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Objectives: The incidence of odontogenic sinusitis has been gradually increasing due to the recent increases in invasive dental procedures. This study aimed to describe the clinical features of present patients with odontogenic sinusitis compared to the past, confirm the importance of endoscopic sinus surgery (ESS), and analyze the predictive factors for ESS. Methods: This retrospective review included all patients diagnosed with odontogenic sinusitis between January 2010 and December 2011 and between January 2019 and December 2020. The patients were classified into 2 groups (past and present) depending on the time of the first visit. The clinical characteristics and treatment modalities were compared between the two groups. In addition, among patients in the present group, we analyzed variables to identify factors contributing to the risk of undergoing ESS. Results: This study included 56 patients (23 in the past group and 33 in the present group). Compared to the past group, the present group had an older mean age (P =.001) and significantly increased iatrogenic etiologies (52.1% vs 90.9%; P =.002). The proportion of patients treated with ESS also increased in the present group compared to that in the past group (39.1% vs 66.7%; P =.041). In the present group, 11 patients (33.3%) were cured with conservative treatment, while 22 patients (66.7%) underwent additional ESS. Multivariate analysis revealed that the Lund–Mackay score was the only significant predictor of ESS (odds ratio [OR]: 14.901, P =.035). Conclusion: The incidence of odontogenic sinusitis with iatrogenic etiologies has increased compared to the past. In addition, two-thirds of the patients in the present study underwent ESS, a significantly higher proportion than in the past. Therefore, ESS is one of the most important treatment modalities for odontogenic sinusitis, especially iatrogenic, in recent years. A severe Lund–Mackay score was associated with a significantly increased risk of ESS. [ABSTRACT FROM AUTHOR]

Aim: To determine outcome measurement when odontogenic sinusitis (ODS) is treated by Endoscopic Sinus Surgery (ESS). Materials and Methods: A PRISMA compliant systematic review using MeSH headings on Pubmed, Ovid and Embase. Inclusion criteria: Adults with odontogenic maxillary sinus disease undergoing ESS. Exclusion criteria: Adolescents, odontogenic disease related to; trauma, neoplasia, tumour resection, palatal cleft or fungal infection, previous sinus surgery, endoscopic surgery not involving the middle meatus. Results: A total of 1462 papers were identified, 68 eligible for review. No randomised controlled trials were identified. Twenty‐three papers (34%) reported a successful outcome as no disease at endoscopy and reduced sinonasal symptoms; 14 papers (21%) based outcomes on endoscopy, reduced symptoms and resolution of sinus opacification or reduced mucosal thickness; 1 paper established success on reduced symptoms only and 7 papers (10%) based outcomes on radiographic findings only. Other primary measures of success were excision and closure of oro‐antral fistula, 6 (9%), removal of odontogenic cysts, 5 (7%), removal of displaced dental implants, 4 (6%), removal of displaced root of tooth, 3 (4%). Five papers (7%) reported no outcome measure. Additional measures of outcome were; retention of dental implants perforating the sinus floor, survival of sinus floor grafting with subsequent implant placement and retention of teeth with persistent apical periodontitis. Conclusion: Reported outcome measures were very heterogeneous. In consideration of the weak evidence base for the role of ESS in ODS management, more consistent measurement and reporting of patient symptoms, clinical and radiological signs with endoscopic findings is recommended to enable meta‐analysis. [ABSTRACT FROM AUTHOR]

Background/Objectives: Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification. Initial treatment consists of intranasal steroids and antimicrobial therapy. In case of persistence of the disease, endoscopic sinus surgery (ESS) is advised. It is still not clear what extension of ESS is required and whether frontal sinusotomy or ethmoidectomy is justified in ODS with frontal sinus involvement. Methods: Adult patients presented with uncomplicated recalcitrant bacterial ODS due to endodontic-related dental pathology were evaluated by an otolaryngologist and a dentist and scheduled for ESS. Sinus CT scan demonstrated opacification of maxillary sinus and partial or complete opacification of extramaxillary sinuses ipsilateral to the side of ODS. Patients were undergoing either maxillary antrostomy, antroethmoidectomy, or antroethmofrontostomy. Preoperative and postoperative evaluations were done with nasal endoscopy, dental examination, subjective and radiological symptoms. Results: The study group consisted of 30 patients. Statistically significant decreases in values after surgery were found for SNOT-22, OHIP-14, Lund–Mackay, Lund–Kennedy, and Zinreich scale. Tooth pain was present in 40% cases during the first visit and in 10% during the follow-up visit. Foul smell was initially reported by 73.3% and by one patient during follow-up visit (3.3%). Significantly longer total recovery time and more crusting was marked for antroethmofrontostomy when compared to maxillary antrostomy. Conclusions: ESS resolved ODS with ethmoid and frontal involvement in almost every case. Minimal surgery led to improved overall clinical success in the same way as antroethmofrontostomy without risking the frontal recess scarring and stenosis. [ABSTRACT FROM AUTHOR]

Aim of the study was to carry out a comparative analysis of the height of the maxillary sinuses, the thickness of their upper wall and bone plate in the first period of adulthood and old age using 3D digital technologies. Material and methods. The work is based on the results of a 3D study of the facial part of the skull of 92 people with a normal maxillary sinus structure who were treated at a dental clinic in Perm. All patients were mesocrans, right-handed. The subjects were divided by gender and age into two groups. The first group consisted of 21 women and 27 men of the first period of adulthood (from 22 to 35 years old), the second group was represented by 23 men and 21 women of senile age (from 75 to 86 years old). The 3D study consisted in measuring the height of the maxillary sinuses and determining the thickness of their upper wall and bone plate. The height of the sinus was considered to be its largest vertical size on the frontal section. The thickness of the upper sinus wall was determined as the widest part of the orbital surface of the maxillary bone at its most prominent point. The thickness of the bone graft was calculated as the distance from the periosteum of the roots of six teeth (from the canine to the third molar) to the deepest point of the bottom of the maxillary sinus in the projection of these teeth. Results. There is a decrease in sinus height in old age compared to the first period of adulthood (p < 0.01). The dynamics of the maxillary sinuses size indicators is manifested in thinning of the upper wall and bone lamina by old age (p < 0.01). Both in the first period of adulthood and in old age there is a tendency to anatomical asymmetry of maxillary sinuses with predominance of parameters on the right side (p > 0.05). Conclusions. The data of a lifetime comparative analysis of the linear dimensions of the right and left sinuses in patients of the first adult and infantile ages, allow us to form an idea about the

