close

Вход

Забыли?

вход по аккаунту

?

Clinical aspects of odontogenic maxillary sinusitis a case series.

код для вставкиСкачать
ORIGINAL ARTICLE
Clinical aspects of odontogenic maxillary sinusitis: a case series
Anthony B. Longhini, BS1 Berrylin J. Ferguson, MD2
Background: The incidence of odontogenic maxillary sinusitis (OMS) is unknown. Failure to address dental pathology causing sinusitis can lead to failure of medical and surgical treatments. The purpose of this article is to present
an OMS patient series.
Methods: Retrospective review of prospectively accrued
patients. Sinusitis guidelines were reviewed for OMS incidence and management. The clinical aspects of OMS in
21 patients diagnosed by sinus computed tomography (CT)
scan over the last 30 months were assessed.
of 21 (67%) of initial sinus CT reports but reevaluation of CT
scans found dental pathology in all patients.
Conclusion: Dental pathology causing sinusitis was frequently missed on plain dental X-rays and CT scan reports.
Dental pain and foul-smelling nasal discharge are present in
less than one-half of patients and symptoms commonly persist for years. Otolaryngologists must have a high index of
suspicion for an odontogenic cause of refractory maxillary
C 2011 ARS-AAOA, LLC.
sinusitis. Key Words:
Results: In our series the mean age was 53 years (range,
21–70 years), mean duration of symptoms was 2.6 years
(range, 1 month to 15 years), roen smell or bad taste was
present in 10 of 21 (48%) patients, dental pain was present
in 6 of 21 (29%) patients, and unilateral maxillary opacification was present in 12 of 23 (57%) patients. Dental pathology
was not noted in 6 of 7 (86%) of pre-CT dental films and 14
H
istorically 10% to 12% of maxillary sinusitis cases
have been attributed to odontogenic infections,1 but
this is only referenced anecdotally.2 A 2010 article from
Romania by Albu and Baciut3 reported a 25% (104/411)
incidence of odontogenic maxillary sinusitis (OMS) in
patients undergoing endoscopic sinus surgery (ESS) for
chronic rhinosinusitis (CRS) without nasal polyps (NP).
The authors attributed their higher incidence of OMS to
a shared outpatient office with oral-maxillofacial surgeons.
Classically, OMS is considered in patients with upper tooth
pain, dental infection, dental surgery, unilateral maxillary
sinusitis, foul drainage or smell, and resistance to conventional sinusitis therapy.4–7
maxillary sinusitis; odontogenic infection; oroantral fistula;
periapical abscess; sinusitis
How to Cite this Article:
Longhini AB, Ferguson BJ. Clinical aspects of odontogenic
maxillary sinusitis: a case series. Int Forum Allergy Rhinol,
2011; 1:409–415
Melen6 reported on the inherent difficulty of diagnosing
OMS because “the dental infection may progress slowly
and produce only minor symptoms until an exacerbation
occurs, and the dental foci can therefore easily be overlooked.” Recognition of OMS is important because failure
to address the dental pathology can result in failure of medical and surgical therapies and persistence of symptoms.8,9
We reviewed the English-language medical literature and
CRS guidelines with attention to recognition and recommendations for OMS. Prospectively, we enrolled all patients in a 30-month period with OMS based on computed
tomography (CT) scan and report on their clinical and demographic findings.
Materials and methods
1
School of Medicine, University of Pittsburgh School of Medicine,
Pittsburgh, PA; 2 Department of Otolaryngology, University of
Pittsburgh School of Medicine, Pittsburgh, PA
Correspondence to: Anthony Longhini, UPMC Mercy Building D, Suite 2100,
1400 Locust Street, Pittsburgh, PA 15219; e-mail:
longhini.anthony@medstudent.pitt.edu
Potential conflict of interest: B.J.F. is a consultant for MEDA and Schering
Plough and performs research for Inverness and Genentech.
Received: 13 October 2010; Revised: 18 January 2011; Accepted: 8 February
2011
DOI: 10.1002/alr.20058
View this article online at wileyonlinelibrary.com.
