (p = 0.7) between groups, a trend toward higher incidence of immunosuppression was found in the pre-COVID patients (18.2% vs. 0%, p = 0.06). A higher incidence of sphenoid sinus involvement (31.8% vs. 8.9%, p < 0.05) was identified in the pre-COVID group; however, no differences in ethmoid (86.4% vs. 86.7%, p = 0.999) or frontal sinus involvement (54.5% vs. 37.8%, p = 0.3) were found between the groups. CONCLUSION: There was an increase in the incidence of ODS during the first 2 years of the COVID-19 pandemic compared to the 2 years prior. Similar clinical characteristics were found in both groups. Future studies focusing on specific etiologies to explain ODS preponderance may help determine optimal treatment and prevention strategies. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1597-1602, 2024.

Incidence of Sinusitis Postoperatively in Orthognathic Surgery: A Systematic Review and Meta-Analysis.

Maxillary osteotomies as a component of orthognathic surgery disrupt the normal anatomy and function of the sinus. The osteotomy with advancement of the inferior component of the sinus leaves a bony and mucosal opening in the sinus. Immediately after surgery, nasal drainage is impeded because of intranasal swelling. Acute and chronic maxillary sinusitis would be expected; however, its incidence as an expected complication is not well documented. A systematic review and meta-analysis was completed using PubMed to determine the incidence of sinusitis after maxillary orthognathic surgery. Studies were reviewed by two authors, and incidence data were extracted. Two hundred six articles were identified with 24 meeting the criteria for analysis. The incidence of sinusitis was based on 4213 participants who had undergone orthognathic surgery. Twenty-three studies reported a total number of sinusitis cases, and the results demonstrated a pooled incidence of 3.3% (95% confidence interval: 1.77, 6.06). One study did not report a total number of cases but reported chronic sinusitis survey-duration-based and Lund-Mackay scores. These scores, respectively, worsened from 7.6 to 14.8 and from 1.58 to 2.90 postoperatively. Despite the variability of maxillary surgery, the surgical technique, and the postoperative management, the incidence is low but sinusitis does occur. Prospective studies with validated questionnaires within the context of a specific protocol may further elucidate the causality of sinusitis. Further, patients with sinonasal symptoms postsurgery should be encouraged to consult with an otolaryngologist to ensure prompt treatment.

[Dynamic indicators of the use of puncture method for the treatment of acute maxillary sinusitis in healthcare institutions of the city of Moscow]. / Dinamicheskie pokazateli primeneniya punktsionnogo metoda lecheniya ostrogo verkhnechelyustnogo sinusita v uchrezhdeniyakh zdravookhraneniya goroda Moskvy.

According to the statistical forms medical and preventive treatment centres (MPTC), the analysis of dynamic indicators of the treatment of patients with acute sinusitis (AS) in outpatient polyclinic centers (OPC) and ENT hospitals in Moscow for the period from 2017 to 2021 was carried out. The total number of visits to an otorhinolaryngologist in the OPC in Moscow for 2017-2021 amounted to 6 834 952 patients, including 245 172 patients with AS (3.6%).The total number of hospitalizations in the departments of otorhinolaryngology for the same period amounted to 184 735 patients, including 12 906 patients with AS (7%).The number of patients with AS who was consulted by an otorhinolaryngologist from 2017 to 2021 decreased by 18.2%, which can be explained by a change in the routing of patients with mild form of AS to general practitioners. An analysis of the dynamic indicators of maxillary sinus punctures carried out in the medical and preventive treatment centres (MPTC) in Moscow during the period from 2017 to 2021 showed that there was a redistribution of this manipulation from ENT hospitals to the OPC. At the same time, the proportion of patients requiring puncture treatment in the OPC for 2017-2019 was stable and amounted to 9.3%. However, since 2020, there has been an increase in this indicator by more than 2 times (21.7%), which probably indicates an increase in the treatment of patients with moderate forms of AS in the OPC. The frequency of maxillary sinus punctures that were performed in ENT hospitals in 2017-2019 amounted to 83.5%, in 2020-2021 decreased to 63.4%. The average number of maxillary sinus punctures per patient in ENT hospitals from 2017 to 2019 was 13.3. Since 2020, this value has decreased by about 2 times and has become equal to 8.5. The decrease in the number of maxillary sinus punctures that were performed in ENT hospitals is probably due to the fact that patients with severe and complicated forms of acute sinusitis hospitalized from 2020 to 2021 required more radical surgical treatment.

Global Prevalence of Maxillary Sinusitis of Odontogenic Origin and Associated Factors: A Systematic Review and Meta-Analysis.

