1
|
Pannkuk TF, Craig JR, Tušas P, Simuntis R. Management of Endodontic Disease for Odontogenic Sinusitis. Otolaryngol Clin North Am 2024:S0030-6665(24)00099-9. [PMID: 39214736 DOI: 10.1016/j.otc.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Primary dental treatments for odontogenic sinusitis (ODS) due to endodontic infections (pulpal necrosis and apical periodontitis ± periapical abscess) include extraction and root canal treatment (RCT). Published evidence is lacking on the success of primary endodontic treatment for purulent ODS, with the majority of RCT-related series reporting on its success at resolving reactive maxillary sinus mucositis. Dental extraction is the most definitive treatment of endodontic disease causing ODS, but compromises the functional dentition and still often fails to resolve the purulent sinusitis. This article highlights key concepts of RCT and dental extraction techniques, as well as their published success at resolving ODS.
Collapse
Affiliation(s)
- Terrell F Pannkuk
- Private Practice, Santa Barbara Endodontics, 9 East Pedregosa Street, Suite B, Santa Barbara, CA 93101, USA.
| | - John R Craig
- Rhinology, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, MI, USA
| | - Paulius Tušas
- Faculty of Medicine, Institute of Dentistry, Vilnius University, Giedraiciu 39-58, Vilnius 09302, Lithuania
| | | |
Collapse
|
2
|
Craig JR, Saibene AM, Adappa ND, Douglas JE, Eide JG, Felisati G, Kohanski MA, Kshirsagar RS, Kwiecien C, Lee D, Makary CA, Palmer JN, Ray A, Wilson C, Kuan EC. Maxillary Antrostomy Versus Complete Sinus Surgery for Odontogenic Sinusitis With Frontal Sinus Extension. Laryngoscope 2024. [PMID: 39189339 DOI: 10.1002/lary.31731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/30/2024] [Accepted: 08/08/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVES Endoscopic sinus surgery (ESS) is often necessary when managing odontogenic sinusitis (ODS), but ESS extent for ODS with extramaxillary sinus involvement has been incompletely studied. This study compared outcomes after wide maxillary antrostomy (MA) alone versus complete ESS for ODS with frontal sinus involvement. METHODS A multicenter prospective cohort study was conducted on patients with uncomplicated ODS (no extrasinus spread) who underwent ESS when computed tomography demonstrated maxillary, anterior ethmoid (AE), and frontal sinus opacification. Multiple preoperative and postoperative variables were recorded, including 22-item sinonasal outcome tests (SNOT-22) and endoscopic findings. Ultimate SNOT-22 and endoscopic resolution, and time to SNOT-22 and endoscopic resolution were compared between patients who underwent MA alone versus "complete" ESS (maxillary, ethmoid, frontal; not sphenoid). RESULTS Of 70 patients, mean age was 59.2 years, and 55.7% were male. Thirty-five underwent MA alone, and 35 had complete ESS. At first postoperative visits (mean 9.3 days), AE sinus purulence was more likely resolved after complete ESS compared with MA (97.1% vs. 71.4%, p = 0.006). However, time to resolution of AE purulence was comparable by 6 weeks postoperatively (p = 0.158). There were no significant differences in times to foul smell resolution and achieving ≥9 point SNOT-22 reduction (p > 0.05). CONCLUSIONS For ODS with frontal sinus involvement, MA alone and complete ESS both resulted in rapid and long-term symptomatic resolution. While ultimate resolution of sinus purulence was equivalent between surgery groups, complete ESS did lead to faster resolution of frontoethmoidal purulence in a significant number of cases. LEVEL OF EVIDENCE 2 Laryngoscope, 2024.
Collapse
Affiliation(s)
- John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Alberto M Saibene
- Department of Otolaryngology-Head and Neck Surgery, University of Milan, Milan, Italy
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Jacob G Eide
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Giovanni Felisati
- Department of Otolaryngology-Head and Neck Surgery, University of Milan, Milan, Italy
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Rijul S Kshirsagar
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Redwood City Medical Center, Redwood City, California, U.S.A
| | - Catherine Kwiecien
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Daniel Lee
- Department of Otolaryngology-Head and Neck, University of Toronto, Toronto, Canada
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, U.S.A
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Amrita Ray
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Carl Wilson
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| |
Collapse
|
3
|
Kwon KW, Gwak JW, Chung YS. Retrospective comparison of first-line treatments for odontogenic sinusitis based on duration of symptoms. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:91-99. [PMID: 38420842 DOI: 10.14639/0392-100x-n2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/06/2023] [Indexed: 03/02/2024]
Abstract
Objectives To investigate the clinical efficacy of dental treatment and endoscopic sinus surgery (ESS), each primary/combined treatment modality, in patients with odontogenic sinusitis (ODS), according to its phase, acute or chronic. Materials and methods We retrospectively reviewed clinical data on 172 patients diagnosed with ODS. They were divided into two groups: acute (≤ 3 months; 90 patients) and chronic (> 3 months; 82 patients) ODS. The success rate and time to resolution of each primary/combined treatment modality were compared between the two groups. Results In both ODS groups, the success rate was highest with combined ESS and dental therapy, followed by ESS alone and dental therapy alone. ESS outperformed dental therapy (96.6% vs 65.5% for acute ODS, p = 0.011; 80.6% vs 56.5% for chronic ODS, p = 0.046) and led to quicker resolution of symptoms for acute ODS than dental therapy (0.9 vs 1.7 months, p = 0.012). In the comparison between ESS alone and combined therapy, no significant difference was observed for acute ODS, whereas combined therapy demonstrated a superior success rate for chronic ODS (100% vs 80.6%, p = 0.046). Conclusions In our study, the clinical utility of dental treatment and/or ESS depended on the morbidity period of ODS. For chronic ODS, combined ESS and dental treatment seems to be an effective first-line treatment.
Collapse
Affiliation(s)
- Kyung Won Kwon
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otolaryngology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jang Wook Gwak
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoo-Sam Chung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Kocum P, Šedý J, Traboulsi J, Jirák P. One-stage combined ENT and dental surgical treatment of odontogenic sinusitis: a prospective study. Eur Arch Otorhinolaryngol 2024; 281:1347-1356. [PMID: 37982839 PMCID: PMC10858141 DOI: 10.1007/s00405-023-08332-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE The study analyses outcomes of the surgical treatment of odontogenic sinusitis that concurrently address sinusitis and its dental source. METHODS A total of 364 adult patients were included, representing 13% of all patients we have operated on for any rhinosinusitis over the past 18 years. The diagnosis was based on both ENT and dental examinations including CT imaging. Patients were divided into three groups: (1) FESS with dental surgery without antrotomy, (2) FESS with intraoral antrotomy, and (3) intraoral surgery without FESS. The mean postoperative follow-up was 15 months. RESULTS First group involved 64%, second group 31%, and third group 6% of the cases. The one-stage combined ENT and dental approach was used in 94% of cases (group 1 and 2) with a success rate of 97%. Concerning FESS, maxillary sinus surgery with middle meatal antrostomy only was performed in 54% of patients. Oroantral communication flap closure was performed in 56% of patients (success rate 98%). Healing was achieved within 3 months. The majority (87%) of patients were operated on unilaterally for unilateral findings. Over the past 18 years, a 6% increase of implant-related odontogenic sinusitis was observed. CONCLUSION Odontogenic sinusitis is common, tending to be unilateral and chronic. Its dental source needs to be uncovered and treated and should not be underestimated. Close cooperation between ENT and dental specialists has a crucial role in achieving optimal outcomes. The one-stage combined surgical approach proves to be a reliable, safe, fast and effective treatment.
Collapse
Affiliation(s)
- Petr Kocum
- Department of ENT, Head and Neck Surgery, Na Homolce Hospital, Roentgenova 37/2, Prague 5, Czech Republic.