409
We conducted 2 literature searches, 1 PubMed search was
conducted for the terms “odontogenic sinusitis OR odontogenic rhinosinusitis OR odontogenic maxillary sinusitis.”
The search was limited to articles with full text available in
English published between November 1988 and June 2010.
We pursued the primary source material referenced in these
articles regarding cited incidence rates.
A second PubMed search reviewed rhinosinusitis guidelines to determine how frequently an odontogenic etiology
International Forum of Allergy & Rhinology, Vol. 1, No. 5, September/October 2011
Longhini and Ferguson
TABLE 1. Sinonasogram scale
1 = No problems
No symptoms evident
2 = Mild
Symptoms clearly present but minimal awareness: easily
tolerated
3 = Moderate
Definite awareness of symptom that is bothersome but
tolerable
4 = Severe
Symptom is hard to tolerate: interferes with activities of
daily living and/or sleeping
is listed using a PubMed search for the terms “guideline
AND (sinusitis [MeSH Terms]).” The search was limited
to articles with full text available in English published between March 1998 and June 2010. We did not evaluate pediatric articles. The full text of each guideline was searched
for the terms “dental” and “odontogenic.”
We retrospectively reviewed patients with symptoms of
CRS and maxillary dental abnormalities on CT scan who
were prospectively accrued by the senior author from
January 2008 to June 2010. CT evidence of dental pathology and sinusitis was identified by the initial radiographic
report or by secondary report by a head and neck radiologist after initial identification by the senior author. The
study was reviewed by the Institutional Review Board of
the University of Pittsburgh and approved under the exempt heading as a retrospective review of existing medical
records.
All patients completed a sinonasogram at each visit that
assessed their symptoms on the day of the visit and over
the previous 4 weeks. The survey included 13 symptoms
and 1 global sinonasal assessment using a 4-point scale
(Table 1).
Results
From January 2008 to June 2010, 21 patients with OMS
were identified. In our series 11 patients were female and
10 were male with a mean age of 53 years (range, 21–70
years) and an average duration of symptoms of 2.6 years
(range, 1 month to 15 years). Three patients had diabetes
mellitus and 1 was insulin dependent. Four patients had a
history of environmental allergies. None of the patients in
the series had NP.
Symptom scores reported on the sinonasogram were not
significantly different between the 2 temporal periods, although most patients reported less severe symptoms on the
day of the exam than over the preceding 4 weeks. (Fig. 1)
A total of 29% (6/21) of patients reported dental pain
and 48% (10/21) reported rotten smell or bad taste.
A total of 61% (11/18) of the patients reported a history of temporary symptomatic improvement with antibiotic therapy. Antibiotic therapy was not attempted for
3 patients.
A total of 62% (13/21) of patients reported visiting a
dentist during their disease course before our recognition
of OMS. Seven of these 13 patients had dental X-rays,
FIGURE 1. Mean sinonasogram scores for all patients. Symptoms were
assessed on a 4-point scale on the day of the visit and for 4 weeks preceding
visit. No significant difference was found between the 2 temporal periods.
Error bars = standard deviation.
which showed abnormalities in only 1 patient, specifically
a case of dental caries, visible on digital but not plain dental
X-ray. Thus 86% of patients had dental X-rays that failed
to diagnose OMS. Nineteen patients had dental procedures
after recognition of OMS. Two patients had ESS concomitant with dental treatment; 1 extraction and 1 extraction
with repair of oroantral fistula. One patient, whose symptoms did not resolve with dental therapy alone, required
additional ESS, which did lead to resolution of symptoms
(Table 2).
Without correction of the dental pathology, ESS was unsuccessful in our series. Six patients (29%) received 15 sinus
surgeries prior to recognition of OMS. OMS was refractory
to ESS in all cases except 2 in which the patient underwent
a simultaneous ESS and dental extraction after the recognition of OMS.