INTRODUCTION: The overall prevalence of maxillary sinusitis of odontogenic origin (MSOO) is still unknown. Therefore, this study aimed to determine the pooled prevalence of MSOO and verify associations between different odontogenic conditions and MSOO. METHODS: Six electronic databases and the gray literature were searched on August 25, 2022. Two independent reviewers selected observational studies reporting the prevalence of MSOO and associated conditions in adults. Studies that did not use computed tomography for diagnosis were excluded. The methodological quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. Data were analyzed by proportion and association meta-analyses. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Thirty-eight studies were included in the qualitative analysis and thirty-one in the meta-analyses. Only 12 studies (31.6%) fulfilled all items of the methodological quality checklist. Overall, the studies reported prevalence measures per maxillary sinus or patient. Thus, the pooled prevalence of MSOO was 51% per sinus (95% confidence interval [CI] [40%-61%]) and 50% per patient (95% CI [41%-59%]). Apical lesion (odds ratio [OR]: 4.03, 95% CI [2.26-7.19]), periodontitis (OR: 5.49, 95% CI [2.27-13.24]), moderate (OR: 2.57, 95% CI [1.85-3.57]) and severe bone loss (OR: 13.80, 95% CI [2.81-67.85] were significantly associated with MSOO. The certainty of the evidence for the associations was very low. CONCLUSIONS: The pooled prevalence of MSOO on computed tomography assessment was 51% per maxillary sinus and 50% per patient. Therefore, half of the maxillary sinusitis may be of odontogenic origin. Apical lesion, periodontitis, and moderate and severe bone loss were significantly associated with MSOO.

Odontogenic Sinusitis is a Common Cause of Operative Extra-Sinus Infectious Complications.

BACKGROUND: Orbital, intracranial, and osseous extra-sinus complications can arise from bacterial or fungal sinusitis. Odontogenic sinusitis (ODS) can cause extra-sinus complications, but its prevalence remains poorly characterized. OBJECTIVE: To determine the frequency of ODS as a cause of operative extra-sinus infectious complications and describe clinical features of all complicated sinusitis cases. METHODS: A multi-institutional retrospective review was performed on all operative sinusitis-related extra-sinus complications from 2011 to 2020. ODS was diagnosed by sinus computed tomography (CT) and dental evaluations when available. Demographics, complication types, sinusitis etiologies, and various clinical features were analyzed. RESULTS: Forty-five patients were included (mean age 55.5 years, 56% male). Of the extra-sinus complications, 40% were orbital only, 22% intracranial only, 13% osseous only, and 25% involved combined complications. The 2 most common causes of extra-sinus complications were ODS (40%) and mucopyocele (27%). When invasive fungal etiologies were excluded, and only unilateral maxillary opacification on CT was considered, nearly 60% of extra-sinus complications were due to ODS. Unilateral maxillary sinus opacification on CT was present in 100% of complicated ODS compared to 44% of nonodontogenic cases, and oral anaerobes were only identified in ODS cases. No complicated ODS patients underwent dental interventions during hospitalization. CONCLUSION: ODS was the most common cause of operative extra-sinus infectious complications. Clinicians should consider ODS high on the differential diagnosis of all patients presenting with complicated sinusitis, especially when sinusitis is unilateral and invasive fungal infection is not suspected.

Prevalence and Risk Factors for Chronic Maxillary Sinusitis After Surgery for Mid-Facial Fracture: A Cross-Sectional Study.

ABSTRACT: Posttraumatic chronic maxillary sinusitis deleteriously affects the life quality of patients with recurrent episodes and related discomfort. However, few studies have been performed to investigate the prevalence of chronic maxillary sinusitis after surgery of mid-facial fracture and related risk factors. The early prevention and cure of posttraumatic chronic maxillary sinusitis have received little attention. This study aimed to investigate the prevalence of chronic maxillary sinusitis after surgery for mid-facial fracture and to identify related risk factors. The authors retrospectively collected the medical history, radiographic examination, and clinical examination of patients with mid-facial fracture (experimental group) and patients with mandibular cyst (control group) in our department between January 2015 and December 2020. A total of 298 patients (416 maxillary sinuses) in the experimental group and 172 patients (344 maxillary sinuses) in the control group were included for analyses. The prevalence of chronic maxillary sinusitis in the experimental group and control group were, respectively, 9.14% and 2.04% ( P < 0.05). History of sinusitis/rhinitis (odds ratio = 63.70, P = 0.000) was an independent risk factor for posttraumatic chronic maxillary sinusitis. In conclusion, these findings showed that the prevalence of chronic maxillary sinusitis after surgery for midfacial fracture was significantly higher than that in the control group and long-term follow-up may be beneficial for these patients. Moreover, patients with a history of sinusitis/rhinitis should be informed of the increased risk.