- Centre for Dental Surgery Podstata-Hudler, Ltd., Jinonická 1313/25, Prague 5, Czech Republic.
| | - Jiří Šedý
- 3DK Clinic, U Zdravotního Ústavu 2213/8, Prague 10, Czech Republic
- Faculty of Medicine, Institute of Dentistry and Oral Sciences, Palacký University, Palackého 12, Olomouc, Czech Republic
- Second Faculty of Medicine, Institute of Anatomy, Charles University, V Úvalu 84, Prague 5, Czech Republic
| | - Joseph Traboulsi
- Department of ENT, Head and Neck Surgery, Na Homolce Hospital, Roentgenova 37/2, Prague 5, Czech Republic
| | - Petr Jirák
- Department of ENT, Head and Neck Surgery, Na Homolce Hospital, Roentgenova 37/2, Prague 5, Czech Republic
| |
Collapse
|
5
|
Lin J, Wang C, Wang X, Chen F, Zhang W, Sun H, Yan F, Pan Y, Zhu D, Yang Q, Ge S, Sun Y, Wang K, Zhang Y, Xian M, Zheng M, Mo A, Xu X, Wang H, Zhou X, Zhang L. Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment. Int J Oral Sci 2024; 16:11. [PMID: 38302479 PMCID: PMC10834456 DOI: 10.1038/s41368-024-00278-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
ABSTARCT Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multi-disciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.
Collapse
Affiliation(s)
- Jiang Lin
- Department of Stomatology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Xiangdong Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Faming Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi' an, China
| | - Wei Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
| | - Hongchen Sun
- Department of Oral &Maxillofacial Pathology, School and Hospital of Stomatology, Jilin University, Jilin, China
| | - Fuhua Yan
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yaping Pan
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Dongdong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qintai Yang
- Department of Otolaryngology, Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaohua Ge
- Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration, Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Yao Sun
- Department of Implantology, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Kuiji Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Mu Xian
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Zheng
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Anchun Mo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanguo Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
6
|
Zhao X, Li Z, Liu J. The Necessity of Subsequent Dental Treatment for Odontogenic Sinusitis After Endoscopic Sinus Surgery. EAR, NOSE & THROAT JOURNAL 2023:1455613231196105. [PMID: 37681249 DOI: 10.1177/01455613231196105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To investigate the necessity of subsequent dental treatment for patients with odontogenic sinusitis (OS) after endoscopic sinus surgery (ESS). METHODS OS patients who received ESS from January 2018 to May 2022 were eligible. Demographic data, medical history, Lund-Mackay (LM) computed tomography (CT) score, Lund-Kennedy (LK) endoscopic score, and OS-specific CT score were recorded and analyzed. All patients were followed up for 6 months after surgery. RESULTS A total of 48 patients (30 males and 18 females) were enrolled. A total of 35 cases (72.9%) were caused by dental diseases (periapical periodontitis), and 13 cases (27.1%) were caused by iatrogenic factors (including tooth extraction or implantation). The overall treatment success rate was 97.9%, and the success rates in the dental disease OS group (97.1%) and the iatrogenic OS group (100%) were not significantly different (X2 = 0.329, P = .729). None of the patients in the dental disease group received treatment of the causative teeth within 6 months after the operation, except for one patient who received tooth extraction treatment 6 months after the operation. CONCLUSION Without considering the impact of dental disease on patients' oral health, OS can be completely alleviated by ESS alone, even if no dental treatment is carried out after surgery.
Collapse
Affiliation(s)
- Xiaochang Zhao
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zufei Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jinfeng Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Yassin-Kassab A, Peterson EL, Craig JR. Total times to treatment completion and clinical outcomes in odontogenic sinusitis. Am J Otolaryngol 2023; 44:103921. [PMID: 37187016 DOI: 10.1016/j.amjoto.2023.103921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/30/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Multidisciplinary collaboration is essential for effective odontogenic sinusitis (ODS) management. One point of debate has been the optimal timing of primary dental treatment and endoscopic sinus surgery (ESS), but differences in time to completion of these treatment pathways have not been studied. METHODS A retrospective cohort study was conducted on ODS patients from 2015 to 2022. Demographic and clinical variables were recorded, and various durations of time were analyzed from rhinologic consultation through treatment completion. Resolution of sinusitis symptoms and purulence on endoscopy was also recorded. RESULTS Eighty-nine ODS patients were analyzed (47.2 % male, median 59 years-old). Of the 89 ODS patients, 56 had treatable dental pathology, and 33 had no treatable dental pathology. Median time to treatment completion for all patients was 103 days. Of 56 ODS patients with treatable dental pathology, 33 had primary dental treatment, and 27 (81 %) required secondary ESS. In patients who underwent primary dental treatment followed by ESS, median time from initial evaluation to treatment completion was 236.0 days. If ESS was pursued primarily followed by dental treatment, median time from initial evaluation to treatment completion was 112.0 days, which was significantly shorter than if dental treatment was pursued primarily (p = 0.002). Overall symptomatic and endoscopic resolution was 97.8 %. CONCLUSIONS After dental and sinus surgical treatment, ODS patients experienced 97.8 % resolution of symptoms and purulence on endoscopy. In patients with ODS due to treatable dental pathology, primary ESS followed by dental treatment resulted in a shorter overall treatment duration than primary dental treatment followed by ESS.
Collapse
Affiliation(s)
- Abdulkader Yassin-Kassab
- University of Pittsburgh School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Pittsburg, PA, United States of America
| | - Edward L Peterson
- Henry Ford Health, Department of Public Health Sciences, Detroit, MI, United States of America
| | - John R Craig
- Henry Ford Health, Department of Otolaryngology-Head and Neck Surgery, Detroit, MI, United States of America.
| |
Collapse
|
8
|
Real-Life Experience in the Management of Sinonasal Complications of Dental Disease or Treatments. J Pers Med 2022; 12:jpm12122078. [PMID: 36556298 PMCID: PMC9781878 DOI: 10.3390/jpm12122078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Diagnosis and management of sinonasal complications of dental diseases or treatment (SCDDT) may be challenging. We aimed to report our real-life experience in patients treated with endoscopic endonasal approach describing data about symptoms, etiology, extension of the disease and success rate. We evaluated retrospectively data about 262 patients diagnosed as SCDDT and managed from August 2015 to May 2022. In 44.65% cases, maxillary sinus complications were determined by a dental disorder; the remaining 55.34% of cases were iatrogenic. Patients were managed according to our multidisciplinary protocol including ENT, dental, and radiological evaluation. Treatments were planned with a personalized approach, based on the patient’s clinical characteristics; all patients were treated with an endonasal endoscopic mini-invasive conservative approach. Combined dental treatment was performed simultaneously in 152/262 (58%) of patients; in the remaining cases, it was postponed after surgery. The overall treatment success rate (symptom resolution and endoscopically observed maxillary sinus healing) was 96.5%. At 15 days after surgery, we observed a significant improvement in the quality of life. The mean post-operative Sinonasal outcome test-22 (SNOT-22) score was significantly lower compared to baseline (6 versus 43.4; p < 0.05). Our study showed that endoscopic sinus surgery can be a successful procedure for treatment of SCDDT, leading to fast resolution of sinonasal symptoms and improving the quality of life. Furthermore, the technique allows removal of migrated dental material or dental implants even in challenging cases.
Collapse
|
9
|
Martu C, Martu MA, Maftei GA, Diaconu-Popa DA, Radulescu L. Odontogenic Sinusitis: From Diagnosis to Treatment Possibilities-A Narrative Review of Recent Data. Diagnostics (Basel) 2022; 12:1600. [PMID: 35885504 PMCID: PMC9319441 DOI: 10.3390/diagnostics12071600] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 12/17/2022] Open
Abstract
The maxillary sinus is a structure at the border of specialties: otorhinolaryngology and maxillofacial surgery. Due to this fact, regarding etiology, it can be affected by both the rhinogenic and odontogenic path and can impose diagnostic difficulties. The etiopathogenic mechanisms that can affect the Schneiderian membrane are mainly inflammatory, iatrogenic, traumatic, and tumorous in nature. From a microbiological point of view, the bacteriology is polymorphic, including both aerobic and anaerobic species in acute OS, the predominating species in acute OS being aerobic, and in chronic anaerobic germs. The role of fungi in the determination of this pathology and in the production of the biofilm that leads to resistance to antibiotic treatment is also discussed. The present paper aims to present the etiopathogenesis, bacteriology, clinical manifestations, as well as treatment of odontogenic sinusitis (OS) from an updated perspective through reviewing the literature. If unilateral maxillary sinusitis is usually due to odontogenic causes, this does not clinically exclude the possibility of strictly rhinogenic causes in the occurrence of sinusitis. This underlines the important role of complex oral and rhinological clinical examination as well as the role of preclinical examinations in specifying the certainty diagnosis. Simple radiography, orthopantomography, CT, and CBCT are compared in terms of diagnostic accuracy. The treatment of OS is complex, involving medication, dental, and surgical measures. The value of endoscopic surgery is emphasized, comparing its advantages over the classic Caldwell-Luc technique.