Fifteen patients had an endoscopic bacterial culture
(Table 3). There were 26 isolates with an average of 1.7
bacterial species per patient. Polymicrobial cultures were
obtained from 8 patients. Sinus pathogens were rarely
TABLE 2. Dental history
n (%)
Dental assessment before sinus CT diagnosis of OMS
Dental visit
13/21 (62)
Dental X-rays with dental exam
7/13 (54)
Abnormality on dental X-ray
1/7 (14)
Dental assessment after sinus CT diagnosis of OMS
Dental procedures
19/21 (90)
Dental extraction
15/19 (79)
Endodontic therapy
Resolution of sinusitis symptoms
6/19 (32)
18/19 (95)
CT = computed tomography; OMS = odontogenic maxillary sinusitis.
International Forum of Allergy & Rhinology, Vol. 1, No. 5, September/October 2011
410
Clinical aspects of OMS
TABLE 3. Microbiology
Organism
Number of isolates
Alpha hemolytic Streptococcus
4
Group A Streptococcus
1
Beta hemolytic Streptococcus
1
Streptococcus intermedius
1
Streptococcus morbillorum
1
Streptococcus veridans
1
Coagulase-negative Staphylococcus
3
Methicillin-sensitive Staphylococcus aureus
3
Methicillin-resistant Staphylococcus aureus
1
Diptheroids
3
Haemophilus influenzae
1
Enterobacter aerogenes
2
Serratia marcescens
2
“Negative”
2
cultured and cultures yielded oral flora and organisms generally thought to be commensal such as alpha-hemolytic
Streptococcus, diphtheroids, and coagulase-negative
Staphylococcus. Anaerobic cultures were rarely obtained
and, even when obtained in the operating room, were
negative.
All patients had evidence of dental disease associated with
sinusitis on sinus CT (Table 4). Periapical abscesses, including those with fistula, were present in 95% of patients on
CT scan (Fig. 2); 24% demonstrated oroantral fistula. In
our series there were no oroantral fistulas involving an absent tooth. Our definition of oroantral fistula included apical abscesses that had perforated into the maxillary antrum
(Fig. 3).
FIGURE 3. Unenhanced axial image from a sinus CT shows a periapical
abscess (white arrow) with communication into the maxillary sinus that
represents an oral-antral fistula.
A total of 91% of patients had maxillary opacification
and in all cases the opacification was ipsilateral to dental
disease. Frontal opacification was present in 43% of patients and ethmoid opacification was present in 65% of
patients. Dental pathology was reported on initial sinus
CT radiology report in only 30% of patients. Two patients,
who were not included in our series, had no maxillary sinus
radiographic abnormality except for dental disease appreciated on sinus CT. In these 2 patients symptoms resolved
with dental therapy.
Discussion
Over the course of 30 months we prospectively accrued
21 patients with OMS. In only 2 patients were symptoms
present for less than 3 months; thus, for the vast majority
TABLE 4. Radiology
n (%)
Evidence of dental disease on CT
Periapical cyst
2/21 (5)
Oroantral fistula
5/21 (24)
Maxillary opacification
ing right maxillary molar periapical abscess (white arrow) in a tooth with a
prior root canal.
411
20/21 (95)
Periodontal disease
Initial radiologist comment
FIGURE 2. Coronal reformatted CT with no initial comment made regard-
21/21 (100)
7/21 (33)
21/21 (100)
Bilateral
9/21 (43)
Unilateral
12/21 (57)
Frontal opacification
10/21 (48)
Ethmoid opacification
15/21 (71)
CT & equals; computed tomography.
International Forum of Allergy & Rhinology, Vol. 1, No. 5, September/October 2011
Longhini and Ferguson
of patients in our series, OMS meets the definition of CRS.
The actual importance of odontogenic sinusitis as a cause
of CRS is probably underappreciated. The diagnosis was
initially missed by the radiologist on CT scan in 66% of
our patients.
OMS literature search
We found 58 articles in our search on odontogenic sinusitis with full text available in English published between
November 1988 and June 2010. Thirteen articles gave an
OMS incidence range, of either 10% to 12% or 4.6% to
47%. The source documents referenced in the articles for
these incidence values of OMS are reviewed under “Primary
sources of incidence of OMS.”
Primary sources of incidence of OMS
Most of the primary source data for incidence of OMS is
from Sweden and Germany and 5 of 7 source documents
were published prior to 1965. The most recent article, Albu
and Baciut,3 carefully defined their population as chronic
maxillary sinusitis without NP. This reference was published after all of the currently available sinusitis guidelines.