Objectives: To study the association between perforation dental implants into the maxillary sinus cavity and the development of sinus pathology. Methods: We retrospectively examined 3732 computerized tomography (CT) scans to detect maxillary implants. The detected scans were grouped based on apparent or lack of perforated dental implants in the maxillary sinus (study and control group, respectively). Clinical data was gathered including the CT indication, patients' demographics, comorbidities and medications, implant features, and the radiographic appearance of the maxillary sinuses. We conducted a logistic regression to identify risk factors to develop radiopaque thickening in the sinuses. Results: Included in the study were 198 patients with 719 maxillary implants; of these, 236 and 483 implants were in the study and control groups, respectively. Sinus opacification was associated with implants' perforations (p < 0.001), diameter, and side and place (p < 0.05). Implants' perforation (OR = 3.679; 95% CI = 1.891–7.157) and diameter (OR = 1.608; 95% CI = 1.067–2.424), sinus floor augmentation (OR = 2.341; 95% CI = 1.087–5.042), male gender (OR = 2.703; 95% CI = 1.407–5.192), and smoking (OR = 6.073; 95% CI = 2.911–12.667) were associated with ipsilateral sinus fullness. Conclusions: A first large study on the association between maxillary dental implant and sinus pathology. Dental implant perforation is associated with sinus opacification. Considering dental implant diameter, rather than vertical depth of penetration into the sinus, as an important criterion when examining perforated dental implants necessitates a new approach to clinical decision-making. [ABSTRACT FROM AUTHOR]

Abstract Background Odontogenic sinusitis (ODS) has clinical features like rhinogenic sinusitis. Although it is usually unilateral, diagnostic overlap could happen. However, ODS necessitates different management which includes dental intervention to eliminate the dental infection source. In some patients, ODS may persist even after management of dental pathology. The aim of this study was to assess the clinical features, and diagnostic criteria of ODS that is persistent after management of dental pathology, and to evaluate the efficacy of endoscopic sinus surgery (ESS) as a therapeutic option of the disease. Methods Twenty patients were included in this study. All patients were presented with ODS refractory to medical treatment after management of their dental problems. Clinical features of the patients were analyzed. Also, endoscopic nasal examination and computed tomography of paranasal sinuses (CT) were performed for all patients. ESS were used, with widening of the maxillary ostium for drainage. Follow-up was carried out for at least 6 months. Results All patients had unilateral disease, with 3 main complaints: malodourous nasal discharge (90%), facial pain (75%), and nasal obstruction (45%). Endoscopic nasal examination showed either middle meatal purulence (70%) or polypoid mucosa (30%). CT showed either thickened maxillary sinus mucosa (50%), or complete maxillary opacity (50%) with retained foreign body in 2 patients (10%). After ESS, all patients reported relieve of their sinonasal symptoms, and nasal endoscopy showed patent middle meatus, with one patient demonstrated adhesions between the middle turbinate and lateral nasal wall which was asymptomatic. Conclusion Prior dental intervention is a suspicious diagnostic landmark for ODS, and unilateral foul nasal discharge is the main prevalent complaint. Nasal endoscopy usually shows purulence or polypoid mucosa in the middle meatus, and CT is a good diagnostic tool for ODS. ESS with good widening of the maxillary ostium is an effective therapeutic option for those patients.

Aim: To present the most recent evidence about odontogenic sinusitis. Materials and methods: An electronic search was conducted in MEDLINE via OVID, Embase via OVID and PubMed for odontogenic sinusitis. Results: Odontogenic sinusitis originates from pathology of the dentition and surrounding structures. This disease differs from sinusitis of other causes in pathophysiology, diagnosis, microbiology and management. Symptoms of unilateral nasal obstruction and purulent discharge are highly suggestive of the disease. Computed tomography is considered the gold standard in assessing the relationship between dental conditions and sinus disease. Failure to eliminate the dental source of infection will often result in treatment failures. Collaboration and multidisciplinary management between dental surgeons and otolaryngologists is imperative for the successful identification and treatment of the disease, as either treatment in isolation may be inadequate leading to poor patient outcomes. Primary dental treatment may be effective in patients with lower sinonasal disease burden and similarly, patients suffering from minimal dental disease may recover from sinus surgery alone. Combined dental and sinus surgery results in disease resolution in 90%–100% of patients; however, controversy remains regarding the optimal sequence of interventions. Conclusion: This review describes the aetiological, microbiological, clinical findings and diagnostic methods, as well as clinical and patient factors influencing treatment modalities of odontogenic sinusitis. Furthermore, a management decision tree is provided. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract Background The microbiome plays a crucial role in odontogenic sinusitis (OS); however, the bacterial characteristics of the sinuses and connected dental regions in OS are poorly understood. In this study, nasal secretion samples were collected from 41 OS patients and 20 simple nasal septum deviation patients, and oral mucosa samples from dental regions were collected from 28 OS patients and 22 impacted tooth extraction patients. DNA was extracted, and 16S rRNA sequencing was performed to explore the characteristics and structure of the microbiome in the sinuses and dental regions of OS patients. Results The alpha diversity of the oral and nasal microbiomes in OS patients was higher than that in controls. Principal coordinate analysis (PCoA) showed that oral samples clustered separately from nasal samples, and the beta diversity of oral and nasal samples in OS patients was higher than that in controls. The dominant phylum was Bacteroidetes in OS patients and Firmicutes in controls in both the oral and nasal cavity. The dominant genera in the oral microbiome and nasal microbiome of OS patients were similar, including Fusobacterium, Porphyromonas and Prevotella. Co-occurrence network analysis showed decreased microbial connectivity in the oral mucosa and nasal secretion samples of OS patients. Conclusions Odontogenic infection promotes structural and functional disorders of the nasal microbiome in OS. The interaction of dominant pathogens in the nasal and oral regions may promote the development of OS. Our study provides the microbiological aetiology of the nasal and connected dental regions in OS and is expected to provide novel insights into the diagnosis and therapeutic strategies for OS.

The aim of this study was to analyze the oral etiology of patients with odontogenic sinusitis (ODS) and to compare the differences in demographic data, clinical symptoms, extent of sinus involvement, bone penetration of the maxillary sinus floor (MSF) between different etiologies. A retrospective investigation was conducted on 103 patients with ODS recruited from Beijing TongRen Hospital. All enrolled patients underwent sinus CT, nasal endoscopy, and oral examination. A comparison of the patients' clinical symptoms, the extent of involvement of the sinuses, and bone resorption of the MSF according to odontogenic etiologies was conducted. Follow-up was based on symptoms and clinical examination. The most common odontogenic etiologies were endo-periodontal lesions (EPLs, 49.5%), apical periodontitis (AP, 32.0%), and periodontitis (PE, 8.7%). There were statistically significant differences in age (p = 0.002), sex (p = 0.036), inflammation involving the ethmoid sinus (p = 0.037), and bone penetration of the MSF (p < 0.001) between the AP, EPL, and PE groups. There were no significant differences in sinusitis symptoms (p > 0.005) among patients with different odontogenic etiologies. In conclusion, EPL is a neglected oral etiology with a destructive effect on the bone of the MSF, which deserves more attention in diagnosis and treatment. [ABSTRACT FROM AUTHOR]

