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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.
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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
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The Influence of Endodontic Lesions on The Clinical Evolution of Odontogenic Sinusitis-A Cohort Study. J Clin Med 2023; 12:jcm12031103. [PMID: 36769751 PMCID: PMC9918245 DOI: 10.3390/jcm12031103] [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: 11/18/2022] [Revised: 01/01/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Endodontic disease with formation of periapical lesions (PALs) is one of the most common causes of chronic odontogenic sinusitis (ODS). It requires close collaboration between otolaryngologists and dentists, but the best sequence of management is still unknown. The aim of the present study is to clarify how radiological characteristics of teeth with PALs and previous root-canal treatment (RCT) influence the clinical evolution of the disease and to define the predictive value of its radiological and endoscopic features in determining the need for further surgical intervention. A total of 68 symptomatic patients with ODS with PALs were included in the study. The evaluation was performed by an otolaryngologist and a dentist based on a medical interview, nasal endoscopy, cold pulp testing and tomography images. Patients were prospectively followed for at least 12 months, during which nasal steroids, saline irrigations and RCT were administered. The criteria of disease improvement were: decrease of symptoms, healed sinonasal mucosa in endoscopy and radiological resolution of periapical radiolucency and sinus inflammation. Results showed that 9 (13%) patients improved after conservative treatment and 59 (87%) required further surgical intervention. Patients who improved after medical treatment and RCT were younger (p = 0.043) and had a greater distance from the top of the periapical lesion to the maxillary sinus' floor (p = 0.003). When expansion of PALs and bone destruction toward the maxillary sinus was observed on radiological imaging (p = 0.041), and when more than one tooth root was affected (p = 0.004), patients were more likely to require surgical intervention. In conclusion, the more roots that are affected and the closer the top of the PAL is to the maxillary sinus' floor, the greater the possibility of medical treatment and RCT failure. When the bone destruction extends into the maxillary sinus, patients eventually require both tooth extraction and FESS in order to resolve ODS completely.
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Are We Missing Something in the CT-PNS Report? – an Observational Study on the Rate of Reporting the Presence of Dental Disease and the Probable Etiology of Sinusitis on CT Scans. J Belg Soc Radiol 2022; 106:109. [DOI: 10.5334/jbsr.2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
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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: 1] [Impact Index Per Article: 0.5] [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.
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Affiliation(s)
- John R. Craig
- Department of Otolaryngology‐Head and Neck Surgery Henry Ford Health System Detroit Michigan USA
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Rey-Martínez MH, Ruiz-Sáenz PL, Martínez-Rodríguez N, Barona-Dorado C, Meniz-García C, Cortés-Bretón Brinkmann J, Suárez-Quintanilla JA, Martínez-González JM. Analysis of the Radiological Changes of the Sinus Membrane Using Cone Beam Computed Tomography and Its Relationship with Dental Treatments. A Retrospective Study. BIOLOGY 2022; 11:biology11020165. [PMID: 35205032 PMCID: PMC8869354 DOI: 10.3390/biology11020165] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
Simple Summary Changes in the sinus membrane, in the form of thickening or opacification, usually pose problems of differential diagnosis between rhinological and odontogenic causes, given the similarity in their clinical behaviour. The interrelation between tooth roots and the possibility of maxillary sinus involvement seems to be a key determinant. Moreover, the role played by iatrogenic factors, especially surgical interventions, such as dental extractions, or impacted teeth, as well as implant treatments, must be considered. The contribution of new imaging procedures, such as conventional computed tomography or cone beam computed tomography, has triggered an increase in the identification of dental aetiology as a cause of the unilateral opacification of the anterior paranasal sinuses with the predominant involvement of the maxillary sinus. Abstract The aim of this study was to identify the most relevant dental factors and iatrogenic causes in the development of pathological changes to the sinus membrane and to analyse their possible influence on the development of odontogenic sinusitis. A descriptive, observational study was designed, with 276 patients who had been evaluated via cone beam computed tomography, analysing possible sinus thickening factors, such as apical infections, endodontic treatments, periodontitis, radicular cysts and impacted teeth, as well as iatrogenic factors caused by implant treatments or the development of oroantral communications produced during tooth extraction manoeuvres. Among the dental factors, periodontitis (47.1%), apical pathology (23.5%) and endodontic treatments (23.1%) were the predominant causes of sinus membrane thickening that most frequently produced an occupancy between 2 and 10 mm. Regarding the implant treatments, the placement of implants through the floor of the maxillary sinus was the main cause (9.8%), followed by sinus elevation techniques (6.2%). Dental extraction was the first cause of oroantral communication (5.0%), being the procedure that caused the greatest thickening of the sinus membrane. This study highlights the importance of dental treatments and iatrogenic factors in sinus pathology, and the need for diagnostic interrelations between the different specialists who address this pathology.
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Affiliation(s)
| | - Pedro Luis Ruiz-Sáenz
- Department of Odontology, Central Hospital of the Red Cross of Madrid, 28003 Madrid, Spain;
| | - Natalia Martínez-Rodríguez
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (N.M.-R.); (C.B.-D.); (J.C.-B.B.); (J.M.M.-G.)
| | - Cristina Barona-Dorado
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (N.M.-R.); (C.B.-D.); (J.C.-B.B.); (J.M.M.-G.)
| | - Cristina Meniz-García
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (N.M.-R.); (C.B.-D.); (J.C.-B.B.); (J.M.M.-G.)
- Correspondence: ; Tel.: +34-609-016-107
| | - Jorge Cortés-Bretón Brinkmann
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (N.M.-R.); (C.B.-D.); (J.C.-B.B.); (J.M.M.-G.)
| | - Juan Antonio Suárez-Quintanilla
- Department of Morphological Sciences, School of Medicine, University Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - José María Martínez-González
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (N.M.-R.); (C.B.-D.); (J.C.-B.B.); (J.M.M.-G.)
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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.
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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
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Saibene AM, Pipolo C, Borloni R, Felisati G. ENT and dentist cooperation in the management of odontogenic sinusitis. A review. ACTA ACUST UNITED AC 2021; 41:S116-S123. [PMID: 34060527 PMCID: PMC8172100 DOI: 10.14639/0392-100x-suppl.1-41-2021-12] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/23/2021] [Indexed: 11/23/2022]
Abstract
Odontogenic sinusitis represents by definition a border condition between otolaryngology and dental science and, from a holistic perspective, cannot be managed without a proficuous collaboration between specialists. This review focus on the different scenarios currently considered by international literature as related to odontogenic sinusitis and sinonasal complications of dental disease or treatment. Consequently, this review will cover all paranasal sinuses infections caused not only by dental disease (e.g. periodontitis and caries), but also by dental procedures (extractions, endodontics and the like), implantological procedures, pre-implantological (maxillary sinus grafting) and medication-related osteonecrosis of the jaw. After dealing with the odontogenic sinusitis diagnostic process and general principles of treatment, we will thoroughly cover odontogenic sinusitis scenarios treatment following an aetiology-based approach. This literature review shows that, albeit more prospective and rigorous studies are badly needed for determining the best treatment for each patient affected by odontogenic sinusitis, the sheer variety of scenarios that may be encountered should be enough to encourage mutual collaboration between ENTs and dentist. Such collaboration is required both to perfect diagnostic and treatment and to provide a solid scientific and medico-legal foundation for each intervention proposed to patients.
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Affiliation(s)
- Alberto Maria Saibene
- Head and Neck Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Carlotta Pipolo
- Head and Neck Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Roberto Borloni
- Head and Neck Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Felisati
- Head and Neck Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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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: 6] [Impact Index Per Article: 2.0] [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.
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