Table 2 presents the year, country, number of patients, incidence, and method of diagnosis for all cited and available
source data.
Ten articles10–17 cite a range of 10% to 12% that originates from Maloney and Doku’s18 1968 paper entitled
“Maxillary sinusitis of odontogenic origin,” which cites
the incidence rate from 2 papers from 1954 and 195819,20
(Table 5). However these 2 “primary” sources present no
patient data to support their claims. Silcox’s19 1958 article states that “about 10% of all maxillary sinus infections
are of a dental origin”; however, there are no references
to support this assertion. Fleming’s20 1954 article does not
provide an incidence of OMS, despite being referenced for
this incidence in several reviews.
Three articles21–23 cite Melen’s incidence range of 4.6%
to 47% that traces back to 4 articles written from 1949 to
198224–27 (Table 5). Incidence of symptoms is rarely presented in these papers; the exception is Bjork,27 who found
that 46 of the 47 cases of OMS were unilateral and foul
smelling. Several articles described the inherent difficulty in
diagnosing OMS and attribute the wide range in incidence
values to this difficulty.
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). The diagnostic
methods used were ear, nose, and throat (ENT) examination, routine dental examination, dental and sinus X-rays,
nasal endoscopy, and extended maxillodental examination.
OMS was considered in patients with oroantral fistula or
evidence of dental disease interfacing with the maxillary
sinus on radiography or nasal endoscopy. In addition, he
found that over one-half of patients referred with a diagnosis of chronic sinusitis actually had no objective evidence
of sinusitis.
Sinusitis guidelines that reference OMS
We found 85 sinusitis guidelines published in English with
full text available from March 1998 to June 2010. Eleven
(13%) guidelines mentioned a dental or odontogenic cause
of maxillary sinusitis.2,28–37 In Table 6 we analyze the total
number of pages of each of these guidelines and the number
of sentences devoted to OMS.
None of the 11 guidelines provided incidence values for
OMS. Three articles provided a recommendation for the
evaluation of a dental pathology. The senior author’s 2009
article suggests a CT scan to identify periodontal disease
and periapical abscess as causes of sinusitis.28 Tichenor
TABLE 5. Primary sources from literature for OMS incidence
Author
Year
Country
Incidence values
Total number of patients
2010
Romania
25% of nonpolypoid maxillary sinusitis
411
1958
Canada
10%
0
Not specified
1954
Australia
None provided
0
Not specified
Lindahl et al.24
1982
Sweden
47%
62
Schuchardt et al.25
1964
Germany
77%
1233
Not specified
1952
Germany
12.4%
1792
Patient history, symptoms, X-rays, operative
report, history of dental extraction or cyst
1949
Sweden
4.6%
1019
Signs and symptoms, transillumination
3
Albu and Baciut
Method of diagnosis
ENT and dental exam with oral maxillofacial
surgeon, sinus CT scan
10%-12% incidence
Silcox19
20
Fleming
4.6%-47% incidence
Martensson
Bjork27
26
ENT and dental examination,
orthopantomogram and intraoral radiographs,
antral puncture
CT = computed tomography; ENT = ear, nose, and throat; OMS = odontogenic maxillary sinusitis.
International Forum of Allergy & Rhinology, Vol. 1, No. 5, September/October 2011
412
Clinical aspects of OMS
TABLE 6. Sinusitis guidelines that reference odontogenic maxillary sinusitis
Author
28
Ferguson et al.
Total number
Sentences dedicated
Year
of pages
to OMS
2009
14
7
Comments on OMS
Include OMS in differential diagnosis of CRS with mucopurulence
Diagnosis and treatment of OMS discussed
29
Tichenor et al.
2008
13
10
Endoscopy can be used to identify OMS
Include oral surgeon in treatment of OMS
Fokkens et al.2
2007
137
5
“CRS of dental origin should not be overlooked when considering the etiology of CRS.”
Management schemes for adults and children state to “exclude dental infection”
“Anaerobes are more prevalent in infections secondary to dental problems.”