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Objective: Odontogenic sinusitis (OS) is a well-known and important border of specialties in otorhinolaryngology and dentoalveolar surgery. Odontogenic sinusitis can develop due to iatrogenic harm or odontogenic infection. The gold standard diagnostic method is clinical and radiological—CBCT (cone beam computed tomography)—examination. The treatment of this condition requires collaboration between ENT and dentoalveolar surgery specialists and can be non-surgical or surgical based on staging. This paper aims to share the results of our clinical study whereby complex therapy was administered by a dentoalveolar surgeon and an otorhinolaryngologist in cooperation. Patients and methods: We conducted a retrospective study comprising 111 OS patients who underwent complex therapy between 2016 and 2023 at Semmelweis University, Budapest, Hungary. All patients were treated with concurrent FESS (functional endoscopic sinus surgery) and dentoalveolar surgery. Follow-up was based on symptoms, clinical examination and CBCT imaging. Results: Of the 111 patients, 107 were successfully treated with concurrent FESS and dentoalveolar surgery, and only 4 had further symptoms following the complex therapy and needed retreatment. Conclusions: The complex, single-session therapy involving FESS and oral surgery is an effective treatment method, which is less invasive and associated with fewer complications compared to previous interventions, such as the Luc–Caldwell procedure. [ABSTRACT FROM AUTHOR]

It is emphasized that odontogenic sinusitis frequency for at least 9–11% of the total number of inflammatory diseases of the maxillofacial area, and the frequency of their complications ranges from 30% to 50%. Emphasis is placed on the fact that a frequent cause of the development of odontogenic sinusitis is errors in the endodontic treatment of teeth and errors in dental implantation, which is accompanied by the use of tools for processing root canals (root needles, drills, canal fillers, pulp extractors), as well as filling material and an implant behind the apex tooth root into the sinus cavity. Radiological research methods play a leading role in the diagnosis of odontogenic sinusitis. Traditionally, for the evaluation of paranasal sinuses, radiography in the nasolabial projection, inspection radiographs of the skull in direct and lateral projections are used. The advantages and disadvantages of multispiral computed tomography (MCT), magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) are given separately. For a group of 130 patients, the results of the diagnostic informativeness of radiological examination methods in the detection of odontogenic sinusitis are given. The obtained results allow to conclude that in all cases computer tomography (MCT or CBCT) made it possible to accurately diagnose the form of the disease, determine the extent of sinus damage, assess the condition of the lower bone wall of the sinus (reveal a violation of its integrity and report a tooth socket with a sinus), to determine the center of inflammation in the periodontium, as well as to detect the presence of foreign bodies in the maxillary sinus. At the same time, MCT and CBCT data were fully compared with each other, surpassed traditional radiological methods in terms of diagnostic informativeness and had such advantages as the absence of superposition, high contrast resolution, and the possibility of obtaining higher-quality image reconstructions in different planes. The aim of study. To analyze the diagnostic value of radiological examination methods in the detection of odontogenic sinusitis.Material and methods: We examined 130 patients in the period from 2022 to 2023. X-ray examinations were performed on a Planmeca ProMax 3D cone beam computed tomography scanner and MCT.Results: Regarding the data of СBCT, it is possible to specify the localization of the foreign body and its connection with the odontogenic factor with high probability. It is worth noting that these sinusitis belong to the iatrogenic group of diseases.Conclusions: CT methods (MCT or CBCT) are a necessary component of the complex diagnosis of odontogenic sinusitis.

Odontogenic sinusitis is a common maxillary sinus disease. It develops due to the violation of the Schneiderian membrane due to pathological, iatrogenic, or traumatic causes from dental and dentoalveolar structures. The aim of this cohort study was to investigate local and systemic factors associated with Schneiderian mucosal thickening (MT) in patients referred for evaluation of apical periodontitis (AP) and examine their relationship with chronic sinonasal symptoms. Cone-beam computed tomography (CBCT) scans of 197 patients referred for evaluation of endodontic diseases were reviewed. Mucosal thickening in relation to the affected tooth was measured in the coronal section in millimeters at the maximum area perpendicular to the bone. Based on this measurement, the sinus floor was categorized for MT as present (>1 mm) or absent (<1 mm). The sociodemographic and clinical characteristics of the study participants were assessed and compared according to the presence or absence of MT. Furthermore, the relationship between odontogenic sinusitis and chronic sinonasal symptoms was assessed using a chronic sinusitis survey. Male patients had a higher MT than female patients. The presence of periapical lesions and inadequate endodontic treatment were significantly associated with MT. The multivariate logistic regression model showed that the presence of AP increased the odds of MT by approximately 2.5 times (p = 0.028), and nasal obstruction was significantly higher in patients diagnosed with mucosal thickness at different times of their follow-up period (p = 0.018). MT was 2.5 times more likely in the presence of apical periodontitis, and nasal obstruction was the most significant factor associated with the presence of MT. [ABSTRACT FROM AUTHOR]

Background: The microbiome plays a crucial role in odontogenic sinusitis (OS); however, the bacterial characteristics of the sinuses and connected dental regions in OS are poorly understood. In this study, nasal secretion samples were collected from 41 OS patients and 20 simple nasal septum deviation patients, and oral mucosa samples from dental regions were collected from 28 OS patients and 22 impacted tooth extraction patients. DNA was extracted, and 16S rRNA sequencing was performed to explore the characteristics and structure of the microbiome in the sinuses and dental regions of OS patients. Results: The alpha diversity of the oral and nasal microbiomes in OS patients was higher than that in controls. Principal coordinate analysis (PCoA) showed that oral samples clustered separately from nasal samples, and the beta diversity of oral and nasal samples in OS patients was higher than that in controls. The dominant phylum was Bacteroidetes in OS patients and Firmicutes in controls in both the oral and nasal cavity. The dominant genera in the oral microbiome and nasal microbiome of OS patients were similar, including Fusobacterium, Porphyromonas and Prevotella. Co-occurrence network analysis showed decreased microbial connectivity in the oral mucosa and nasal secretion samples of OS patients. Conclusions: Odontogenic infection promotes structural and functional disorders of the nasal microbiome in OS. The interaction of dominant pathogens in the nasal and oral regions may promote the development of OS. Our study provides the microbiological aetiology of the nasal and connected dental regions in OS and is expected to provide novel insights into the diagnosis and therapeutic strategies for OS. [ABSTRACT FROM AUTHOR]