Maxillary sinusitis as a respiratory health indicator: a bioarchaeological investigation into medieval central Italy.

OBJECTIVE: This study aims to assess chronic maxillary sinusitis in an osteoarchaeological sample from the medieval rural site of Pieve di Pava (central Italy), to investigate triggers responsible for sinus inflammation, and to compare prevalence rates with coeval European rural sites. MATERIALS: The analysis focused on 145 10th-12th-century adults with at least one preserved maxillary sinus. METHODS: Sinusitis-related lesions were observed macroscopically and microscopically. Alveolar pathologies of the maxillary posterior dentition were recorded to investigate the impact of odontogenic sinusitis. RESULTS: Maxillary sinusitis was observed in 23.4% of the individuals (n = 34), with similar frequencies in both sexes and bilateral sinusitis appearing more frequently than unilateral sinusitis. An association of alveolar lesions with sinusitis was found in 38.2% of cases. CONCLUSIONS: Compared to coeval rural sites in Northern Europe, Pieve di Pava shows the lowest prevalence of maxillary sinusitis, likely reflecting a greater amount of time spent outdoors. Despite the small size of the sample, odontogenic sinusitis cannot be ruled out. SIGNIFICANCE: This is the first Italian study to investigate maxillary sinusitis and to focus on the Mediterranean area, contributing to the understanding of this condition as a health indicator in ancient populations. LIMITATIONS: Research limitations include preservation issues affecting the number of observable sinuses, the non-homogenous age distribution of the sample, and the impact of inclusion and methodological criteria on the comparability of results. SUGGESTIONS FOR FURTHER RESEARCH: Further investigations into odontogenic sinusitis and the microscopic examination of dental calculus may provide new data on the pathogenesis of sinusitis.

[Characteristic of iatrogenic odontogenic sinusitis]. / Kharakteristika yatrogennykh odontogennykh gaimoritov.

OBJECTIVE: The aim of the study was to study the structure of odontogenic sinusitis and identify iatrogenic etiological factors. MATERIAL AND METHODS: A retrospective analysis of the case histories of patients operated from 2015 to 2019 with a diagnosis of «Sinusitis¼ in the Clinical City Emergency Hospital in Tashkent, Republic of Uzbekistan in the department of emergency maxillofacial surgery was carried out. The total number of patients was 333 people: 105 (31.5%) men and 228 (68.5%), the average age of patients was 39.4 years. RESULTS: When analyzing the reasons for the development of sinusitis, in 73% of the total number of operated patients, there was an associated lesion of the teeth. When detailing the sources of odontogenic infection, it was determined that periapical foci of inflammation (granulomatous, granulating periodontitis, cystogranulomas) accounted for 26%, foreign bodies (teeth, roots of teeth, filling materials removed into the maxillary sinus during endodontic treatment) 31%, fistulous passages after removal teeth and attempts to eliminate perforation by surgery 43%. Other etiological factors were found: chronic polypous rhinosinusitis 14%, benign tumors 8%, allergic fungal sinusitis 5%. CONCLUSION: Clinical analysis showed that the development of most cases of odontogenic sinusitis is associated with the mistakes of dentists and is of iatrogenic origin. To prevent the development of odontogenic iatrogenic sinusitis, prior to dental interventions on the teeth of the upper jaw, it is necessary to carry out a topical diagnosis of their ratio with the maxillary sinus.

A study on the association between accessory maxillary ostium and maxillary sinus mucosal thickening using cone beam computed tomography.

BACKGROUND: Accessory maxillary ostium (AMO) has a major role to play in the aetiology of maxillary sinusitis. Mucosal thickening is one of the key radiographic features of chronic maxillary sinusitis. The aim of this study was to identify the location of the AMOs and investigate the association between Mucosal Thickening [MT] and AMO using Cone Beam Computed Tomography [CBCT]. METHODS: CBCT scans of 400 maxillary sinuses from the records of 200 patients who seeked various dental treatments at the Thumbay Dental Hospital, Gulf Medical University, Ajman, United Arab Emirates were evaluated. The incidence, anatomical position and maximal length of accessory maxillary ostia (AMO) in the maxillary antrum were reviewed using CBCT by two examiners. The association between MTs and AMOs were also analysed. RESULTS: Among the 200 CBCT scans, 131 belonged to male patients and 69 scans belonged to female subjects within the age group of 18-65 years (mean age 41.32 years). AMOs were found in 142 maxillary antra (35.5 %). The inter-observer reliability for using CBCT to detect AMO was (k = 0.83). There was no significant difference in the frequency of AMOs when the age (P = 0.19) and gender (P = 0.54) distribution were considered. Sinuses with AMOs, showed significantly greater frequency of MTs (p = 0.001). AMOs with maximal length of less than 1mm were most commonly observed (51.40 %). AMOs with larger greater maximal length were associated with higher degrees of MT. The location of the AMOs, were not affected by the degree of MT. CONCLUSIONS: The study demonstrates a clear association between degree of MT and occurrence of AMO in the maxillary sinus. However, the location of the AMO is independent of the degree of the MT. There is a greater probability of finding an AMO in the maxillary sinus if the MT in the sinus is more than 3 mm.