Slavin et al.30
2005
35
2
Management scheme for sinusitis lists dental infection listed as an “other diagnosis”
Describes anatomical considerations of odontogenic maxillary sinusitis
31
Klossek and Federspil
2005
9
1
Notes that French guidelines recommend antibacterial therapy for “sinusitis associated
with dental infection”
Fokkens et al.32
2005
19
0
Management scheme for adult acute rhinosinusitis states “exclude dental infection”
Blomgren et al.
2005
6
4
Paragraph on diagnosis and treatment of odontogenic sinusitis as a “special
consideration”
Meltzer et al.34
2004
62
1
Some cases of anaerobic acute sinusitis result from a primary dental pathology
2004
45
1
Lists dental infection as a predisposing factor for acute bacterial rhinosinusitis
2000
32
1
Lists dental infection as a predisposing factor for acute bacterial rhinosinusitis
1998
60
3
Maxillary sinusitis may be secondary dental infections or dental procedures
33
35
Anon et al. (SAHP)
SAHP
36
Spector et al.37
Bad breath is often a symptom of OMS
CRS = chronic rhinosinusitis; OMS = odontogenic maxillary sinusitis; SAHP = Sinus and Allergy Health Partnership.
et al.29 suggests that endoscopy can identify dental disease in the maxillary sinuses. The Finnish Clinical Practice
Guidelines suggested sinus puncture, plain X-ray, dental
panoramic radiograph, and a dental referral.33
The current widely quoted 10% to12% incidence of
OMS is drawn from primary sources dating back over
50 years. 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 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. In 2010,
Albu and Baciut3 reported that 25% (104/411) of patients
without NP undergoing ESS for CRS had OMS. None of
our OMS patients had NP.
We found that only 11 of 85 (13%) recent sinusitis guidelines mention an odontogenic or dental cause of sinusitis.
Only 3 of these guidelines outlined diagnostic procedures
for OMS.28,29,33 Given the common nature of dental disease and sinusitis, we recommend that future guidelines
on diagnosis and management of rhinosinusitis, especially
CRS, include odontogenic sinusitis in the differential diag-
413
nosis with the recommendation that treatment of the dental
pathology is usually required to resolve OMS.
Case series
A recent meta-analysis of 15 articles by Arias-Irimia et al.38
found that OMS is most often diagnosed in the fifth decade
of life and is more common in females. Melen et al.7 found
that only 2 of the 99 patients in his series with OMS were
under the age of 30. In our series the average age was
in the sixth decade of life and no gender difference was
found.
Symptoms that classically have been thought to indicate a
dental source include unilateral maxillary opacification on
CT, found in 57% of our series, and patient perception of
rotten smell or bad taste, present in 48% of patients in our
series. Dental pain was present in only 29% of our patients.
Brook1 also noted that dental pain is infrequent in OMS
which he hypothesized was due to the ostiomeatal complex
remaining patent and venting pressure from the diseased
tooth. In 11% of patients with acute radiographic sinusitis
by plain film, Williams and Simel39 found that pain in the
upper teeth was the most specific indicator of an abnormal
plain sinus film. Dental pain appears to be neither sensitive
nor specific for a dental etiology and can also represent
nonodontogenic causes of maxillary sinusitis.
The symptom most frequently present and given the
highest bothersome score in patients with OMS on the
International Forum of Allergy & Rhinology, Vol. 1, No. 5, September/October 2011
Longhini and Ferguson
sinonasogram was nasal obstruction. This symptom is neither specific nor sensitive for OMS since nasal obstruction
is common to rhinosinusitis regardless of etiology and is
also frequently the most bothersome symptom in disorders
that affect only the nose, irrespective of sinus involvement,
such as allergic rhinitis.
Diabetes could contribute to complications or dental disease; however, we found no evidence of increased risk of
OMS in our series due to diabetes. Three (14%) of our
patients had diabetes, consistent with the predicted incidence of diabetes of 23.1% (12.2 million) of Americans
aged 60 years and older according to the American Diabetes
Association.40 Periodontal disease is a common complication of diabetes and reduced sensation of dental pain due to
diabetic neuropathy could potentially allow more advanced
dental infection to occur before dental intervention.
