Frequency of a dental source for acute maxillary sinusitis

Abstract

Objective:To identify radiographic features of odontogenic acute maxillary sinusitis and to determine the frequency of a causative dental infection in patients with radiographic evidence of maxillary sinus fluid.Study Design:Retrospective review of 101 sinus computed tomography scans with unilateral or bilateral maxillary sinus fluid.Methods:Each maxillary sinus was graded for extent of fluid, degree of mucosal thickening, and presence of dental pathology. Univariate chi‐square analysis was used to identify potential radiologic and demographic features predictive of sinus fluid. Multivariate logistic regression was then used to determine which features were independently predictive.Results:124 of the 202 maxillary sinuses (61%) had sinus fluid. Univariate analysis excluded age, gender, and prior surgery as predictive features. The multivariate analysis included the radiographic features of oroantral fistula, periapical abscess, periodontal disease, projecting tooth root, and dental caries. Of these, only oroantral fistula and the combination of periodontal disease with either a projecting tooth root or periapical abscess were identified as significant sources of maxillary sinusitis. In sinuses that were <1/3 opacified by fluid, 17% had a dental source of infection. In sinuses with 1/3 to 2/3 fluid opacification, 53% had an identifiable dental source, and in sinuses that were >2/3 opacified by fluid, 79% had an identifiable dental source. Mucosal thickening demonstrated a similar relationship with dental sources, so that sinuses having both >2/3 fluid opacification and moderate mucosal thickening were 86% likely to have an identifiable dental source.Conclusions:Odontogenic infections are often the source of acute maxillary sinusitis, especially if the radiographic findings of sinusitis are severe. Laryngoscope, 2009

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…95 Periapical infections of maxillary molars can lead to direct inoculation of the overlying sinus cavity, although dental causes of ARS are rare and more commonly seen in CRS. 96 The evidence addressing the relative contribution of several factors is explored in greater detail in the next sections.…”

“…One retrospective case series showed that a periapical abscess of a maxillary tooth has a 9.75 odds ratio (p < 0.001) of causing substantial reactive mucosal thickening on cone beam CT. 110 Additionally, another study showed that periodontal disease with tooth roots emerging into the antrum and oroantral fistulas can cause the symptoms and signs of ARS. 96 In summary, the evidence for an association between ARS and anatomic variants is weak and largely inferred from studies on RARS, CRS, and mixed groups of RS (Table V- evidence, plausible mechanisms that may explain their interaction, relevant human and animal studies, and whether treatment of AR changes disease expression in ARS.…”

“…138 Historically, the prevalence of RS of odontogenic origin has been quoted to be 10% to 15%. 139 A more recent study by Bomeli et al 96 evaluated the frequency of acute maxillary RS and found that oroantral fistulas to be the only independent predictor of RS. Periodontal disease, projecting tooth roots, and apical abscess were not independent predictors, but there were interaction effects: the presence of periodontal disease along with either a projecting tooth root or an abscess were predictive of RS using regression analysis.…”

“…96 Diagnostic criteria for ARS are usually not met, because nasal congestion, hypersecretion, and/or hyposmia are absent. The lack of other typical ARS-associated symptoms makes the diagnosis of ARS less likely, and dental evaluation by a specialist with appropriate imaging will provide clarification.…”

Chronic odontogenic paranasal sinusitis in the material provided by the Otorhinolaryngology Unit of the 4th Military Teaching Hospital in Wroclaw

“…14 Bomeli et al noted that 79% of all cases of acute maxillary sinusitis may be related to the presence of an odontogenic focus. 15 The development of the X-ray technology, as well as the availability of CT scans led to a situation in which it is currently estimated that almost 86% of all cases of sinusitis may have an odontogenic character. 16 These results correspond with the percentage shown in our sample group -86.1%.…”