Time to be nosy: Evaluating the impact of environmental and sociocultural changes on maxillary sinusitis in the Middle Nile Valley (Neolithic to Medieval periods).

OBJECTIVE: To investigate the prevalence of maxillary sinusitis in people who lived in the Middle Nile Valley across different periods, cultures, and environmental conditions. MATERIALS: 481 skeletons from 13 sites, curated at the British Museum, London, were analysed. The sites ranged in date from the Neolithic to Medieval periods (c. 4900 BCE-CE 1500). METHODS: Bony changes within the maxillary sinuses, associated with sinusitis and oroantral fistulae were systematically recorded according to pre-established criteria. RESULTS: There were significant differences in the prevalence of maxillary sinusitis between time period/subsistence economy groups. The Neolithic hunter-gatherer/early agricultural group had the lowest prevalence, whilst the urban group demonstrated the highest frequency of the disease. CONCLUSIONS: Factors involved in the development of maxillary sinusitis are manifold and complex. However, the results indicate that increased aridity in Sudan in later periods and intensification of agricultural practices may have played a role in increasing prevalence of the disease. Urban environments, including crowding, poor sanitation, and industrial air pollution, could also have influenced susceptibility to maxillary sinusitis. SIGNIFICANCE: Prior to this paper, the impact of arid environments on respiratory health in the past had received little attention despite growing clinical research on the topic. Both arid and urban environments are predicted to expand in the future. This paper provides a deep-time perspective on an issue of increasing concern today. LIMITATIONS: Poor preservation of skeletons and a lack of archaeological settlement data for some sites. FUTURE RESEARCH: Investigation of a greater range of populations from different environments/climates.

Microbiology, Histopathology, and Radiographic Findings in Silent Sinus Syndrome.

BACKGROUND: The histopathology and microbiology associated with silent sinus syndrome (SSS) have not been well described. OBJECTIVE: This study details the histopathological and microbiological characteristics in addition to radiographic findings of SSS in comparison to those of chronic maxillary sinusitis (CRS). METHODS: 42 patients diagnosed with SSS at Mayo Clinic Hospital in Arizona were identified. Paranasal computed tomography scans of the 42 SSS patients as well as 42 matched CRS patients were analyzed in order to assess differences in the prevalence of septal spurs/deviation. 20 of the SSS patients and 19 of the matched CRS patients also had histopathology and microbiology reports, which were compiled and summarized. Additionally, 19 SSS and 19 matched CRS patients were contacted via phone survey for a more complete patient history regarding maxillary dental disease/surgery. RESULTS: SSS patients have a significantly higher prevalence of septal spurs/deviation than CRS patients. The microbiomes of SSS patients more closely resemble those of healthy controls than those of CRS patients. Analysis of the histopathology of SSS reveals chronic, non-specific inflammation similar to that seen in non-eosinophilic CRS without polyps. SSS patients were significantly more likely to have a history of maxillary dental disease requiring surgery. CONCLUSION: These data support the hypothesis that the pathogenesis of SSS is more likely due to anatomical/mechanical factors than inflammatory/microbiological factors.

Predicting Odontogenic Sinusitis in Unilateral Sinus Disease: A Prospective, Multivariate Analysis.