In our series, dentists were not able to reliably detect
dental infection causing sinusitis. One-half of our patients
saw a dentist during their sinus disease, but only 1 of
7 (14%) was noted to have dental pathology on dental
X-ray. Thus dental pathology was missed in 86% of cases.
This is similar to the report by Melen et al.7 that 56 in 99
(55%) of OMS cases are missed on routine dental examination including dental X-ray. Physicians should be mindful
that a negative dental report does not exclude a dental
etiology.
Five patients in our series had unsuccessful ESS and our
previous article has suggested that OMS is a cause of ESS
failure.9 Presurgical CT scans provide an opportunity to examine for dental pathology before conducting unnecessary
and usually unsuccessful ESS.
The majority of the bacterial isolates in this series were
Staphylococcus and Streptococcus species. Brook16 reports
that almost 100% of bacterial maxillary sinusitis is anaerobic and that the organisms associated with OMS typically
consist of a mixed polymicrobial infection with anaerobes
outnumbering aerobes. Our failure to recover anaerobic
bacteria may have been caused by failure to obtain anaerobic cultures, endoscopic sampling technique instead of
antral tap, and lack of rapid transportation to the microbiology laboratory. Brook16 utilized rapid processing and
careful handling of samples to recover a high percentage of
anaerobic isolates.
Over one-half of patients reported improvement of symptoms while on antibiotics; however, symptoms returned
following both long and short courses of antibiotics, when
antibiotics were withdrawn.
For 90% of patients in our series, OMS was a chronic
(<8 weeks) and refractory disease with an average duration
of 2.6 years. Four of the 11 guidelines on rhinosinusitis that
do report a dental etiology for sinusitis restrict it to acute
rhinosinusitis and do not report dental infection as a cause
of CRS. In our series OMS was a more likely cause of
CRS than acute rhinosinusitis. This may reflect the patient
population common to an otolaryngologist specializing in
sinonasal disorders in which chronic sinusitis is more likely
to be seen than acute sinusitis.
The majority of patients had maxillary opacification ipsilateral to their dental pathology. Fewer patients had ethmoid and frontal disease, 65% and 43%, respectively. The
diffuse mucosal disease in the setting of OMS may be secondary to the natural spread from the maxillary to ethmoid
to frontal sinuses. Brook41 has hypothesized that the majority of intracranial infections are secondary to odontogenic infections and therefore the natural history of OMS
may be progression from localized to diffuse sinus mucosal
disease.
The treatment of OMS is different from the treatment
of nonodontogenic sinusitis and requires dental evaluation
and treatment before sinus surgery. If preoperative dental
care does not resolve OMS then ESS is required, especially
in cases of maxillary sinus debris or occluded ostiomeatal
complex. Concomitant ESS and oral surgery may be necessary to treat oroantral fistulas.10
In this series of 21 patients collected over 18 months, 19
patients had improvement of sinus disease with dental treatment and 1 was lost to follow up. The causal relationship
between odontogenic pathology and sinusitis was inferred
from resolution of symptoms following dental treatment
for pathology that had been visualized on CT scan.
A recent meta-analysis of 770 cases by Arias-Irimia
et al.38 found that over one-half (55%) of OMS was secondary to iatrogenic causes (dental extraction, dental foreign body, and dental lift and implant procedures). None of
our 21 patients experienced OMS secondary to dental procedures. Review of 15 case series found the cause of maxillary sinusitis varies with the point of view of the author.
In the series presented by dentists and oral and maxillofacial surgeons (OMFS), 100% to 60% of OMS is caused by
iatrogenic dental procedures (dental extraction, dental foreign body, and dental lift and implant procedures). Articles
from otolaryngologists or relying on radiographic evaluation report 100% to 80% of OMS is from periodontal
disease. The viewpoint of the practitioner alters the perception and most commonly encountered etiology of the
disease. Dentists were more likely to report an iatrogenic
etiology whereas radiology literature reported periodontal
disease as the more common etiology. Otolaryngologists
treat patients with sinus disease that may be subsequently
diagnosed as dental in origin.