Background: Odontogenic sinusitis (ODS) is distinct from non‐odontogenic rhinosinusitis with regard to clinical features as well as diagnostic and therapeutic approaches. While numerous studies have explored immune profiles of chronic rhinosinusitis, very few studies have explored the inflammatory endotype of ODS. Methods: Odontogenic sinusitis was diagnosed by confirming infectious sinusitis adjacent to infectious maxillary odontogenic pathology. Maxillary sinus cultures and mucosal biopsies were obtained during endoscopic endonasal surgery in ODS and control patients. Controls were patients undergoing endoscopic skull base surgery with no sinus disease. Specimens were snap frozen in liquid nitrogen and stored at −80°C. Analysis was performed using a multiplex assay to measure Th‐1 (TNFα, IFNγ, IL‐2,12,18), Th‐2 (IL‐4,5,9,13), Th‐17 (IL‐17A,17F,22), and innate (CCL5,CXCL9,CXCL10, IL‐6,8,10,12,23,27) immune pathways. Groups were compared via independent sample t‐tests; if assumptions were violated, nonparametric Wilcoxon ranked sum tests were performed. Results: Specimens from 22 ODS patients were compared to nine controls. ODS mucosal tissue was sampled in the setting of the following dental pathologies: post‐dental extraction (n = 15), untreated apical periodontitis (n = 2), apical periodontitis after root canal therapy (n = 2), and maxillary sinus bone grafting with or without dental implantation (n = 3). The following cytokines were significantly elevated in ODS compared to controls: IFNγ, TNFα, IL‐6, 8, 10, 27, and CXCL9. IL‐17 levels were similar in both ODS and controls. Therefore, ODS demonstrated heightened innate and Th1 immune activity. Conclusion: ODS demonstrated both innate immune and Th1 inflammatory endotypes. Further studies are needed to explore ODS immunopathobiology and its potential impact on ODS management. [ABSTRACT FROM AUTHOR]

The purpose is to determine the possibility of prognostication of the of acute odontogenic sinusitis development of the maxillary sinus based on the data of the index of leukocytes of blood change аnd determine its prognostic effi cacy in this nosology. We examined 57 persons at the age of 19-52 years, divided into two groups. Group 1 contains healthy persons (15 persons) without pathology of the maxillary sinus. Group 2 included 15 patients who on the basis of the data of radiological methods of examination had the diagnosis of acute odontogenic sinusitis of the maxillary sinus. Group 3 included 27 patients with the diagnosis of acute odontogenic sinusitis of the maxillary sinus, the treatment outcomes and the index of index of leukocytes of blood change were calculated on the basis of the data of the retrospective analysis of archival material. The prognostic effi ciency of index of leukocytes of blood change was 75%. The presented results prove the eff ectiveness of the index of leukocytes of blood change in patients with acute odontogenic sinusitis of the maxillary sinus and the reasonability of its use in clinic and during the out-patient treatment by oral surgeon.

(1) Background: Curved planar reformation (CPR) is a multiplanar reformatting technique of computed tomography (CT) commonly used during dental cone-beam CT (CBCT) to generate panorex-like images for dental evaluation. Here, we evaluated the utility of an additional CPR sequence in detecting dental pathologies in patients with chronic rhinosinusitis (CRS). (2) Methods: CRS patients who underwent paranasal sinus CT were enrolled retrospectively. The CT images featured three orthogonal sequences and a reconstructed CPR sequence. Additional dental CBCT was performed in patients with pathologies with a strongly suspected odontogenic origin. Dental pathologies detected by CT, CPR, and CBCT were analyzed. (3) Results: A total of 82 CRS patients (37 females and 45 males; mean age 47.3 ± 13.7 years) were included, of whom 23 underwent dental CBCT. In total, 1058 maxillary teeth were evaluated. Compared with paranasal sinus CT, CPR identified greater frequencies of dental pathologies, particularly caries (p < 0.001), periapical lesions (p < 0.001), and fistulae (p = 0.014). CBCT identified greater frequencies of periodontal dental pathologies (p = 0.046) and premolar caries (p = 0.002) compared with CPR. CBCT and CPR detected molar dental pathologies at similar frequencies. (4) Conclusions: CPR could increase the diagnostic rate of odontogenic pathologies compared with standard CT orthogonal views, especially when the sinusitis is caused by caries, periapical lesions, or fistulae. The addition of a CPR sequence allows for simple screening of dental pathologies in CRS patients without a need for additional radiation.

Foreign bodies in the maxillary sinus are infrequent findings with various organic and inorganic materials have been reported. Most are iatrogenic due to abnormal communications between the oral cavity and the sinus cavity, predominantly secondary to dental and oral procedures. Oroantral fistulas might be asymptomatic incidental findings or may present with sinusitis-related symptoms. Even though oroantral fistulas are frequently encountered iatrogenic complications, most studies focused on radiologic findings and surgical closure procedures. A few cases reported the histopathologic findings of foreign body-related antral sinusitis. Our aim is to report three cases of chronic maxillary sinusitis induced by various foreign bodies of oral and dental origin associated with oroantral fistulas. Our focus is to highlight the different histopathologic patterns, potential pitfalls and helpful clues of foreign body-induced maxillary sinusitis. Altered foreign bodies in procured sinus specimens might be missed, misinterpreted or ignored by pathologists. Obvious vegetable food remnants were detected, but subtle vegetable residuals showed pulse granuloma, rings and sheet-like patterns embedded in the granulation tissue and fibrous stroma. Some materials mimicked fungal hyphae while others were ignored as nonspecific debris. Periodic acid Schiff stain and polarizing light helped delineate their nature. Other helpful hints included the presence of oral-type squamous epithelium, crystals, hemosiderin pigments, dental materials such as alvogyl, and microorganisms of oral origin for example Actinomyces. Our series emphasizes the importance of correct recognition of foreign bodies of oral and dental origin in paranasal specimens to guide clinicians to the possibility of oroantral fistula-associated odontogenic sinusitis versus conventional rhinosinusitis. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to show our experience with the correct management of patients suffering from odontogenic sinusitis with oroantral communication and fistula. Methods: According to the inclusion criteria, 41 patients were enrolled in this retrospective study with a diagnosis of odontogenic sinusitis with oroantral communication and fistula; 1 patient with pre-implantological complication, 14 with implantological complications, and 26 with classical complications. Results: Two patients were treated with a fractioned combined approach, 13 patients were treated with an oral approach only, and 26 patients were treated with a combination. There was a complete resolution of the symptoms and closure of the fistula in all the patients enrolled. Conclusions: In our study, in all 41 patients, there was a surgical success. The best option is to use a multidisciplinary approach for patients suffering from odontogenic sinusitis. [ABSTRACT FROM AUTHOR]

Context: Odontogenic sinusitis is a prevalent but frequently unrecognized condition, and periapical pathologies of maxillary posterior teeth are accused as one of the main causative factors. Aim: This study aimed to evaluate the relationship between the periapical status of maxillary posterior teeth and its proximity to the maxillary sinus floor in the occurrence of incidental sinus pathologies using cone-beam computed tomography (CBCT). Methodology: CBCT scans of 118 patients of age range 18-77 years were evaluated retrospectively to determine the relationship of maxillary posterior teeth to sinus floor in which vertical relationship was assessed using modified Kwak's classification and periapical status using CBCT periapical index. Statistical analysis was performed using SPSS statistics software. Results: Of all 227 sinuses examined, 56.8% showed pathological changes, with mucosal thickening being the most common. More than 50% (50.2%) of sinuses were associated with periapical lesions of at least one maxillary posterior tooth based on evidence of pathological mucosal thickening. The presence of pathologic mucosal thickening was also significantly related (P < 0.05) to the presence of periapical pathologies. There was a significant association between tooth position and pathological sinus mucosal thickening, especially with second molars, first molars, and second premolars, respectively (P < 0.05). Second molar involvement was the most significant (P < 0.05). Conclusion: The present study established a positive association between periapical disease status of maxillary posteriors and maxillary sinus mucosal thickening. Maxillary second premolar and first and second molars pathologies can significantly affect the maxillary sinus compared to other maxillary posterior tooth. CBCT proved to be an efficient imaging modality in detecting these changes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