BACKGROUND: Odontogenic sinusitis (ODS) is a common cause of unilateral sinus disease (USD), but can be challenging to diagnose due to nonspecific clinical presentations, potentially subtle to absent dental pathology on sinus computed tomography (CT), and underrepresentation in the sinusitis literature. OBJECTIVE: Identify sinonasal clinical variables predictive of ODS in patients presenting with unilateral maxillary sinus opacification on sinus CT. METHODS: A prospective cohort study was conducted on 131 consecutive patients with USD and at least partial or complete maxillary sinus opacification on sinus CT. Patients' demographics, sinonasal symptoms (anterior and posterior drainage, nasal obstruction, facial pressure, smell loss, and foul smell), 22-item sinonasal outcome test, nasal endoscopy findings, CT findings, and histopathology were collected. Patients' diagnoses included ODS, chronic rhinosinusitis with or without nasal polyps, and inverted papilloma. Demographic and clinical data were compared between patients with unilateral ODS and non-odontogenic disease using univariate and multivariate analyses. RESULTS: Of the 131 USD patients, 65 had ODS and 66 had non-odontogenic disease. The following variables were significantly associated with unilateral ODS on multivariate analysis: middle meatal pus on endoscopy (OR= 17.67, 95% CI-5.69, 54.87; p = 0.001), foul smell (OR= 6.11, 95% CI-1.64, 22.82; p=.007), facial pressure (OR= 3.55, 95% CI-1.25, 10.12; p = 0.018), and any frontal opacification on CT (OR= 5.19, 95% CI-1.68, 16.06; p = 0.004). Any sphenoid opacification on CT was inversely related to ODS (OR = 0.14, 95% CI-0.03, 0.69; p = 0.016). The study was adequately powered. CONCLUSION: With unilateral maxillary sinus disease, the following features were significantly associated with ODS: foul smell, ipsilateral facial pressure, middle meatal pus on endoscopy, and any frontal sinus opacification on sinus CT. Additionally, any sphenoid sinus opacification on CT was inversely related to ODS. Presence or absence of these clinical variables can be used to increase or decrease one's suspicion of an odontogenic source of sinusitis.

Correlation between prevelance of Haller cells and postoperative maxillary sinusitis after sinus lifting Procedure.

Our aim was to investigate the prevalence of Haller cells in a group of patients listed for sinus lifting, and to assess the correlation between postoperative maxillary sinusitis and their presence. A total of 102 patients (150 sides) were evaluated retrospectively on cone-beam computed tomography (CT). The presence and dimensions of Haller cells were noted on the scans. The development of postoperative maxillary sinusitis was recorded. Fisher's exact test was used for statistical evaluation and probabilities of less than 0.05 were considered significant. Maxillary sinusitis developed after sinus lifting in five patients, and Haller cells were found in three of them. However, there was no correlation between the presence of Haller cells and postoperative maxillary sinusitis (p=0.638). The cells were larger in patients with postoperative maxillary sinusitis, and the greater dimensions may be a potential risk factor for developing it after a sinus lift.

Anatomical Variation in Maxillary Sinus Ostium Positioning: Implications for Nasal-Sinus Disease.

Among humans, superiorly located maxillary sinus ostia (MSO) result in drainage complications and maxillary sinus (MS) disease. While previous studies investigate maxillary sinusitis frequency or MSO-position relative to specific nasal landmarks, few explore MSO-position to overall MS dimensions. This study investigates whether MSO-position relates to MS size/shape and if sex-based differences exist. Twenty-nine landmarks, placed on magnetic resonance images (MRIs) of 109 individuals (males = 57; females = 52), captured maximum dimensions of the cranium, MS, nasal cavity, and MSO-position relative to the MS floor (MSO_MSF) and nasal floor (MSO_NCF). Landmark coordinates were used to calculate centroid sizes and 13 linear distances; distances were size standardized by cranial centroid-size. Principal components analysis (PCA) on 3D-coordinates indicates that variation in MSO-position relates to superior-inferior MS positioning within the face (PC1 22% variance) and MS height (PC2 12% variance). Regression analyses indicate that MS size (r2 = 0.502; P < 0.001) and height (r2 = 0.589; P < 0.0001) strongly contribute to MSO_MSF: larger, taller MSs exhibit greater MSO_MSFs. Sex-based differences were not evident in PC shape-analyses nor among size-standardized dimensions. However, Mann-Whitney U-tests indicate females have absolutely smaller MSs (P = 0.001) and MSO_MSF distances (P = 0.001). Further, regressions indicate females exhibit lower MSO_MSFs for a similar MS height. Overall, MSOs superiorly placed relative to the MS floor correlate with larger, taller MSs and/or sinuses positioned inferiorly within the face. While craniofacial surgeons/clinicians should be aware of potential sex-based differences in MS size and MSO position, this study does not suggest that higher incidences of female-reported sinusitis relate to sex-based differences in MS anatomy. Anat Rec, 302:917-930, 2019. © 2018 Wiley Periodicals, Inc.

