Odontogenic sinusitis: A state‐of‐the‐art review

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.

Computed tomography-based assessment of odontogenic sinusitis diagnosis: a cross-sectional study

“…Odontogenic infection involvement has been implicated in approximately 70% of cases of unilateral paranasal sinusitis; however, it is not exclusively because recent studies have reported the occurrence of bilateral OS (Matsumoto et al, 2015;Pokorny et al, 2013). In computed tomography, OS findings are represented as unilateral maxillary sinus opacification and the presence of overt maxillary dental pathology (Craig JR, 2022). To final diagnosis, the interrelation between medical and dentists is critical to classify and confirm the cause of this condition, in order to minimize further complications (Wuokko-Landen et al, 2021).…”

Endoscopic-assisted approaches for enucleation of invaded sinonasal region by benign odontogenic cysts: a case series study

“…A combination of medical and surgical approaches was required to treat such association. Concomitant endoscopic management of associated CRS was performed to ensure complete infection resolution and prevent recurrence and complications [18,19]. As pan CRS was present in 67%, working through the natural ostia in ESS; allowed control and drainage of inflammation with the preservation of Schneiderian membrane barriers.…”

Odontogenic Sinusitis: From Diagnosis to Treatment Possibilities—A Narrative Review of Recent Data

“…The flora of chronic OS is characterized by the predominant presence of anaerobes such as Gram-negative bacilli, Peptostreptococcus , and Fusobacterium spp., but aerobes can also be encountered, such as Streptococcus c. alpha-hemolytic , Streptococcus c. microhemolytic, Staphylococcus aureus [ 36 ]. Various studies regarding the bacterial species involved report the presence of more than 158 species and several fungi species [ 37 , 38 , 39 ].…”

“…Intraradicular bacteria and fungi that may cause secondary periapical lesions are Streptococcus, Propionibacteriu , and Candida spp., in particular, Candida albicans [ 16 , 41 , 42 , 43 , 44 ]. In periradicular pathology it is difficult to identify the aetiology of the lesions because the bacteria can be extraradicular and diffuse to the periapical area [ 38 , 42 , 43 , 44 ]. This fact is confirmed by bacteria commonly found in abscesses or fistulas, which are consequences of secondary periapical lesions [ 44 , 45 ].…”

“…In this case, the Moczair sliding flap technique will be used [ 8 ]. If the patient has a dental implant with peri-implantitis that is the cause of OS, there is not a clear indication for implant removal; rather, peri-implantitis treatment should be ensued, plus endoscopic sinus surgery, and the patient monitored [ 38 ].…”