Collapse
Affiliation(s)
- Cristian Martu
- ENT Clinic Department, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania; (C.M.); (L.R.)
| | - Maria-Alexandra Martu
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - George-Alexandru Maftei
- Department of Dento-Alveolar Surgery and Oral Pathology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Diana Antonela Diaconu-Popa
- Department of Oral Implantology, Removable Dentures and Technology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania;
| | - Luminita Radulescu
- ENT Clinic Department, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania; (C.M.); (L.R.)
| |
Collapse
|
10
|
Craig JR. Odontogenic sinusitis: A state‐of‐the‐art review. World J Otorhinolaryngol Head Neck Surg 2022; 8:8-15. [PMID: 35619928 PMCID: PMC9126162 DOI: 10.1002/wjo2.9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/01/2021] [Indexed: 01/07/2023] Open
Abstract
Odontogenic sinusitis (ODS) is more common than historically reported, and is underrepresented in the sinusitis literature. ODS is distinct from rhinosinusitis in that it is infectious sinusitis from an infectious dental source or a complication from dental procedures, and most commonly presents unilaterally. ODS clinical features, microbiology, and diagnostic and treatment paradigms are also distinct from rhinosinusitis. ODS evaluation and management should generally be conducted by both otolaryngologists and dental providers, and clinicians must be able to suspect and confirm the condition. ODS suspicion is driven by certain clinical features like unilateral maxillary sinus opacification on computed tomography, overt maxillary dental pathology on computed tomography, unilateral middle meatal purulence on nasal endoscopy, foul smell, and odontogenic bacteria in sinus cultures. Otolaryngologists should confirm the sinusitis through nasal endoscopy by assessing for middle meatal purulence, edema, or polyps. Dental providers should confirm dental pathology through appropriate examinations and imaging. Once ODS is confirmed, a multidisciplinary shared decision‐making process should ensue to discuss risks and benefits of the timing and different types of dental and sinus surgical interventions. Oral antibiotics are generally ineffective at resolving ODS, especially when there is treatable dental pathology. When both the dental pathology and sinusitis are addressed, resolution can be expected in 90%–100% of cases. For treatable dental pathology, while primary dental treatment may resolve the sinusitis, a significant percentage of patients still require endoscopic sinus surgery. For patients with significant sinusitis symptom burdens, primary endoscopic sinus surgery is an option to resolve symptoms faster, followed by appropriate dental management. More well‐designed studies are necessary across all areas of ODS. Odontogenic sinusitis (ODS) is one of the most common cause of unilateral maxillary sinus disease, but has been underrepresented in previous sinusitis literature. Clinicians must be able to suspect ODS based on certain clinical features like unilateral middle meatal purulence on nasal endoscopy, subjective foul smell, and sinus computed tomography demonstrating maxillary sinus opacification with or without overt adjacent dental pathology. Diagnosing ODS requires confirmation of infectious sinusitis by otolaryngologists ideally with nasal endoscopy, and confirmation of adjacent maxillary dental pathology by dental specialists. Management centers on multidisciplinary collaboration and shared‐decision making between otolaryngologists, dental specialists, and patients.
Collapse
Affiliation(s)
- John R. Craig
- Department of Otolaryngology‐Head and Neck Surgery Henry Ford Health System Detroit Michigan USA
| |
Collapse
|
11
|
Shin JM, Kim SJ, Lee HM, Park IH. Changing Trends in the Clinical Characteristics and Treatment Strategies for Odontogenic Sinusitis Over the Past 10 Years. EAR, NOSE & THROAT JOURNAL 2022:1455613221080918. [PMID: 35199606 DOI: 10.1177/01455613221080918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The incidence of odontogenic sinusitis has been gradually increasing due to the recent increases in invasive dental procedures. This study aimed to describe the clinical features of present patients with odontogenic sinusitis compared to the past, confirm the importance of endoscopic sinus surgery (ESS), and analyze the predictive factors for ESS. METHODS This retrospective review included all patients diagnosed with odontogenic sinusitis between January 2010 and December 2011 and between January 2019 and December 2020. The patients were classified into 2 groups (past and present) depending on the time of the first visit. The clinical characteristics and treatment modalities were compared between the two groups. In addition, among patients in the present group, we analyzed variables to identify factors contributing to the risk of undergoing ESS. RESULTS This study included 56 patients (23 in the past group and 33 in the present group). Compared to the past group, the present group had an older mean age (P = .001) and significantly increased iatrogenic etiologies (52.1% vs 90.9%; P = .002). The proportion of patients treated with ESS also increased in the present group compared to that in the past group (39.1% vs 66.7%; P = .041). In the present group, 11 patients (33.3%) were cured with conservative treatment, while 22 patients (66.7%) underwent additional ESS. Multivariate analysis revealed that the Lund-Mackay score was the only significant predictor of ESS (odds ratio [OR]: 14.901, P = .035). CONCLUSION The incidence of odontogenic sinusitis with iatrogenic etiologies has increased compared to the past. In addition, two-thirds of the patients in the present study underwent ESS, a significantly higher proportion than in the past. Therefore, ESS is one of the most important treatment modalities for odontogenic sinusitis, especially iatrogenic, in recent years. A severe Lund-Mackay score was associated with a significantly increased risk of ESS.
Collapse
Affiliation(s)
- Jae-Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, 58934Korea University College of Medicine, Seoul, Republic of Korea
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University College of Medicine, Seoul, Republic of Korea
- Medical Device Usability Test Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Su-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, 58934Korea University College of Medicine, Seoul, Republic of Korea
| | - Heung-Man Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, 58934Korea University College of Medicine, Seoul, Republic of Korea
| | - Il-Ho Park
- Department of Otorhinolaryngology-Head and Neck Surgery, 58934Korea University College of Medicine, Seoul, Republic of Korea
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University College of Medicine, Seoul, Republic of Korea
- Medical Device Usability Test Center, Korea University Guro Hospital, Seoul, Republic of Korea
| |
Collapse
|
12
|
Odontogenic Maxillary Sinusitis: The Interface and Collaboration between Rhinologists and Dentists. JOURNAL OF OTORHINOLARYNGOLOGY, HEARING AND BALANCE MEDICINE 2021. [DOI: 10.3390/ohbm2040008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Odontogenic maxillary sinusitis (OMS) is an inflammatory condition affecting the paranasal sinuses and is commonly encountered by both Otorhinolaryngologists and Dentists. However, there is an ongoing debate regarding the best sequence of management. Clinicians are faced with the dilemma of first addressing either the affected tooth or the affected sinus. This paper provides a review of the current literature on the aetiology, presentation, and management of OMS, as well as our experience in managing this condition. Overall, the causative pathology of the patient’s OMS, their symptoms, and the risk of surgery should drive decision making with regards to sequence of management.
