Chronic Maxillary Sinusitis:Definition, Diagnosis and Relation to Dental Infections and Nasal Polyposis

Abstract

Various definitions have been proposed for the term 'chronic sinusitis' but too often reports on chronic sinusitis lack a definition. In order to improve the diagnosis and treatment of this disease, and also to facilitate comparisons between clinical investigations, definitions of 'chronic maxillary sinusitis' of either rhinogenous or dental origin are proposed. It is suggested that the differential diagnosis should be based upon the duration of symptoms, ENT and dental examinations, sinus radiographs and/or sinoscopy, and results of conservative treatment. In a study conducted over a 5-year period, 198 patients with 244 affected sinuses fulfilled the proposed criteria. The incidence of chronic maxillary sinusitis in the population was 0.02%. A dental cause was found in 40.6% of the sinuses. The dental cause could be confirmed by routine dental examination in only 43 of 99 cases, while an extended maxillo-dental examination was conclusive in the other cases (56/99). Marginal periodontitis was found as frequently as periapical granuloma and together they constituted 83% of all dental causes. Sinusitis of dental origin was rare before the age of 30. Every sixth patient was found to have nasal polyposis. When related to the number of affected sinuses, the incidence of nasal polyposis was 13.1% in sinusitis of dental origin and 23.4% in that of rhinogenous origin. The importance of close cooperation between the ENT specialist and the oral surgeon is stressed.

Clinical aspects of odontogenic maxillary sinusitis: a case series

“…Recently, guidelines have advocated division of CRS into NP and no NP. In the same study, Melen et al 7 noted NP were associated with OMS in 13.1% of cases and 23.4% of non-OMS cases. Similarly, bilateral sinus disease was less frequent in OMS cases than in non-OMS cases, 18% and 23%, respectively.…”

“…Careful examination of these source documents shows that they fail to support this incidence. In a more recent investigation of the incidence of OMS, Melen et al 7 found that in a highly selected population of 198 adults referred for evaluation with refractory CRS, 40% of affected maxillary sinuses were from an odontogenic cause and of these 18% were bilateral OMS. Recently, guidelines have advocated division of CRS into NP and no NP.…”

“…In 1986, Melen et al 7 reported an incidence of OMS of 40.6% (99/198) in a highly selected population of patients with at least 3 months of symptoms and objective evidence of disease on endoscopy or plain sinus X-ray. This series incorporated their earlier smaller series from 1982, which found an OMS incidence of 47% (29/62).…”

Molecular analysis of bacterial flora associated with chronically inflamed maxillary sinuses

“…Oral bacteria may ascend from the mouth through the middle meatus to the maxillary sinus, or through the Eustachian tube to the middle ear, causing infections. Dental conditions such as periodontitis or periapical granuloma have been associated with 40 % of chronic maxillary sinusitis cases (Melen et al, 1986). Typically oral anaerobic bacteria such as Porphyromonas, Prevotella and Fusobacterium species can be detected by culture methods in infections of the middle ear (Brook et al, 2000), tonsils (Rajasuo et al, 1996) and sinuses (Le Moal et al, 1999).…”

Panoramic and tomographic implant studies: Role in the diagnosis of sinus disorders

“…In most cases, the finding is discovered by chance through routine radiographic examinations. Symptomatic cases may occur when the sinus is completely full, the most common clinical manifestations being that of headaches, periorbital and hemifacial pains, and sometimes dizziness, nasal obstruction and recurrent sinusitis, among others (2,3). The incorporation of tomographic tests performed in order to assess implant treatment has led to an increase in the diagnosis of these types of disorders, which occasionally have an apparent dental origin.…”