There is a weak evidence base on which to define the most appropriate radiographic technique to evaluate dental tissues that may impact on the maxillary sinus, including the risk assessment for oroantral communications, identification and removal of displaced roots, timing and optimal management of oroantral fistula, in the presence of odontogenic sinusitis. There is no demonstrable benefit from the routine use of CBCT in exodontia. However, cross‐sectional imaging is strongly recommended over 2‐dimensional radiographic techniques when identifying displaced roots of teeth, and during surgical management of oroantral fistulae, particularly when considering the incidence of extra‐maxillary disease in odontogenic sinusitis. In this narrative review, using the limited evidence available, and relying on clinical experience, we adopt a risk–benefit analysis for the optimal use of various radiographic imaging modalities from pre‐operative assessment to management of complications, focusing on patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant‐related complications in patients diagnosed with implant‐related odontogenic sinusitis (IR‐ODS). Study Design: Case–control study. Methods: This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR‐ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR‐ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR‐ODS. Results: The mean age of the IR‐ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri‐implantitis, bone graft disruption–extrusion were associated with a significantly higher incidence in the IR‐ODS (p = 0.035, p = 0.003, p = 0.011, respectively). The IR‐ODS sides showed an adjusted‐OR (95% confidence interval) of 27.4 (2.7–276.5) for extrusion length >4 mm, 11.8 (3.0–46.5) for peri‐implantitis, and 34.1 (3.3–347.8) for bone graft disruption (p = 0.005, p < 0.001, and p = 0.003, respectively). Conclusion: Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri‐implantitis, and disrupted–extruded bone grafts show significant association with IR‐ODS. Level of Evidence: 4 Laryngoscope, 133:237–243, 2023 [ABSTRACT FROM AUTHOR]

Odontogenic sinusitis (ODS) refers to the maxillary sinus infection, which is secondary to either adjacent infectious dental pathologies or procedures. The aim of this retrospective study is to report the experiences of the department of integrated therapies in otolaryngology (Campus Bio-Medico Foundation, Rome, Italy) in classifying and treating patients that are affected by odontogenic sinusitis derived from "classic complications". A total of 68 patients responding to the criteria and to the definition as a classical odontogenic complication were included. The surgical therapy consisted of a combined oral and nasal simultaneous approach for 28 patients (43%), a combined non-simultaneous approach for 4 patients (6%), a nasal only approach for 14 patients (21%), and an oral only approach for 20 patients (30%). All the patients presented a complete resolution of the symptoms. The choice of performing a nasal, oral, or combined approach is based on the presence of anatomical elements that facilitate sinusitis and reinfection occurrence, such as deviated nasal septum, concha bullosa, or obstructed osteo-meatal complex. The correct use of validated classification, the pre-operative CT scan, a multidisciplinary approach, and an appropriate presurgical examination are the necessary elements to obtain a good success rate. [ABSTRACT FROM AUTHOR]

Affected tooth conservation is an often-overlooked problem in odontogenic sinusitis (ODS) treatment. Treatable dental conditions are improperly managed with extractions imposing an unnecessary health burden on patients. Furthermore, no down-to-earth protocols have been proposed for the clinical management of these patients. This study aims to prospectively validate a treatment protocol for ODS based on dental mobility, an indirect sign of poor long-term tooth survival. The protocol suggests endoscopic sinus surgery (ESS) alone followed by dental treatment for immobile affected teeth, and concomitant ESS and extraction for mobile teeth. Extraction of immobile teeth is considered if inflammation persists after the treatment. Forty cases treated with our protocol were prospectively examined about ODS cure and preservation of affected teeth. Among the 35 patients with immobile affected teeth, only one required extraction for complete ODS cure after ESS. All five cases with mobile teeth and one with postoperative extraction had marginal periodontitis. Ninety-seven percent of immobile affected teeth were preserved with complete ODS cure in this study. In case marginal periodontitis is present, extraction is likely to be necessary, although ESS should be prioritized over blanket extractions to preserve the teeth for patients' quality life. [ABSTRACT FROM AUTHOR]

Introduction: Endodontic pathology is one of the most common causes of odontogenic sinusitis, and its evaluation is challenging. Omission of periapical lesions in diagnostic process leads to recurrent sinusitis after cessation of medical therapy. Methods: Sixty-one symptomatic patients presented with odontogenic sinusitis with periapical lesions of teeth adjacent to the maxillary sinus were included in the study. Symptoms evaluated with SNOT-22 and OHIP-14 questionnaires were compared to signs during endoscopic and radiological evaluation. Results: Coexistence of odontogenic sinusitis with nasal polyps significantly decreases the quality of life, especially concerning the emotional domain (p = 0.047). Patency of ostiomeatal corresponds well with the severity of sinonasal symptoms reported with SNOT-22 (p = 0.051). Extent of maxillary sinus opacifications scored with Zinreich scale correlates positively with the presence of discharge (p = 0.001) and edema (p = 0.072) in the endoscopic Lund-Kennedy scale. Among 67 teeth with periapical lesions, 73.1% had undergone previous root canal treatment, but in 47.8% of cases, it was defined as incomplete. Endodontic status did not affect the severity of patient's complaints. Conclusion: In case of odontogenic sinusitis of endodontic origin, endoscopic signs correlate better than radiological with the self-reported symptoms. In order to better evaluate the severity of the disease and possible need of surgical intervention, both otolaryngologists and dental specialists should focus on extent of inflammatory lesions in the maxillary sinus. [ABSTRACT FROM AUTHOR]

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.