Collapse
|
13
|
Craig JR, Tataryn RW, Sibley HC, Mason WD, Deuel JA, Loyd GE, Nerenz DR, Goyal P. Expected Costs of Primary Dental Treatments and Endoscopic Sinus Surgery for Odontogenic Sinusitis. Laryngoscope 2021; 132:1346-1355. [PMID: 34418111 DOI: 10.1002/lary.29825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/02/2021] [Accepted: 08/08/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Treatment of odontogenic sinusitis (ODS) due to apical periodontitis (AP) is highly successful when both dental treatment and endoscopic sinus surgery (ESS) are performed. Variation exists in the literature with regard to types and timing of dental treatments and ESS when managing ODS. This study modeled expected costs of different primary dental and sinus surgical treatment pathways for ODS due to AP. STUDY DESIGN Decision-tree economic model. METHODS Decision-tree models were created based on cost and treatment success probabilities. Using Medicare and consumer online databases, cost data were obtained for the following dental and sinus surgical treatments across the United States: root canal therapy (RCTx), revision RCTx, apicoectomy, extraction, dental implant, bone graft, and ESS (maxillary, ± anterior ethmoid, ± frontal). A literature review was performed to determine probabilities of dental and sinus disease resolution after different dental treatments. Expected costs were determined for primary dental extraction, RCTx, and ESS pathways, and sensitivity analyses were performed. RESULTS Expected costs for the three different primary treatment pathways when dental care was in-network and all diseased sinuses opened during ESS were as follows: dental extraction ($4,753.83), RCTx ($4,677.34), and ESS ($7,319.85). CONCLUSIONS ODS due to AP can be successfully treated with primary dental treatments, but ESS is still frequently required. Expected costs of primary dental extraction and RCTx were roughly equal. Primary ESS had a higher expected cost, but may still be preferred in patients with prominent sinonasal symptoms. Patients' insurance coverage may also impact decision-making. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
Collapse
Affiliation(s)
- John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Roderick W Tataryn
- Tataryn Endodontics, Spokane, Washington, U.S.A.,Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, California, U.S.A
| | - Haley C Sibley
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | | | - Joshua A Deuel
- Department of Oral Maxillofacial Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Gary E Loyd
- Department of Anesthesiology, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - David R Nerenz
- Henry Ford Health System, Department of Neurosurgery, Center for Health Policy and Health Services Research, Detroit, Michigan, U.S.A
| | - Parul Goyal
- Syracuse Otolaryngology, Syracuse, New York, U.S.A
| |
Collapse
|
14
|
Gâta A, Toader C, Valean D, Trombitaș VE, Albu S. Role of Endoscopic Sinus Surgery and Dental Treatment in the Management of Odontogenic Sinusitis Due to Endodontic Disease and Oroantral Fistula. J Clin Med 2021; 10:jcm10122712. [PMID: 34205358 PMCID: PMC8234404 DOI: 10.3390/jcm10122712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Odontogenic sinusitis (ODS) is frequently encountered in ENT practice; however, there are no guidelines regarding its management. This study aims to analyse the results of endoscopic sinus surgery versus dental treatment in ODS. Additionally, we aim to demonstrate the benefit of associating endoscopic sinus surgery (ESS) to surgical closure of chronic oroantral fistulas (OAF) by comparing mean time to healing in patients who opted or not for concurrent ESS. Methods: Records of patients with ODS were reviewed. Group one consisted of patients with ODS caused by periapical pathology undergoing either endoscopic sinus surgery (ESS) or dental treatment. Resolution of ODS was considered treatment success and was compared between the two treatment strategies. Group two included patients with ODS and associated chronic oroantral communication. Time to healing was compared between patients undergoing OAF closure alone versus patients receiving associated ESS, using the Log-Rank test to correlate Kaplan–Meier curves. Results: 25 patients from a total of 45 in group one underwent dental treatment alone, and 20 opted for exclusive ESS treatment. The failure rate was 40% for patients treated with ESS compared to 4% (one patient) for dental treatment. ODS resolved in all patients in the second group, but the mean time to healing was half (10 days) when ESS was complementary to OAF closure. Conclusion: The present study represents the first estimator of the role ESS plays in OAF treatment. Nonetheless, it provides proof of the importance of first addressing dental problems in odontogenic sinusitis.
Collapse
Affiliation(s)
- Anda Gâta
- Department of Otorhinolaryngology, University of Medicine and Pharmacy ‘Iuliu Hațieganu’, 400349 Cluj Napoca, Romania; (V.E.T.); (S.A.)
- Correspondence: ; Tel.: +40-746-210-022
| | - Corneliu Toader
- Clinic of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 41914 Bucharest, Romania;
| | - Dan Valean
- County Clinical Emergency Hospital, 400000 Cluj Napoca, Romania;
| | - Veronica Elena Trombitaș
- Department of Otorhinolaryngology, University of Medicine and Pharmacy ‘Iuliu Hațieganu’, 400349 Cluj Napoca, Romania; (V.E.T.); (S.A.)
| | - Silviu Albu
- Department of Otorhinolaryngology, University of Medicine and Pharmacy ‘Iuliu Hațieganu’, 400349 Cluj Napoca, Romania; (V.E.T.); (S.A.)
| |
Collapse
|
15
|
Craig JR, Tataryn RW, Cha BY, Bhargava P, Pokorny A, Gray ST, Mattos JL, Poetker DM. Diagnosing odontogenic sinusitis of endodontic origin: A multidisciplinary literature review. Am J Otolaryngol 2021; 42:102925. [PMID: 33486208 DOI: 10.1016/j.amjoto.2021.102925] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Endodontic disease is one of the most common causes of bacterial odontogenic sinusitis (ODS). Diagnosing ODS of endodontic origin involves otolaryngologists confirming sinusitis, and dental specialists confirming endodontic sources. The purpose of this study was to conduct a multidisciplinary literature review to highlight clinical and microbiological features of ODS, and the most optimal diagnostic modalities to confirm endodontic disease. METHODS An extensive review of both medical and dental literature was performed by rhinologists, endodontists, and an infectious disease specialist. Frequencies of various clinical and microbiological features from ODS studies were collected, and averages were calculated. Different endodontic testing and imaging modalities were also evaluated on their abilities to confirm endodontic disease. RESULTS ODS patients most often present with unilateral sinonasal symptoms for over 3 months, purulence on nasal endoscopy, and overt dental pathology on computed tomography (CT). Subjective foul smell, and maxillary sinus cultures demonstrating anaerobes and α-streptococci (viridans group) may be more specific to ODS. For endodontic evaluations, cold pulp testing and cone-beam CT imaging are most optimal for confirming pulpal and periapical disease. CONCLUSION Diagnosing ODS requires collaboration between otolaryngologists and dental specialists. Clinicians should suspect ODS when patients present with unilateral sinonasal symptoms, especially foul smell. Patients will generally have purulent drainage on nasal endoscopy, and both sinus opacification and overt dental pathology on CT. However, some patients will have subtle or absent dental pathology on CT. For suspected endodontic disease, endodontists should be consulted for at least cold pulp testing, and ideally cone-beam CT.
Collapse
|
16
|
Allevi F, Fadda GL, Rosso C, Martino F, Pipolo C, Cavallo G, Felisati G, Saibene AM. Diagnostic Criteria for Odontogenic Sinusitis: A Systematic Review. Am J Rhinol Allergy 2020; 35:713-721. [PMID: 33236664 DOI: 10.1177/1945892420976766] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Odontogenic sinusitis affects a significant proportion of patients with paranasal sinus infections. Nevertheless, no shared diagnostic criteria for this condition have yet been implemented and published studies differ in their definition of the disease. OBJECTIVE The present systematic review of the literature was undertaken to characterize and analyze the different diagnostic criteria currently employed for odontogenic sinusitis. METHODS Systematic searches for studies published between 2009 and 2019 were performed in Medline, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Search criteria were designed to identify all studies focusing, even partially, on odontogenic sinusitis. Human original studies except single case reports published in the English, French, German, Spanish, or Italian language were included. We removed duplicate abstracts and conducted full-text reads, data extraction, and quality assessment procedures (using the Oxford Centre for Evidence-based Medicine levels of evidence and National Heart Lung and Blood Institute Study Quality Assessment Tools). We reviewed articles for diagnostic criteria, both in terms of definition and etiology identification. RESULTS Among 1,000 unique citations, 63 studies were deemed eligible. Most articles (n = 45) were retrospective case series; a single randomized clinical trial was available. Only 49 studies reported diagnostic criteria, yet relied marginally on published guidelines (n = 10 articles) for identifying sinusitis, often choosing instead to develop their own clinical (n = 15 articles), endoscopic (n = 12 articles), and/or radiologic (n = 30 articles) criteria. For odontogenic focus identification, 14 papers required a multidisciplinary evaluation, 11 papers required a time relationship between dental procedures and sinusitis, 24 papers required oroscopy and/or dental evaluation, and 53 papers required computed tomography. CONCLUSIONS Current diagnostic criteria for odontogenic sinusitis are extremely heterogeneous. Establishing shared diagnostic criteria aimed at defining both sinusitis and related odontogenic foci would spur collaboration between investigators and support more comprehensive outcomes evaluations together with a better understanding of treatment options.