Nested PCR for the detection of Aspergillus species in maxillary sinus samples of patients with chronic sinusitis / PCR con cebadores internos para la detección de especies de Aspergillus en muestras de seno maxilar de pacientes con sinusitis crónica

Background: Fungal rhinosinusitis has become an increasingly recognized disease, being Aspergillus species responsible for most of the cases. Its diagnosis is quite difficult because of the non-specific symptoms and low sensitivity of the current diagnostic methods. Aims: An Aspergillus-specific nested polymerase chain reaction (PCR) assay using biopsy specimens taken from the maxillary sinuses was performed in order to assess its usefulness. Conventional diagnostic methods (histology and culture) were also carried out. Methods: A case-control study was performed in the Institute of Stomatology, Jagiellonian University in Kraków, between 2011 and 2014. The case group consisted of 21 patients with suspected rhinosinusal mycetoma while the control group included 46 patients with no suspicion of fungal rhinosinusitis. The two-step PCR assay amplified an Aspergillus specific portion of the 18S rRNA gene. Interval estimation of sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated to assess the diagnostic test performance. The agreement between the PCR and the other tests was evaluated using the Kappa coefficient (k). Results: Ninety percent of the samples obtained from patients diagnosed with mycetoma yielded positive PCR results. The PCR showed almost perfect concordance with histology (k=0.88). Sensitivity, specificity, PPV and NPV estimates were 90%; 95% CI: (55.5-99.7%), 98.3%; 95% CI: (90.9-100%), 90%; 95% CI: (55.5-99.7%) and 98.3%; 95% CI: (90.9-100%), respectively. One clinical sample showed growth of Aspergillus fumigatus and positive PCR despite the negative histological examination. Conclusions: Nested PCR assay is a promising diagnostic tool to evaluate the presence of Aspergillus in the tissue of maxillary sinus from patients with suspicion of sinus aspergillosis

Antecedentes: La rinosinusitis fúngica se ha convertido en una enfermedad cada vez más frecuente y el género Aspergillus es el causante de la mayoría de los casos. Su diagnóstico es relativamente difícil debido a la inespecificidad de los síntomas y a la baja sensibilidad de los métodos de diagnóstico actuales. Objetivos: Evaluar la eficacia de un ensayo de reacción en cadena de la polimerasa (RCP), con cebadores internos y específica de Aspergillus en muestras de biopsia tomadas de los senos maxilares de algunos pacientes, y compararla con la eficacia de los métodos de diagnóstico convencionales (histología y cultivo). Métodos: Se realizó un estudio de casos y controles en el Instituto de Estomatología de la Universidad Jaguelónica de Cracovia entre 2011 y 2014. El grupo de casos estaba formado por 21 pacientes en que se sospechaba rinosinusitis por micetoma mientras que el grupo control estaba compuesto por 46 pacientes sin sospecha de rinosinusitis fúngica. El ensayo de PCR en dos etapas amplificó una porción específica del gen 18S rRNA de Aspergillus. Se obtuvieron estimaciones de la sensibilidad, la especificidad y de los valores predictivos positivo (VPP) y negativo (VPN) para evaluar el rendimiento de la prueba. La concordancia entre la PCR y las otras pruebas realizadas se evaluó utilizando el coeficiente kappa (k). Resultados: El 90% de las muestras obtenidas de pacientes diagnosticados de micetoma mostró resultados positivos en la PCR, con una concordancia casi perfecta de este método con la histología (k=0,88). Las estimaciones de sensibilidad, especificidad, VPP y VPN fueron las siguientes: 90%, IC95% (55,5-99,7%); 98,3%, IC95% (90,9-100%); 90%, IC95% (55,5-99,7%) y 98,3%, IC95%: (90,9-100%), respectivamente. Aspergillus fumigatus se aisló en el cultivo de una muestra clínica, además de obtenerse un resultado positivo por PCR de dicha muestra a pesar de que el examen histológico fue negativo. Conclusiones: El ensayo de PCR con cebadores internos es una herramienta de diagnóstico prometedora para evaluar la existencia de Aspergillus en tejidos del seno maxilar de pacientes en que se sospeche aspergilosis sinusal

Bola fúngica de cavidades paranasales: serie de casos / Fungus ball of the paranasal sinuses: case series

RESUMEN Introducción La bola fúngica (BF) es una sinusitis fúngica no invasiva, con acumulación extramucosa de conglomerados densos de hifas de hongos en cavidades paranasales (CPN), afectando generalmente a mujeres inmunocompetentes. Objetivo Describir la presentación cínica, diagnóstico y tratamiento de una serie de pacientes con diagnóstico de BF de CPN. Material y método Estudio descriptivo retrospectivo de pacientes con diagnóstico histopatológico de BF sometidos a cirugía endoscópica nasal (CEN) en nuestra institución entre 2010 y 2016. Resultados Se incluyeron 20 pacientes (15 mujeres, 5 hombres), con edad promedio al diagnóstico de 64 años (35-86 años), la mayoría inmunocompetente (85%). El síntoma más frecuente fue dolor facial (8/20). Todos los pacientes fueron estudiados con tomografia computarizada (TC) de CPN, presentando calcificaciones en 70%. La ubicación más frecuente fue el seno maxilar (12/20) y luego esfenoidal (6/20). Se realizó CEN en todos los pacientes, combinándolo con Caldwell Luc en 3 de ellos. Los cultivos intraoperatorios resultaron negativos en el 75% de los pacientes. Conclusión La BF tiene presentación cínica inespecifica. Se sospecha en base a hallazgos imagenológicos en la TC de CPN y se confirma histopatológicamente, dado el bajo rendimiento de los cultivos. La CEN es la herramienta diagnóstico-terapéutica de elección, con baja tasa de recidiva local.