Conclusion
The incidence of OMS is unknown and the diagnosis of
OMS is underappreciated. An extensive review of the literature found that only a minority of guidelines written
in the last decade list dental infection as a potential cause
of sinusitis. In our prospectively acquired and retrospectively reviewed series of 21 patients with OMS we found
that bilateral sinus disease is present almost as frequently
as unilateral disease, only 48% of patients note rotten or
foul smells, and only 29% complain of dental pain. OMS
is far more likely to be responsible for refractory CRS than
for acute maxillary sinusitis in our series. Otolaryngologists
International Forum of Allergy & Rhinology, Vol. 1, No. 5, September/October 2011
414
Clinical aspects of OMS
should carefully review the sinus CT for dental pathology,
because both dentists and radiologists may miss periodontal disease or a periapical abscess that may be the cause of
OMS. Recognition of OMS should prompt dental management and if symptoms and abnormality persist consideration for ESS. Dental management led to the resolution of
sinusitis symptoms in 18 of 19 patients.
Acknowledgments
We thank Margaretha Casselbrant, MD, PhD, for assistance in translation of Swedish source documents, Elizabeth Koopmann, RN, BSN, for assistance in translation of
German source documents, and Barton F. Branstetter, MD,
for radiology commentary.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
415
Brook I. Sinusitis of odontogenic origin. Otolaryngol
Head Neck Surg. 2006;135:349–355.
Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol
Suppl. 2007;1–136.
Albu S, Baciut M. Failures in endoscopic surgery of
the maxillary sinus. Otolaryngol Head Neck Surg.
2010;142:196–201.
Mehra P, Murad H. Maxillary sinus disease of
odontogenic origin. Otolaryngol Clin North Am.
2004;37:347–364.
Abrahams JJ, Glassberg RM. Dental disease: a frequently unrecognized cause of maxillary sinus abnormalities? AJR Am J Roentgenol. 1996;166:1219–
1223.
Melen I. Chronic sinusitis: clinical and pathophysiological aspects. Acta Otolaryngol Suppl.
1994;515:45–48.
Melen I, Lindahl L, Andreasson L, et al. Chronic maxillary sinusitis. Definition, diagnosis and relation to
dental infections and nasal polyposis. Acta Otolaryngol. 1986;101:320–327.
Richtsmeier WJ. Top 10 reasons for endoscopic
maxillary sinus surgery failure. Laryngoscope.
2001;111:1952–1956.
Longhini AB, Branstetter BF, Ferguson BJ. Odontogenic maxillary sinusitis: a cause of endoscopic sinus
surgery failure. Am J Rhinol Allergy. 2010;24:296–
300.
Hajiioannou J, Koudounarakis E, Alexopoulos K,
et al. Maxillary sinusitis of dental origin due
to oroantral fistula, treated by endoscopic sinus
surgery and primary fistula closure. J Laryngol Otol.
2010;124:986–989.
Andric M, Saranovic V, Drazic R, et al. Functional endoscopic sinus surgery as an adjunctive treatment for
closure of oroantral fistulae: a retrospective analysis.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2010;109:510–516.
Mehra P, Jeong D. Maxillary sinusitis of odontogenic
origin. Curr Allergy Asthma Rep. 2009;9:238–243.
Bomeli SR, Branstetter BF, Ferguson BJ. Frequency of
a dental source for acute maxillary sinusitis. Laryngoscope. 2009;119:580–584.
Mehra P, Jeong D. Maxillary sinusitis of odontogenic
origin. Curr Infect Dis Rep. 2008;10:205–210.
15. Costa F, Emanuelli E, Robiony M, et al. Endoscopic
surgical treatment of chronic maxillary sinusitis of
dental origin. J Oral Maxillofac Surg. 2007;65:223–
228.
16. Brook I. Microbiology of acute and chronic
maxillary sinusitis associated with an odontogenic origin. Laryngoscope. 2005;115:823–
825.
17. Mehra P, Caiazzo A, Bestgen S. Odontogenic sinusitis causing orbital cellulitis. J Am Dent Assoc.
1999;130:1086–1092.