Collapse
Affiliation(s)
- Fabiana Allevi
- Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy
| | - Gian Luca Fadda
- Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Cecilia Rosso
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Federica Martino
- Unit of Otorhinolaryngology, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Rome, Italy
| | - Carlotta Pipolo
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Alberto Maria Saibene
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a broad classification of airway inflammation that affects a significant portion of the population. The current model of delineating patients suffering from CRS is dated and is no longer as simple as the presence of polyps or no polyps. Continued advances in the endotype descriptions of CRS have allowed for new phenotypic descriptions that aid in driving management and research efforts. RECENT FINDINGS Geographic differences exist between patient presentations, which require a molecular evaluation of the driving forces. Increased understanding of these differences allows for patient-specific treatment decisions. SUMMARY New descriptions of CRS phenotypes allow for more targeted therapy for patients, particularly to those with difficult to control disease. The previously broad classification of CRS with or without nasal polyps is no longer sufficient at driving these treatment decisions.
Collapse
|
18
|
Craig JR, Saibene AM, Felisati G. Chronic Odontogenic Rhinosinusitis: Optimization of Surgical Treatment Indications. Am J Rhinol Allergy 2020; 35:142-143. [PMID: 33334132 DOI: 10.1177/1945892420965474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John R Craig
- Department of Otolaryngology- Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | | | | |
Collapse
|
19
|
Psillas G, Papaioannou D, Petsali S, Dimas GG, Constantinidis J. Odontogenic maxillary sinusitis: A comprehensive review. J Dent Sci 2020; 16:474-481. [PMID: 33384837 PMCID: PMC7770314 DOI: 10.1016/j.jds.2020.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/08/2020] [Indexed: 02/07/2023] Open
Abstract
Odontogenic maxillary sinusitis (OMS) is a well-recognized condition in both the dental and otolaryngology communities. Close to 30% of cases of unilateral maxillary sinusitis may have an underlying dental pathology. Failure to identify a dental cause usually lead to cases recalcitrant sinusitis often associated with serious complications. The aim of this study is to describe the literature findings on odontogenic maxillary sinusitis that discuss anatomy, epidemiology, etiology, bacteriology, diagnosis and treatment. The present review is based on a current search using bibliographic database and academic search engine. All the articles on odontogenic maxillary sinusitis published after 2000 were included. This study seeks to provide clinicians with evidence that motivates a comprehensive approach to the evaluation and management of OMS. Controversies on diagnosis and management have been addressed and data from different treatment plans were collected by exploring relevant publications. The surgical treatment of OMS is based essentially on the dental surgery, combined with endoscopic sinus surgery, in order to completely remove the infection, restore the physiological drainage of the sinus and prevent recurrences of sinusitis. A multidisciplinary otolaryngology and dental team is mandatory to successfully manage the dental pathology and the complications resulting from the dental treatments.
Collapse
Affiliation(s)
- George Psillas
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Despoina Papaioannou
- School of Dentistry, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Spyridoula Petsali
- School of Dentistry, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Grigorios George Dimas
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Jiannis Constantinidis
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| |
Collapse
|
20
|
Nallani R, Wichova H, McAroy JL, Chiu AG, Villwock JA. Incidence of Odontogenic Disease in Patients With Pott's Puffy Tumor. J Oral Maxillofac Surg 2020; 79:389-397. [PMID: 32890475 DOI: 10.1016/j.joms.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Osteomyelitis with subperiosteal abscess of the frontal bone, or Pott's puffy tumor (PPT), is a rare but life-threatening condition. The relationship of concurrent dental disease to PPT has not been well described. This study sought to delineate the incidence of odontogenic disease in PPT, especially in cases where there is no history of facial trauma or prior frontal sinus surgery. METHODS A retrospective chart review of patients diagnosed with PPT between 2010 and 2019 was carried out. Demographics, pertinent medical history, surgical procedures performed, and microbial cultures and antibiotics used were extracted for analysis. Maxillofacial computed tomography scans were reviewed for presence of odontogenic disease. RESULTS A total of 17 patients were identified. Four had documented history of frontal bone trauma; 3 had previous frontal sinus surgery. Seven (41%) had documented odontogenic disease on initial radiology reports; however, upon dentist review, 16 (94%) had various pathology visible on their computed tomography scans. Twelve of these 16 patients had no previous frontal sinus trauma or surgery. Eight patients (47%) had only ipsilateral maxillary or ethmoid inflammation respective to PPT on computed tomography. Seventy-six percent of patients underwent endoscopic sinus surgery. Of 14 patients with cultures collected at the time of surgery, 7 (50%) had polymicrobial growth and 6 (43%) had anaerobic growth. CONCLUSIONS The incidence of odontogenic disease in this population of PPT was 94%. In the absence of a history of frontal bone trauma or frontal sinus surgery, underlying dental origin should be suspected in cases of PPT. Initial radiology reports may not document all identifiable dental pathology. Therefore, patients presenting with PPT should undergo comprehensive evaluation, including an oral cavity and dental examination, and potential referral to dental colleagues.
Collapse
Affiliation(s)
- Rohit Nallani
- Clinical Research Fellow, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS.
| | - Helena Wichova
- Resident, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jennifer L McAroy
- Volunteer Faculty Affiliate, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Alexander G Chiu
- Department Head, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jennifer A Villwock
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
21
|
Yoo BJ, Jung SM, Lee HN, Kim HG, Chung JH, Jeong JH. Treatment Strategy for Odontogenic Sinusitis. Am J Rhinol Allergy 2020; 35:206-212. [PMID: 32722916 DOI: 10.1177/1945892420946969] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The treatment options for odontogenic sinusitis (OS) include medical management including antibiotics and saline nasal irrigation, endoscopic sinus surgery (ESS), and dental treatment. OBJECTIVE The purpose of this study was to evaluate whether OS caused by dental caries and periapical abscess can be cured by dental treatment alone and which patients should consider surgery early. METHODS A total of 33 patients with OS caused by dental caries and periapical abscess were enrolled. Patients with OS caused by dental implants, trauma, surgery, or tooth extraction were excluded. All patients were initially treated with dental treatment and medical management without ESS. The patients were divided into two groups according to the results of dental treatment and multiple clinical parameters were compared between the two groups. RESULTS Among the 33 enrolled patients, 22 patients (67%) were cured with dental and medical management, and 11 patients (33%) required ESS after the failure of dental and medical management. Based on the multivariate analysis results, patients who were smokers (OR 33.4) and had a higher Lund-Mackay score on CT (OR 2.0) required ESS after the failure of dental and medical treatment. CONCLUSIONS Two-thirds of the patients with OS caused by dental caries and periapical abscess were cured with dental treatment and medical management without ESS. We recommend dental treatment and medical management first in OS caused by dental caries and periapical abscess. However, we recommend early ESS in patients with smoking habits and severe CT findings of the sinus.
Collapse
Affiliation(s)
- Byung Joon Yoo
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Seon Min Jung
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Ha Na Lee
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Hyung Gu Kim
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Ho Chung
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jin Hyeok Jeong
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Loureiro RM, Naves EA, Zanello RF, Sumi DV, Gomes RLE, Daniel MM. Dental Emergencies: A Practical Guide. Radiographics 2020; 39:1782-1795. [PMID: 31589571 DOI: 10.1148/rg.2019190019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Dental disease is a frequent finding on head and neck images, especially in the context of emergencies, and can be a challenge for radiologists who are inexperienced with findings of dental trauma or disease. Dental abnormalities can be subtle and therefore must be included in the systematic approach to these images. Although dedicated dental images are not acquired in most emergency cases, the teeth are included on many different images of the head and neck, and their initial evaluation seldom requires a specific protocol. The high prevalence of craniofacial trauma, sinus infection, and maxillomandibular procedures, among other conditions, frequently requires interpretation of dental images in daily emergency practice. The imaging findings can be categorized into infection, trauma, and complications of procedures, although sometimes these categories can overlap. Such categories can help the radiologist decide which imaging protocol and dynamic maneuvers should be used and are also useful when reading images and proposing differential diagnoses. Familiarity with the imaging findings of dental emergencies improves the radiologist's diagnostic confidence and role in guiding patient care, avoiding progression to life-threatening conditions, and reducing aesthetic problems, dental loss, and related conditions. Information about the imaging protocols is provided, the relevant anatomy of the teeth and related structures is reviewed, and the key imaging findings of dental emergencies are presented.©RSNA, 2019.