In the treatment of odontogenic maxillary sinusitis, the removal of causative teeth is actively used, although the tooth removal indications are not always clearly defined. Modern endodontic approaches and technologies, in most cases, help preserve the tooth in the oral cavity with the elimination of the chronic infection focus, thus restoring the integrity of the maxillary sinus. Background. Improve the effectiveness in the treatment of odontogenic maxillary sinusitis while preserving the causative teeth. Materials and methods. The study involved 50 patients aged 18 to 45 years. All patients had clinical signs of maxillary odontogenic sinusitis and signs of failed endodontic treatment of teeth with a dark, radiolucent focus in the apex region. Radiological parameters and quality of obturation was assessed using CBCT; the presence of symptoms of inflammation was assessed clinically during examination. The results were evaluated after 6, 12 and 24 months. The treatment effectiveness and the quality of obturation was assessed in accordance with the directives of the European Society of Endodontology. Results. High-quality endodontic treatment resolved clinical signs of odontogenic sinusitis in all patients, restored the bone tissue of the alveolar process and restored the mucous membrane of the maxillary sinus after 12 months in 96% of cases. In 2 cases, additional microsinusotomy was required. Conclusion. Improving the quality of endodontics in the first treatment or retreatment of the upper jaw teeth can significantly reduce the number of dental extractions in odontogenic maxillary sinusitis

Background: Orbital, intracranial, and osseous extra-sinus complications can arise from bacterial or fungal sinusitis. Odontogenic sinusitis (ODS) can cause extra-sinus complications, but its prevalence remains poorly characterized. Objective: To determine the frequency of ODS as a cause of operative extra-sinus infectious complications and describe clinical features of all complicated sinusitis cases. Methods: A multi-institutional retrospective review was performed on all operative sinusitis-related extra-sinus complications from 2011 to 2020. ODS was diagnosed by sinus computed tomography (CT) and dental evaluations when available. Demographics, complication types, sinusitis etiologies, and various clinical features were analyzed. Results: Forty-five patients were included (mean age 55.5 years, 56% male). Of the extra-sinus complications, 40% were orbital only, 22% intracranial only, 13% osseous only, and 25% involved combined complications. The 2 most common causes of extra-sinus complications were ODS (40%) and mucopyocele (27%). When invasive fungal etiologies were excluded, and only unilateral maxillary opacification on CT was considered, nearly 60% of extra-sinus complications were due to ODS. Unilateral maxillary sinus opacification on CT was present in 100% of complicated ODS compared to 44% of nonodontogenic cases, and oral anaerobes were only identified in ODS cases. No complicated ODS patients underwent dental interventions during hospitalization. Conclusion: ODS was the most common cause of operative extra-sinus infectious complications. Clinicians should consider ODS high on the differential diagnosis of all patients presenting with complicated sinusitis, especially when sinusitis is unilateral and invasive fungal infection is not suspected. [ABSTRACT FROM AUTHOR]

(1) Background: Curved planar reformation (CPR) is a multiplanar reformatting technique of computed tomography (CT) commonly used during dental cone-beam CT (CBCT) to generate panorex-like images for dental evaluation. Here, we evaluated the utility of an additional CPR sequence in detecting dental pathologies in patients with chronic rhinosinusitis (CRS). (2) Methods: CRS patients who underwent paranasal sinus CT were enrolled retrospectively. The CT images featured three orthogonal sequences and a reconstructed CPR sequence. Additional dental CBCT was performed in patients with pathologies with a strongly suspected odontogenic origin. Dental pathologies detected by CT, CPR, and CBCT were analyzed. (3) Results: A total of 82 CRS patients (37 females and 45 males; mean age 47.3 ± 13.7 years) were included, of whom 23 underwent dental CBCT. In total, 1058 maxillary teeth were evaluated. Compared with paranasal sinus CT, CPR identified greater frequencies of dental pathologies, particularly caries (p < 0.001), periapical lesions (p < 0.001), and fistulae (p = 0.014). CBCT identified greater frequencies of periodontal dental pathologies (p = 0.046) and premolar caries (p = 0.002) compared with CPR. CBCT and CPR detected molar dental pathologies at similar frequencies. (4) Conclusions: CPR could increase the diagnostic rate of odontogenic pathologies compared with standard CT orthogonal views, especially when the sinusitis is caused by caries, periapical lesions, or fistulae. The addition of a CPR sequence allows for simple screening of dental pathologies in CRS patients without a need for additional radiation. [ABSTRACT FROM AUTHOR]

Background: One of the most common causes of bacterial odontogenic sinusitis (ODS) is endodontic disease with periapical lesions (PAL). Referrals between otolaryngologists and dental specialists are indispensable for proper diagnosis and treatment. If the disease does not resolve after medical and root-canal treatment (RCT), tooth extraction, endoscopic sinus surgery (ESS) or both are the ways of management.The aim was to clarify the predictive value of disease's radiological characteristics for the further surgical intervention., Methodology: 68 symptomatic patients evaluated by an otolaryngologist and dental specialist were included to this prospective observational cohort study. Patients who failed medical treatment of sinusitis (intranasal steroids, saline rinses and antibiotics) and RCT were treated either with ESS, tooth extraction or both at the same time., Results: 87% of patients required surgical intervention. 12% improved after tooth extraction alone, 47% after ESS and 31% required both procedures. The degree of maxillary sinus' (MS) opacification was not correlated with the need of invasive procedures implementation, as opposed to ostiomeatal complex' patency (p&lt;0.001). Cortical bone destruction towards the MS and multiple tooth roots involvement suggested ODS resolution only after combined surgical approach (p=0.041)., Conclusions: Radiological characteristics of causative tooth and patency of ostiomeatal unit correlate with the evolution of ODS and need for either ESS and/or tooth extraction. Patients with multiple roots affected, shorter distance to the MS floor and PAL's with visible bone destruction may require tooth extraction and ESS to resolve ODS completely., Clinical Implications: Radiological data may help in earlier diagnosis and treatment of ODS with PALs for both otolaryngologists and dental specialists.

The physiological behavior of paranasal sinuses depends on the potency of the ostiomeatal complex and on normal mucociliary function. The interruption of this delicate equilibrium can lead to pathological conditions such as sinusitis. Anywhere between 10% and over 25% of cases of maxillary sinusitis have an odontogenic origin, such as: dental infection; alveolar dental trauma; or iatrogenic causes, such as extractions, endodontic therapies, maxillary osteotomies or placement of endosseous implants. The resolution of sinus pathology is related to the resolution of odontogenic pathology. Aim: to evaluate the therapeutic efficacy of a combined oral and endoscopic approach in the treatment of chronic odontogenic sinusitis vs. oral dental management through a case control study. Materials and Methods: all patients showing signs and symptoms of odontogenic sinusitis with obliteration (appreciable radiopacity in CT) of unilateral maxillary sinus between January 2018 and September 2019 at Padua University Hospital were enrolled in this retrospective study. The exclusion criteria were: maxillary sinusitis without odontogenic origin, or resolution with a systemic antibiotic therapy; and presence of anatomical abnormalities that promote the onset of rhinosinusitis. The patients were divided into two groups: one group was treated with a combined surgical approach under general anesthesia (Functional Endoscopic Sinus Surgery-FESS and simultaneous closure of oroantral communication with Bichat’s fat pad advancement); while the other group was treated only with an intraoral approach under local anesthesia and conscious sedation (closure of oroantral communication with Bichat’s fat pad advancement). The variable “success of the surgical procedure” in the two groups was compared by a Student test (with p < 0.05). Results: among the patients enrolled, 10 patients (aged between 42 and 70) made up the case group and the other 10 patients (aged between 51 and 74) constituted the control group. There was no statistically significant difference in success between the two groups (p < 0.025). Conclusions: according to this case study, an exclusive annotation invasive intraoral approach seemed to be comparable to the transoral endoscopic combined method. However, during diagnosis it is necessary and fundamental to distinguish between odontogenic and rhinogenic sinusitis in order for the resolution of odontogenic sinusitis to be achieved.