18. Maloney PL, Doku HC. Maxillary sinusitis of odontogenic origin. J Can Dent Assoc (Tor). 1968;34:591–
603.
19. Silcox LE. Diseases of the ear, nose and throat of interest to the dentist. Dent Clin North Am. 1958:381–
396.
20. Fleming WE. Effects of chronic pyogenic infection on
maxillary sinus. Qld Dent J. 1954;6.
21. Wysluch A, Maurer P, Ast J, et al. Orbital complications due to an acute odontogenic focus in a child. A
case report. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod. 2009;107:e39–e42.
22. Legert KG, Zimmerman M, Stierna P. Sinusitis of
odontogenic origin: pathophysiological implications
of early treatment. Acta Otolaryngol. 2004;124:655–
663.
23. Ngeow WC. Orbital cellulitis as a sole symptom of odontogenic infection. Singapore Med J.
1999;40:101–103.
24. Lindahl L, Melen I, Ekedahl C, et al. Chronic maxillary sinusitis. Differential diagnosis and genesis. Acta
Otolaryngol. 1982;93:147–150.
25. Schuchardt K, Pfeifer G, Lentfrodt J. Observations in
the treatment of odontogenic sinusitis. Fortsch Kiefer
Gesichtschir. 1964;9:130–137.
26. Martensson G. Dental sinusitis. Dtsch zahnarztl Z.
1952;7:1417–1427.
27. Bjork H. On stomatic (dental) maxillary sinusitis.
Odontologisk. 1949;57:113–122.
28. Ferguson BJ, Otto BA, Pant H. When surgery, antibiotics, and steroids fail to resolve chronic rhinosinusitis. Immunol Allergy Clin North Am. 2009;29:719–
732.
29. Tichenor WS, Adinoff A, Smart B, et al. Nasal and
sinus endoscopy for medical management of resis-
International Forum of Allergy & Rhinology, Vol. 1, No. 5, September/October 2011
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
tant rhinosinusitis, including postsurgical patients. J
Allergy Clin Immunol. 2008;121:917–927 e2.
Slavin RG, Spector SL, Bernstein IL, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005;116:S13–
S47.
Klossek JM, Federspil P. Update on treatment guidelines for acute bacterial sinusitis. Int J Clin Pract.
2005;59:230–238.
Fokkens W, Lund V, Bachert C, et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy. 2005;60:583–601.
Blomgren K, Alho OP, Ertama L, et al. Acute sinusitis:
Finnish clinical practice guidelines. Scand J Infect Dis.
2005;37:245–250.
Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg.
2004;131:S1–S62.
Anon JB, Jacobs MR, Poole MD, et al. Antimicrobial
treatment guidelines for acute bacterial rhinosinusitis.
Otolaryngol Head Neck Surg. 2004;130:1–45.
Antimicrobial treatment guidelines for acute bacterial
rhinosinusitis. Sinus and Allergy Health Partnership.
Otolaryngol Head Neck Surg. 2000;123:5–31.
Spector SL, Bernstein IL, Li JT, et al. Parameters for
the diagnosis and management of sinusitis. J Allergy
Clin Immunol. 1998;102:S107–S144.
Arias-Irimia O, Barona-Dorado C, Santos-Marino JA,
et al. Meta-analysis of the etiology of odontogenic
maxillary sinusitis. Med Oral Patol Oral Cir Bucal.
2010;15:e70–e73.
Williams JW Jr, Simel DL. Does this patient have
sinusitis? Diagnosing acute sinusitis by history and
physical examination. JAMA. 1993;270:1242–1246.
Centers for Disease Control and Prevention.
National diabetes fact sheet: general information and national estimates on diabetes in the
United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.
http://www.cdc.gov/diabetes/pubs/pdf/ndfs 2007.pdf.
Accessed February 21, 2011.
Brook I. Microbiology of intracranial abscesses and
their associated sinusitis. Arch Otolaryngol Head
Neck Surg. 2005;131:1017–1019.
Документ
Категория
Без категории
Просмотров
5
Размер файла
280 Кб
Теги
series, clinical, aspects, case, sinusitis, maxillary, odontogenic
1/--страниц
Пожаловаться на содержимое документа