Collapse
Affiliation(s)
- Rafael M Loureiro
- From the Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, Av Albert Einstein 627/701, 05652-900 São Paulo, Brazil
| | - Erica A Naves
- From the Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, Av Albert Einstein 627/701, 05652-900 São Paulo, Brazil
| | - Rafael F Zanello
- From the Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, Av Albert Einstein 627/701, 05652-900 São Paulo, Brazil
| | - Daniel V Sumi
- From the Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, Av Albert Einstein 627/701, 05652-900 São Paulo, Brazil
| | - Regina L E Gomes
- From the Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, Av Albert Einstein 627/701, 05652-900 São Paulo, Brazil
| | - Mauro M Daniel
- From the Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, Av Albert Einstein 627/701, 05652-900 São Paulo, Brazil
| |
Collapse
|
23
|
Yassin-Kassab A, Bhargava P, Tibbetts RJ, Griggs ZH, Peterson EI, Craig JR. Comparison of bacterial maxillary sinus cultures between odontogenic sinusitis and chronic rhinosinusitis. Int Forum Allergy Rhinol 2020; 11:40-47. [PMID: 32656998 DOI: 10.1002/alr.22627] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bacterial odontogenic sinusitis (ODS) is distinct from other forms of rhinosinusitis. Diagnosing ODS can be challenging because of nonspecific clinical presentations and underrepresentation in the literature. The purpose of this study was to compare maxillary sinus bacterial cultures between patients with ODS and chronic rhinosinusitis (CRS), to determine whether certain bacteria are associated with ODS. METHODS This was a retrospective case-control study of 276 consecutive patients from August 2015 to August 2019 who underwent endoscopic sinus surgery (ESS) for bacterial ODS, CRS without nasal polyps (CRSsNP), or CRS with nasal polyps (CRSwNP). When present, pus was sterilely cultured from maxillary sinuses after maxillary antrostomy, and aerobic and anaerobic cultures were immediately sent for processing. Demographics and culture results were compared between ODS and CRS patients, and then separately between ODS and CRSsNP, and ODS and CRSwNP. ODS culture results were also compared between different dental pathologies (endodontic vs oroantral fistula). RESULTS The following bacteria were significantly more likely in ODS compared to CRS: mixed anaerobes, Fusobacterium spp., Eikenella corrodens, Streptococcus intermedius, Streptococcus anginosus, and Streptococcus constellatus. Staphylococcus aureus and Pseudomonas aeruginosa were inversely related to ODS. There were no significant differences in cultures between the different dental pathologies. CONCLUSION Certain bacteria were more likely to be associated with ODS compared to CRS when purulence was cultured from the maxillary sinus. Physicians should evaluate for an odontogenic source of sinusitis when these ODS-associated bacteria are identified in maxillary sinus cultures.
Collapse
Affiliation(s)
| | - Pallavi Bhargava
- Department of Internal Medicine, Division of Infectious Disease, Henry Ford Health System, Detroit, MI
| | - Robert J Tibbetts
- Department of Public Health Services, Henry Ford Health System, Detroit, MI
| | - Zachary H Griggs
- Department of Otolaryngology, Henry Ford Health System, Detroit, MI
| | - Edward I Peterson
- Department of Public Health Services, Henry Ford Health System, Detroit, MI
| | - John R Craig
- Department of Otolaryngology, Henry Ford Health System, Detroit, MI
| |
Collapse
|
24
|
Craig JR, Tataryn RW, Aghaloo TL, Pokorny AT, Gray ST, Mattos JL, Poetker DM. Management of odontogenic sinusitis: multidisciplinary consensus statement. Int Forum Allergy Rhinol 2020; 10:901-912. [PMID: 32506807 DOI: 10.1002/alr.22598] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Odontogenic sinusitis (ODS) can present a therapeutic dilemma because multiple treatment strategies have been reported. ODS review articles have been published, but they have lacked multidisciplinary collaboration and an evidence-based methodology. The purpose of this article was to perform an evidence-based review of ODS management options, and develop a multidisciplinary consensus statement on ODS management options. METHODS An evidence-based review of dental and medical literature on ODS management was performed using PubMed, EMBASE, and Cochrane Review Databases up to December 2019. Exclusion criteria included non-English-language articles, case series with fewer than 10 patients, fungal sinusitis, and studies that did not report treatment success rates. Because aggregate levels of evidence for recommendations were no higher than level C, a clinical consensus statement was conducted using a modified Delphi method. RESULTS Sixteen articles met inclusion criteria for the evidence-based review on the following ODS management options: dental treatment alone or combined with ESS for various dental pathologies, and endoscopic sinus surgery (ESS) alone for dental implant-related ODS. Strong consensus was achieved for 9 of the 10 clinical statements, the strongest being the use of shared decision-making for selecting management strategies. No consensus was reached for determining the extent of ESS necessary for uncomplicated ODS. CONCLUSION Strong consensus was reached that ODS management should involve shared decision-making between the otolaryngologist, dental provider, and patient, where the benefits and risks of dental treatment and ESS are discussed. Higher-quality studies are necessary to develop evidence-based treatment recommendations for ODS.
Collapse
Affiliation(s)
- John R Craig
- Department of Otolaryngology, Henry Ford Health System, Detroit, MI
| | - Roderick W Tataryn
- Tataryn Endodontics, Spokane, WA.,Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA
| | - Tara L Aghaloo
- University of California, Los Angeles (UCLA) School of Dentistry, UCLA, Los Angeles, CA
| | - Alan T Pokorny
- Spokane ENT Clinic, Spokane, WA.,Department of Otolaryngology, University of Washington, Seattle, WA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Jose L Mattos
- Department of Otolaryngology, University of Virginia, Charlottesville, VA
| | - David M Poetker
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
25
|
Newsome HA, Poetker DM. Odontogenic Sinusitis: Current Concepts in Diagnosis and Treatment. Immunol Allergy Clin North Am 2020; 40:361-369. [PMID: 32278457 DOI: 10.1016/j.iac.2019.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Odontogenic sinusitis is a unique cause of sinus disease that deserves special consideration. An astute clinician can elicit historical findings such as recent dental work, and symptoms such as unilateral facial pain and foul drainage, despite a relatively benign oral cavity examination. Otolaryngologists and dental professionals who care for these patients must be able to interpret imaging studies for dental disorder such as periapical abscesses and periodontal disease. Treatment is frequently some combination of antibiotic therapy, dental procedures, and endoscopic sinus surgery. More prospective studies are needed to determine the best approach to caring for this patient population.
Collapse
Affiliation(s)
- Hillary A Newsome
- Rhinology and Skull Base Division, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA; Zablocki VAMC, Milwaukee, WI, USA
| | - David M Poetker
- Rhinology and Skull Base Division, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA; Zablocki VAMC, Milwaukee, WI, USA.
| |
Collapse
|
26
|
Oreški I, Gregurić T, Gulin P, Prica Oreški N, Brajdić D, Vagić D. Differences in self-reported symptoms in patients with chronic odontogenic and non-odontogenic rhinosinusitis. Am J Otolaryngol 2020; 41:102388. [PMID: 31924413 DOI: 10.1016/j.amjoto.2020.102388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/27/2019] [Accepted: 01/03/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the possible differences in self-reported symptoms between patients with chronic odontogenic rhinosinusitis (CORS) and patients with chronic non-odontogenic rhinosinusitis (CnORS). MATERIALS AND METHODS The study included 64 patients diagnosed with chronic rhinosinusitis according to EPOS guidelines. 32 patients had CORS, and the control group were 32 patients with CnORS. Patients were matched according to gender and age. All the patients underwent a CT scan evaluated by a radiologist, and were evaluated by an oral surgeon and otorhinolaryngologist before being assigned to one of the groups. The severity of the symptoms was assessed through questioners SNOT-22 (sino-nasal outcome test) and VAS (visual analogue scale) symptom score. Kolmogorov-Smirnov's, Fisher's and Mann-Whitney U test were used in the statistical analysis of the data. RESULTS People with CORS show similar symptomatology on SNOT-22 score to patients with CnORS, with no significant statistical difference between any of the SNOT-22 symptoms. VAS symptom score showed that odontogenic group had a significantly higher score for fever (p = .004) and halitosis (p = .003). CONCLUSION Halitosis and fever might be the most important symptoms in differentiating between CORS and CnORS symptomatology. Better diagnostic tools, such as VAS symptom score might help medical professionals to be quicker at recognizing CORS specific symptomatology, and help them treat the disease as early and adequately as possible.