ABSTRACT Introduction A fungus ball (FB) is a non-invasive fungal sinusitis, consisting of extramucosal accumulation of dense fungal hyphae conglomerates, located in paranasal sinuses. It generally affects immunocompetent women. Aim To describe the clinical presentation, diagnosis and treatment in a series of patients diagnosed with FB of paranasal sinuses. Material and method Retrospective descriptive study regarding all patients with a histopathologic diagnosis of FB, who underwent endoscopic sinus surgery (ESS) in our institution between 2010 and 2016. Results Twenty patients (15 women, 5 men) were included, with a mean age at diagnosis of 64 years (35-86 years). Most were immunocompetent (85%). Facial pain was the most frequent symptom (8/20). All patients were studied with a sinus CT, finding paranasal calcifications in 70%. It predominantly involved the maxillary (12/20), and sphenoid sinus (6/20). All patients were treated with ESS, with a combined Caldwell Luc approach in only 3 of them. Intraoperative cultures were negative in 75% of patients. Conclusions Sinus FB has a non-specific clinical presentation. CT findings help suspect it, and it is confirmed with a histopathological study, given the poor efficiency of cultures. ESS is the diagnostic-therapeutic procedure of choice, with a low local recurrence rate.

ACTUAL ISSUES OF ODONTOGENIC MAXILLARY SINUSITIS (REVIEW).

Odontogenic maxillary sinusitis has now increasing incidence in dental and otorhynolaryngological practice. Its incidence varies from 10-12 % to 50-75 %, according to different authors. Literature study showed that odontogenic maxillary sinusites are mostly unilateral, and significantly differ in complaints, clinical signs, and diagnostic and treatment measures from other types of sinusitis. This should be taken into account, because often odontogenic maxillary sinusitis is misdiagnosed with common sinusitis, and only in 77 % such patients are examined by both dental specialist and otorhynolaryngologist. Study of causes of odontogenic maxillary sinusitis revealed that now iatrogenic impact prevails over other causes, which had been previously considered as main causes of odontogenic maxillary sinusitis. Especially endodontic treatment and implantation surgery are major causes of odontogenic maxillary sinusitis in present time, due to increasing incidence of perforation and damage of sinus by filling materials, bone or tooth particles, and implants. Anatomical structure of dental-sinus border area, and volume of endodontic treatment and implanting procedures, determines last ones as causative triggers due to development of complications and inflammatory processes. Microbial flora is mostly presented by anaerobic microorganisms; at the same time aerobic and fungal organisms are found in the microscopy of histology of patients with odontogenic maxillary sinusitis. At the same time, polymicrobial associations show high resistance to wide spectrum of antimicrobial medications. In past years theory of microbial biofilms is considered leading in explanation of recurrent and persistent odontogenic sinusitis. Such polymicrobial associations are covered with complex shield of different compounds, providing protection and nutrients. This significantly complicates treatments and can cause recalcitrant and recurrent infections.

Afección del sistema nervioso central en la enfermedad relacionada con IgG4: descripción de un caso y revisión de la bibliografía / Central nervous system in IgG4-related disease: case report and literature review

Introducción. La enfermedad relacionada con IgG4 es una entidad clínica multisistémica recientemente descrita y que se presenta con diferentes manifestaciones clínicas. Los órganos que están afectados con mayor frecuencia son el páncreas, la vía biliar y las glándulas salivales, y es menos frecuente la afección del sistema nervioso central. Caso clínico. Mujer de 33 años con alteraciones cognitivas, alucinaciones, cefalea, síndrome convulsivo, sinusitis maxilar con afección ósea y evidencia de paquimeningitis y panhipopituitarismo, con biopsia meníngea que confirmó una enfermedad relacionada con IgG4, tras haberse descartado causas secundarias. Se inició tratamiento con glucocorticoides y azatioprina, sin recaídas después de 12 meses de seguimiento. Conclusiones. Se debe considerar el diagnóstico de enfermedad relacionada con IgG4 en casos de paquimeningitis hipertrófica e hipofisitis, incluso sin que se acompañen de otras manifestaciones sistémicas, siempre que se hayan descartado otras causas más frecuentes. El tratamiento de elección son los glucocorticoides, y puede ser necesario añadir otro inmunosupresor como ahorrador de esteroides y para evitar las recaídas. Se necesitan estudios prospectivos para evaluar las diferentes manifestaciones clínicas y paraclínicas y establecer los resultados del tratamiento a largo plazo (AU)