Abstract Background Prevotella histicola is a facultative oral pathogen that under certain conditions causes pathologies such as caries and periodontitis in humans. Prevotella spp. also colonize the oral cavity of horses and can cause disease, but P. histicola has not yet been identified. Case presentation A 12-year-old Tinker mare was referred to the clinic for persistent, malodorous purulent nasal discharge and quidding. Conservative antibiotic (penicillin), antiphlogistic (meloxicam), and mucolytic (dembrexine-hydrochloride) treatment prior to referral was unsuccessful and symptoms worsened. Oral examination, radiography, sino-/ rhinoscopy, and standing computed tomography revealed severe apical/ periapical infection of the upper cheek tooth 209 with accompanying unilateral sinonasal inflammation and conchal necrosis. The tooth exhibited extensive subocclusal mesial infundibular cemental hypoplasia and caries, and an occlusal fissure fracture. After mechanical debridement and thermoplastic resin filling of the spacious subocclusal carious infundibular lesion, the tooth was extracted intraorally. The sinusitis and conchal necrosis were treated transendoscopically. Selective bacteriological swab cultures of affected tooth roots and subsequent matrix-assisted laser desorption ionization-time of flight mass spectrometry showed an infection with the obligate anaerobic, Gram-negative bacterium P. histicola. Surgical intervention and adapted antibiotic therapy led to normal healing without complications. Conclusions This study provides the first documented case of dental infection in a horse caused by P. histicola at once indicating necessity of more sufficient microbiological diagnostics and targeted antibiotic treatment in equine dental practice. This finding is also conducive to understand species-specific Prevotella diversity and cross-species distribution.

Objectives: To (i) identify the prevalence of dental disease, (ii) identify the proportion of sinusitis cases that could be considered odontogenic in origin and, (iii) audit the rate of diagnosis of incidental dental disease and odontogenic sinusitis in radiology reports on CT scans covering the maxillary teeth and sinuses. Materials and methods: Images and reports of CT studies performed in our institution that covered the paranasal sinuses and maxilla were retrospectively audited for documentation of findings pertaining to maxillary sinusitis and maxillary dental disease. Trauma cases, edentulous and pediatric patients and patients without maxillary sinusitis or dental disease were excluded. The etiologies of maxillary sinusitis was defined as likely odontogenic, indeterminate and rhinogenic sinusitis. Only molar and pre-molar tooth disease were considered as these are most commonly in direct contact with the floor of the maxillary sinus. Results: One-hundred sixty CT studies were reviewed. The prevalence of dental caries and periapical lucency was 80.6% and 15.0%, respectively. The cause of sinusitis was determined to be likely odontogenic in 30.0%, rhinogenic in 33.1% and of indeterminate origin in 36.9%. The rate of reporting dental findings or raising the suspicion of odontogenic sinusitis was 8.5% (n = 14). Conclusions: Under-reporting of dental disease and odontogenic sinusitis is common. Early recognition results in higher chances of salvaging the diseased tooth, preventing complications and providing appropriate treatment. An urgent and collective effort by the radiological fraternity is warranted to recognize the significance of reporting of dental pathologies, even in CT scans done for other indications.

Odontogenic sinusitis is a common maxillary sinus disease. It develops due to the violation of the Schneiderian membrane due to pathological, iatrogenic, or traumatic causes from dental and dentoalveolar structures. The aim of this cohort study was to investigate local and systemic factors associated with Schneiderian mucosal thickening (MT) in patients referred for evaluation of apical periodontitis (AP) and examine their relationship with chronic sinonasal symptoms. Cone-beam computed tomography (CBCT) scans of 197 patients referred for evaluation of endodontic diseases were reviewed. Mucosal thickening in relation to the affected tooth was measured in the coronal section in millimeters at the maximum area perpendicular to the bone. Based on this measurement, the sinus floor was categorized for MT as present (>1 mm) or absent (p = 0.028), and nasal obstruction was significantly higher in patients diagnosed with mucosal thickness at different times of their follow-up period (p = 0.018). MT was 2.5 times more likely in the presence of apical periodontitis, and nasal obstruction was the most significant factor associated with the presence of MT.

The maxillary sinus is a structure at the border of specialties: otorhinolaryngology and maxillofacial surgery. Due to this fact, regarding etiology, it can be affected by both the rhinogenic and odontogenic path and can impose diagnostic difficulties. The etiopathogenic mechanisms that can affect the Schneiderian membrane are mainly inflammatory, iatrogenic, traumatic, and tumorous in nature. From a microbiological point of view, the bacteriology is polymorphic, including both aerobic and anaerobic species in acute OS, the predominating species in acute OS being aerobic, and in chronic anaerobic germs. The role of fungi in the determination of this pathology and in the production of the biofilm that leads to resistance to antibiotic treatment is also discussed. The present paper aims to present the etiopathogenesis, bacteriology, clinical manifestations, as well as treatment of odontogenic sinusitis (OS) from an updated perspective through reviewing the literature. If unilateral maxillary sinusitis is usually due to odontogenic causes, this does not clinically exclude the possibility of strictly rhinogenic causes in the occurrence of sinusitis. This underlines the important role of complex oral and rhinological clinical examination as well as the role of preclinical examinations in specifying the certainty diagnosis. Simple radiography, orthopantomography, CT, and CBCT are compared in terms of diagnostic accuracy. The treatment of OS is complex, involving medication, dental, and surgical measures. The value of endoscopic surgery is emphasized, comparing its advantages over the classic Caldwell-Luc technique. [ABSTRACT FROM AUTHOR]

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: NA Laryngoscope, 132:1346–1355, 2022 [ABSTRACT FROM AUTHOR]

Objective: This study aims to consolidate the emerging data regarding the pathophysiology and clinical features of odontogenic maxillary sinusitis (ODMS). Methods: A search of existing English literature was performed on Pubmed, and Scopus databases using the following keywords: “odontogenic sinusitis” and “maxillary sinusitis of dental origin”. A total of 56 articles were included in this study. Results: Endodontic and periodontal infections are one of the most frequently mentioned causes of ODMS in the literature. However, newer studies suggest iatrogenic causes as the leading cause. Microbiological studies reveal that the most common anaerobic isolates are Peptostreptococcus spp, Fusobacterium spp, pigmented Prevotella, and Porphyromonas spp. Histological findings of the maxillary sinus mucosa demonstrate numerous papillary-like folds in the surface of the epithelium with an increased expression of TJ protein claudin-4, round cell infiltration, fibrosis, cystic degeneration, and mucosal hyperplasia. The most common symptoms are: unilateral purulent rhinorrhoea and foul smell/ taste. Patients may also have post nasal drip, nasal congestion, cheek pain, purulent discharge in the oral cavity and dental pain. Conclusion: Our study comprehensively reviews the pathophysiology and clinical features of ODMS to provide a more holistic understanding of this condition, facilitating the early diagnosis and management of ODMS patients.