Collapse
Affiliation(s)
- Ivan Oreški
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Dubrava, Gojka Šuška 6, 10000 Zagreb, Croatia.
| | - Tomislav Gregurić
- Department of Radiology, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, 10000 Zagreb, Croatia
| | - Petar Gulin
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Dubrava, Gojka Šuška 6, 10000 Zagreb, Croatia
| | | | - Davor Brajdić
- Department of Oral and Maxillofacial Surgery, University Hospital Dubrava, Avenue G. Šuska 6, 10000 Zagreb, Croatia
| | - Davor Vagić
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, 10000 Zagreb, Croatia
| |
Collapse
|
27
|
Analysis of Treatment Outcome Associated with Pre-Operative Diagnostic Accuracy Changes and Dental Treatment Timing in Odontogenic Sinusitis Involving Unilateral Maxillary Sinus. ACTA ACUST UNITED AC 2019. [DOI: 10.3342/kjorl-hns.2018.00703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
28
|
Haider AA, Marino MJ, Yao WC, Citardi MJ, Luong AU. The Potential of High-Throughput DNA Sequencing of the Paranasal Sinus Microbiome in Diagnosing Odontogenic Sinusitis. Otolaryngol Head Neck Surg 2019; 161:1043-1047. [PMID: 31382814 DOI: 10.1177/0194599819866692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE High-throughput DNA sequencing of the paranasal sinus microbiome has potential in the diagnosis and treatment of sinusitis. The objective of this study is to evaluate the use of high-throughput DNA sequencing to diagnose sinusitis of odontogenic origin. STUDY DESIGN Case series with chart review. SETTING Single tertiary care academic medical center. SUBJECTS AND METHODS A chart review was performed of DNA sequencing results from the sinus aspirates obtained under endoscopic visualization in 142 patients with sinusitis. The identification of any potentially pathogenic bacteria associated with oral flora in a sample was classified as a positive result for sinusitis of odontogenic etiology. The sensitivity, specificity, and predictive values of using high-throughput DNA sequencing to diagnose sinusitis of odontogenic etiology were determined, with the patient's computed tomography sinus scan as the reference standard. On computed tomography scans, an odontogenic source was determined by the presence of a periapical lucency perforating the schneiderian membrane. RESULTS Seven of the 142 patients enrolled in this study had an odontogenic source based on computed tomography scans. Relative to this reference standard, high-throughput DNA sequencing produced a sensitivity of 85.7% (95% CI, 42.1%-99.6%), a specificity of 81.5% (95% CI, 73.9%-87.6%), a positive predictive value of 19.4% (95% CI, 13.1%-27.7%), and a negative predictive value of 99.1% (95% CI, 94.7%-99.9%). CONCLUSION This study supports the use of high-throughput DNA sequencing in supplementing other methods of investigation for identifying an odontogenic etiology of sinusitis.
Collapse
Affiliation(s)
- Asad A Haider
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael J Marino
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,McGovern Medical School, The University of Texas Health Science Center at Houston, Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, Houston, Texas, USA
| |
Collapse
|
29
|
Khachatryan L, Khachatryan G, Hakobyan G, Khachatryan A. Simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement: A retrospective clinical study of 23 patients. J Craniomaxillofac Surg 2019; 47:1233-1241. [PMID: 31080051 DOI: 10.1016/j.jcms.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/04/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement. PATIENTS AND METHODS The study patients (n = 23) were partially or completely edentulous in the posterior maxilla and required maxillary sinus augmentation. All included patients had a sinus pathology confirmed clinically and radiographically. The technique of simultaneous endoscopic endonasal sinus surgery and sinus augmentation was used in 15 patients, with eight endonasal sinus surgery procedures being performed 2-3 months before sinus augmentation. Where possible, implants were placed during the same surgical procedure (with a ridge bone height of at least 4 mm). RESULTS There were no any major intraoperative complications. Implants placed in the reconstructed areas were shown to integrate normally, and postoperative occlusal function and aesthetics were favorable. Of the 95 implants placed in these 23 patients, two failed to osseointegrate. CONCLUSION The method of simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement leads to a reduction in postoperative complications, significantly shortening the rehabilitation period for patients with maxillary sinus diseases and insufficient bone tissue.
Collapse
Affiliation(s)
- Levon Khachatryan
- Medical Center of Maxillofacial and Plastic Surgery, (Head of the MIM Medical Center), Yerevan, Armenia
| | - Grigor Khachatryan
- Dept. of Oral and Maxillofacial Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Gagik Hakobyan
- Dept. of Oral and Maxillofacial Surgery, Yerevan State Medical University, Yerevan, Armenia.
| | - Anna Khachatryan
- Dept. of Oral and Maxillofacial Surgery, Yerevan State Medical University, Yerevan, Armenia
| |
Collapse
|
30
|
Whyte A, Boeddinghaus R. Imaging of odontogenic sinusitis. Clin Radiol 2019; 74:503-516. [PMID: 30926134 DOI: 10.1016/j.crad.2019.02.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/20/2019] [Indexed: 12/29/2022]
Abstract
The aetiological relationship between dental disease and procedures and mucosal disease within the maxillary sinus has received extensive attention in the recent otolaryngological and dental literature. In contrast, the concept of an odontogenic cause for sinusitis is not well appreciated by radiologists. Review of the maxillary dentition, the alveolar process, and the relationship of the tooth roots to the floor of the maxillary sinus should be an integral part of interpretation of imaging of the paranasal sinuses. The pathogenesis, clinical presentation, and imaging features of rhinogenic and odontogenic sinusitis are discussed and compared. Clinical definitions of rhinosinusitis are explained and the huge impact on healthcare of this disease is briefly discussed. Periapical inflammatory lesions, post-extraction oroantral communication, and procedures used to augment the alveolar process prior to placement of dental implants are the commonest causes of odontogenic sinusitis. Current estimates are that an odontogenic cause for maxillary sinusitis is present in 25-40% of cases. The incidence of odontogenic sinusitis is rising, extension outside the maxillary sinus is common, and the diagnosis is often delayed, resulting in inappropriate and failed treatment. Differentiation of rhinological and odontogenic causes of sinusitis is usually difficult on clinical grounds and imaging plays a key role in the distinction.
Collapse
Affiliation(s)
- A Whyte
- Perth Radiological Clinic, Subiaco, WA, 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, WA, 6009, Australia; Departments of Medicine and Radiology, University of Melbourne, Carlton, Victoria, 3000, Australia.
| | - R Boeddinghaus
- Perth Radiological Clinic, Subiaco, WA, 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, WA, 6009, Australia
| |
Collapse
|
31
|
Assessment of Simultaneous Surgery for Odontogenic Sinusitis: Endoscopic Sinus Surgery With Endoscopic Apicoectomy. J Craniofac Surg 2019; 30:239-243. [PMID: 30444772 DOI: 10.1097/scs.0000000000005134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Odontogenic sinusitis (OS) is a disease commonly encountered by otolaryngologists and oral surgeons. There is currently no standard consensus for the management of the causative teeth of OS, and the therapeutic outcomes of endodontic surgery remain unclear. The authors herein report the outcomes of simultaneous surgery for OS, endoscopic sinus surgery (ESS) with endoscopic apicoectomy. Twenty-one OS patients who underwent ESS were included in the intent-to-treat population. Eleven patients who simultaneously underwent endoscopic apicoectomy were included as the study group, and another 10 patients who were subjected to the extraction of the causative teeth preceding or during surgery were included as the control group. The postoperative tooth course after surgery in the study group was assessed as the primary outcome by periodic radiographs. The postoperative sinus course was compared between the 2 groups as the secondary outcome. Seventeen teeth were subjected to endoscopic apicoectomy concurrently with ESS, and the treatment success rate for periapical lesions was 94.1% (16 out of 17 teeth), which was consistent with previously reported outcomes for endodontic microsurgery. Ten of 11 patients (90.9%) had good postoperative sinus courses, and the mean wound-healing period of the sinus mucosa was 6.9 ± 3.5 weeks. These results were not significantly different from those obtained for the control group (90% and 6.1 ± 3.2 weeks). This surgical procedure may contribute to the preservation of causative teeth without having an impact on the successful treatment of sinusitis. A comprehensive surgical approach by otolaryngologists and oral surgeons is desirable for the treatment of OS.