Introduction. IgG4-related disease is a recently described multisystemic clinical entity that can occur with different clinical manifestations. The most often affected organs are the pancreas, bile duct and salivary glands, with unusual central nervous system affection. Case Report. A 33 year old woman who presented with cognitive impairment, hallucinations, headache, convulsive syndrome, maxillary sinus inflammation with bone involvement and evidence of pachymeningitis and panhypopytuirarism with meningeal biopsy that confirmed IgG4-related disease, after ruling out secondary causes. Treatment was started with steroids and azathioprine without relapses after 12 months follow-up. Conclusions. IgG4-related disease should be considered in cases of hypertrophic pachymeningitis and hypophysitis especially when no other cause has been found, even if they are not accompanied by other systemic disease manifestations, having ruled out other common causes. The treatment of choice is glucocorticoids and it could be needed to add another immuno­suppressant agent as steroid sparing and to prevent relapses. Prospective studies are needed to evaluate the different clinical and paraclinical manifestations and to establish the results of long-term treatment (AU)

Management of acute maxillary sinusitis after sinus bone grafting procedures with simultaneous dental implants placement - a retrospective study.

BACKGROUND: The sinus lift was first described in 1974 and it has proven to be a predictable procedure ever since. The complications of this surgical procedure are reported in the literature to be low, and can include acute maxillary sinusitis, scattering of the grafting material into the sinus cavity, wound dehiscence and Schneiderian membrane perforations. We aimed to evaluate the rate of acute maxillary sinusitis after sinus lift procedures and the appropriate management strategies. METHODS: Between 2013 and 2015, 245 dental implants were placed in 116 patients (76 males and 40 females) with concomitant bone augmentation of the maxillary sinus floor. The sinus lifting procedure was bilateral in 35 patients and unilateral in 81 patients (a total of 151 sinuses). RESULTS: Maxillary sinusitis occurred in 5 patients (4.3 %). The clinical signs of infection were: headache, locoregional pain, cacosmia, inflammation of the oral buccal mucosa and rhinorrhea or unilateral nasal discharge. A mucosal fistula was observed during inspection in one patient. The management included only the removal of the grafting material in 3 patients, in 1 patient the grafting material was removed together with all the implants, and in 1 patient only 2 implants and the grafting material were removed, 1 implant being left in place. The sinus cavity was irrigated with metronidazole solution and antibiotic therapy with clindamycin and metronidazole was prescribed for 10 days. Subsequently, all signs of infection disappeared within 5 to 7 days and normal sinus function and drainage were restored. CONCLUSIONS: Although sinus lift is regarded as a safe and reliable procedure, acute sinusitis is a possible complication which has to be managed immediately in order to reduce the risk of further complications like pansinusitis, osteomyelitis of the maxillary bone, and spreading of the infection in the infratemporal space or orbital cavity. To minimize risk, caution must be taken with all the steps of the procedure, in order not to obliterate the ostium, impairing maxillary sinus clearance.

Analysis of sinonasal anatomical variations associated with maxillary sinus fungal balls.

OBJECTIVE: The pathogenesis of MSFB development remains unclear, but it has been suggested that poor sinus ventilation is associated with disease development; such a ventilation is influenced by anatomical variation of the paranasal sinuses. Thus, we sought to determine whether sinonasal anatomical variations were associated with MSFB development. METHODS: Thirty-one patients with MSFB and 28 gender-matched control patients were included in the present study. The presence or absence of Haller cells and a concha bullosa were scored, and the angle of septal deviation and the minimal and maximal lengths of the infundibulum were measured on preoperative computed tomography images. RESULTS: In the MSFB group, both a concha bullosa (61.3% vs. 28.6%, p=0.006) and Haller cells (41.9% vs. 30.4%) were present at higher frequencies than in the control group, although the between-group difference in Haller cell occurrence was not statistically significant (p=0.348). In addition, MSFB patients had a significantly lower mean infundibular width (3.23±0.69mm vs. 3.99±1.17mm, p<0.001) and a longer infundibular length (9.71±1.43mm vs. 8.23±1.72mm, p<0.001) than controls. CONCLUSIONS: Sinonasal anatomical variations, especially the presence of a concha bullosa, and/or a narrow and long infundibulum, may play roles in the development of maxillary sinus fungal balls (MSFBs).