Objective: The aim of this study is to show our experience with the correct management of patients suffering from odontogenic sinusitis with oroantral communication and fistula. Methods: According to the inclusion criteria, 41 patients were enrolled in this retrospective study with a diagnosis of odontogenic sinusitis with oroantral communication and fistula; 1 patient with pre-implantological complication, 14 with implantological complications, and 26 with classical complications. Results: Two patients were treated with a fractioned combined approach, 13 patients were treated with an oral approach only, and 26 patients were treated with a combination. There was a complete resolution of the symptoms and closure of the fistula in all the patients enrolled. Conclusions: In our study, in all 41 patients, there was a surgical success. The best option is to use a multidisciplinary approach for patients suffering from odontogenic sinusitis.

The maxillary sinus is the largest among all the paranasal sinuses located in the maxilla, sis, and treatment. A narrative literature review was carried out through Pubmed, Lilacs and Scielo databases, with selected articles in Portuguese and English. Odontogenic maxillary sinusitis is a disease with a complex diagnosis that requires complementary exams for the proper planningbetween the main orbital and nasal. Diversity can be considered, although special attention should be paid to the causes of alveolar diseases that can cause maximum damage to its membrane. This paper aims to describe the findings of the literature on maxillary sinusitis that discuss the anatomy, etiology, diagno of the case. Its treatment depends on the nature that presides and consists primarily in the definition of the causal factor of dental origin. [ABSTRACT FROM AUTHOR]

Objective: Odontogenic sinusitis (ODS) can cause infectious orbital, intracranial, and osseous complications. Diagnosis and management of complicated ODS have not been discussed in recent sinusitis guidelines. The purpose of this systematic review was to describe epidemiological and clinical features, as well as management strategies of complicated ODS. Data Sources: PubMed, EMBASE, and Cochrane Library. Review Methods: A systematic review was performed to describe various features of complicated ODS. All complicated ODS studies were included in qualitative analysis, but studies were only included in quantitative analysis if they reported specific patient-level data. Results: Of 1126 studies identified, 75 studies with 110 complicated ODS cases were included in qualitative analysis, and 47 studies with 62 orbital and intracranial complications were included in quantitative analyses. About 70% of complicated ODS cases were orbital complications. Only 23% of complicated ODS studies were published in otolaryngology journals. Regarding ODS-related orbital and intracranial complications, about 80% occurred in adults, and 75% were male. Complicated ODS occurred most commonly from apical periodontitis of maxillary molars. There were no relationships between sinusitis extent and orbital or intracranial complications. High rates of anaerobic and α-hemolytic streptococcal bacteria were identified in complicated ODS. Management generally included systemic antibiotics covering aerobic and anaerobic bacteria, and surgical interventions were generally performed to address both the complications (orbital and/or intracranial) and possible infectious sources (dentition and sinuses). Conclusion: ODS should be considered in all patients with infectious extrasinus complications. Multidisciplinary management between otolaryngologists, dental specialists, ophthalmologists, and neurosurgeons should be considered to optimize outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Before implant surgery, a preoperative radiological evaluation is recommended for recognizing maxillary inflammatory conditions. In order to avoid a failure of the dental procedure and prevent medical–legal consequences, it is necessary to treat patients suffering of maxillary sinus pathologies. The classification proposed in our study aims to standardize the reference values for mucosal thickening and to verify their association with the odontogenic or disventilatory causes of sinus pathology. Methods: The maximum mucosal thickness was measured at the level of the maxillary sinus floor: mucosal thickness was present when greater than 1 mm and was classified according to its extension within the sinus cavity. Results: Imaging data of 270 adult patients were included, performed for dental diagnosis and treatment planning, and they were divided into four main classes: Class I (85 pt.), mucosal thickness lesser than 2 mm, not pathological. Class II A (52 pt.), mucosal thickness between 2 and 5 mm, localized to the maxillary sinus floor: it is still considered non-pathological, and a "wait-and-see" approach is recommended. Class II B (46 pt.), mucosal thickness greater than 5 mm but localized at sinus floor: pathological mucosa with odontogenic etiology, requiring dental treatment. Class III A (39 pt.), mucosa thicker than 5 mm and concentric, most likely due to sinus ventilation disfunction: it requires maxillary antrostomy. Class III B (30 pt.), sinonasal manifestations such as nasal polyposis, retention cysts, mucocele, dental foreign body: pathological mucosa to be treated with ESS. Class IV (12 pt.), oroantral fistula: nasal endoscopic or oral approach. Conclusions: Our classification intends to suggest the better therapeutic option, in case of sinus pathology, according to the entity and pathogenesis of the mucosal thickening, in order to reduce complication and failure rate of dental surgery. [ABSTRACT FROM AUTHOR]

Odontogenic maxillary sinusitis (OMS) is a well-recognized condition in both the dental and otolaryngology communities. Close to 30% of cases of unilateral maxillary sinusitis may have an underlying dental pathology. Failure to identify a dental cause usually lead to cases recalcitrant sinusitis often associated with serious complications. The aim of this study is to describe the literature findings on odontogenic maxillary sinusitis that discuss anatomy, epidemiology, etiology, bacteriology, diagnosis and treatment.The present review is based on a current search using bibliographic database and academic search engine. All the articles on odontogenic maxillary sinusitis published after 2000 were included. This study seeks to provide clinicians with evidence that motivates a comprehensive approach to the evaluation and management of OMS. Controversies on diagnosis and management have been addressed and data from different treatment plans were collected by exploring relevant publications.The surgical treatment of OMS is based essentially on the dental surgery, combined with endoscopic sinus surgery, in order to completely remove the infection, restore the physiological drainage of the sinus and prevent recurrences of sinusitis. A multidisciplinary otolaryngology and dental team is mandatory to successfully manage the dental pathology and the complications resulting from the dental treatments.

We present a retrospective study, which was performed on a batch of 177 patients diagnosed with maxillary sinusitis, selected from the total number of patients with OMF disorders during 2017-2018. The patients were examined and treated at the Department of Emergency Medicine of the Institute of Emergency Medicine, Chisinau. The article contains statistical data on odontogenic maxillary sinusitis and the breakdown by age, sex, profession, etiology, addressability, place of life, hospitalization, causal tooth and treatment methods. Results: Out of the total number of 3227 patients with OMF, maxillary sinusitis (5.48%) was established for 177 patients. The majority of the patients 52.54% are from Chisinau. The most affected are the patients aged 31-40 years, constituting 26.56%, the majority being male persons 63.27%. Admission to the medical institution prevailed for 74.01% of the cases by itself, and the medical insurance was presented for 77.97%. Hospitalization of patients ranged from 1-5 days to 55.35%. The frequency of teeth involved in the inflammatory processes of the sinus was 41.78% cases, of which 1st molar prevails with 23.16%, thus being an etiological factor. As a surgical treatment of maxillary sinusitis in the section of oro-maxillofacial surgery, radical cure is used for 58.75% cases.