Collapse
|
32
|
Raman A, Papagiannopoulos P, Kuhar HN, Gattuso P, Batra PS, Tajudeen BA. Histopathologic Features of Chronic Sinusitis Precipitated by Odontogenic Infection. Am J Rhinol Allergy 2018; 33:113-120. [PMID: 30430853 DOI: 10.1177/1945892418811210] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous disease process that can arise in the context of odontogenic disease from the maxillary teeth. The histopathologic features of odontogenic CRS (CRSo) have yet to be determined and may have important implications on disease management and need for escalation of therapy. OBJECTIVES The objectives of this study are to characterize the histopathologic features of CRSo and determine whether the inflammatory profile of CRSo contributes to its recalcitrance to medical therapy and need for surgery in a subset of patients with this disease. METHODS A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Histopathology variables, Lund-Mackay scores (LMS), and Sinonasal Outcome Test-22 scores were compared among CRSo patients, CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients. RESULTS Twenty-three CRSo, 38 CRSwNP, and 53 CRSsNP patients who underwent FESS were analyzed. Compared to CRSsNP, CRSo exhibited increased moderate-severe inflammation (73.9% vs 41.5%, P < .009). Compared to CRSwNP, CRSo had decreased squamous metaplasia (0.0% vs 18.4%, P < .03) and decreased fibrosis (26.1% vs 63.2%, P < .005). Eosinophilia was prevalent in CRSo but to a lesser extent than in CRSwNP (39.1% vs 63.2%, P < .05). CRSo cases had significantly lower mean LMS compared to CRSwNP (7.83 ± 2.77 vs12.18 ± 6.77, P < .005). CONCLUSION CRSo exhibits histopathologic features similar to those of CRSsNP with more severe inflammation. Moreover, eosinophilia, which is not typically considered to coexist with CRSo, was present in a large portion of CRSo patients. These findings may help explain at the inflammatory level why select cases of CRSo may be recalcitrant to medical and dental therapy.
Collapse
Affiliation(s)
- Anish Raman
- 1 Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Peter Papagiannopoulos
- 2 Department of Otorhinolaryngology - Head and Neck Surgery and Rush Sinus Program, Rush University Medical Center, Chicago, Illinois
| | - Hannah N Kuhar
- 1 Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Paolo Gattuso
- 3 Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Pete S Batra
- 2 Department of Otorhinolaryngology - Head and Neck Surgery and Rush Sinus Program, Rush University Medical Center, Chicago, Illinois
| | - Bobby A Tajudeen
- 2 Department of Otorhinolaryngology - Head and Neck Surgery and Rush Sinus Program, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
33
|
Jiam NTL, Goldberg AN, Murr AH, Pletcher SD. Surgical treatment of chronic rhinosinusitis after sinus lift. Am J Rhinol Allergy 2018; 31:271-275. [PMID: 28716179 DOI: 10.2500/ajra.2017.31.4451] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The sinus lift (or sinus augmentation) is a common procedure to improve maxillary bone stock before dental implantation. Chronic rhinosinusitis (CRS) is a potential complication of this procedure and may be refractory to medical treatment. Functional endoscopic sinus surgery has previously been used to address CRS, however, results of previous studies indicated that implant removal is required. There are limited follow-up data available. OBJECTIVE The purpose of this study was to characterize the long-term outcomes and efficacy of endoscopic sinus surgery for refractory CRS after sinus lift, including the ability to salvage dental implants. METHODS This was a retrospective case series that described nine patients who, between June 2011 and September 2016, underwent endoscopic sinus surgery for CRS after a sinus lift procedure. The presenting symptoms of the patients, medical management, imaging results, operative procedures, and outcomes were reviewed. RESULTS The majority of patients developed symptoms (mucopurulent nasal drainage, facial pain and/or pressure, nasal congestion, and foul smell) within 3 months of implant placement and were treated with at least three courses of antibiotics before referral to an otolaryngologist. All the patients underwent wide endoscopic maxillary antrostomy, with no surgical complications or postoperative reports of infection. There was a statistically significant improvement in 22-item Sino-Nasal Outcome Test scores (t(8) = -2.908; p = 0.02) and discharge, inflammation, and polyps/edema endoscopic scores ([z = -2.539; p = 0.011) between pre- and postsurgical treatment. Four patients had their dental implants removed before presentation. Among the five patients who presented with intact dental implants, none required removal before or after functional endoscopic sinus surgery. CONCLUSION Functional endoscopic sinus surgery was a reasonable and efficacious treatment option for patients who presented with paranasal sinus disease after a sinus lift. Dental implant removal may not be a requirement for successful treatment of CRS associated with sinus lift procedures.
Collapse
|
34
|
Little RE, Long CM, Loehrl TA, Poetker DM. Odontogenic sinusitis: A review of the current literature. Laryngoscope Investig Otolaryngol 2018; 3:110-114. [PMID: 29721543 PMCID: PMC5915825 DOI: 10.1002/lio2.147] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/10/2018] [Accepted: 02/15/2018] [Indexed: 01/26/2023] Open
Abstract
Objectives To present current literature on the topic of odontogenic sinusitis. Data Source PubMed literature search for odontogenic sinusitis. Results Odontogenic sinusitis is an inflammatory condition of the paranasal sinuses that is the result of dental pathology, most often resulting from prior dentoalveolar procedures, infections of maxillary dentition, or maxillary dental trauma. Infections are often polymicrobial with an anaerobe-predominant microbiome requiring special considerations for antimicrobial therapy. Medical management and treatment of the underlying dental pathology remains a critical initial step in the treatment of odontogenic sinusitis, however recent literature suggests that a significant portion of patients may require endoscopic sinus surgery for successful disease resolution. Conclusions This review describes the essential epidemiological and etiological factors, relevant clinical findings and diagnostic modalities, microbiologic and antimicrobial considerations, as well as the medical and surgical treatment approaches commonly utilized for the management of odontogenic sinusitis. Level of Evidence NA.
Collapse
Affiliation(s)
- Ryan E Little
- Department of Otolaryngology & Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin U.S.A.,Milwaukee VA Medical Center (Zablocki) Milwaukee Wisconsin U.S.A
| | - Christopher M Long
- Department of Otolaryngology & Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin U.S.A.,Milwaukee VA Medical Center (Zablocki) Milwaukee Wisconsin U.S.A
| | - Todd A Loehrl
- Department of Otolaryngology & Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin U.S.A.,Milwaukee VA Medical Center (Zablocki) Milwaukee Wisconsin U.S.A
| | - David M Poetker
- Department of Otolaryngology & Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin U.S.A.,Milwaukee VA Medical Center (Zablocki) Milwaukee Wisconsin U.S.A
| |
Collapse
|
35
|
Odontogenic sinusitis: developments in diagnosis, microbiology, and treatment. Curr Opin Otolaryngol Head Neck Surg 2018; 26:27-33. [DOI: 10.1097/moo.0000000000000430] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
36
|
Orlandi RR. IFAR JULY EDITORIAL. Int Forum Allergy Rhinol 2018; 6:675-6. [PMID: 27391277 DOI: 10.1002/alr.21821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
37
|
Vidal F, Coutinho TM, Carvalho Ferreira DD, Souza RCD, Gonçalves LS. Odontogenic sinusitis: a comprehensive review. Acta Odontol Scand 2017; 75:623-633. [PMID: 28877613 DOI: 10.1080/00016357.2017.1372803] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Odontogenic sinusitis (OS) is a highly prevalent, underappreciated and underdiagnosed disease that has been known for over 100 years. Apical periodontitis, periodontal disease and iatrogenic extrusion of foreign bodies into the sinus are the main causes of OS. Although the prevalence of sinus pathosis of dental origin is still controversial, otolaryngologists recognize that in the presence of recalcitrant sinusitis, a dental origin should be considered and properly treated. Currently, cone-beam computed tomography is the gold-standard imaging technique to assess the relationship between dental conditions, especially apical periodontitis and sinus diseases, and whenever this association is detected, patients should be seen by both a dentist and an otolaryngologist in order to achieve complete recovery. This article reviews the current concepts regarding the definitions, diagnosis and management of OS from a clinical point of view.
Collapse
Affiliation(s)
- Fábio Vidal
- PostGraduate Program in Dentistry, Estácio de Sá University, Rio de Janeiro, Brazil
| | | | - Dennis de Carvalho Ferreira
- PostGraduate Program in Dentistry, Estácio de Sá University, Rio de Janeiro, Brazil
- Oral Medicine, Veiga de Almeida University, Rio de Janeiro, Brazil
| | | | | |
Collapse
|