REVIEWS   

Otorinolaringologia 2007 June;57(2):77-90

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: English

Surgical treatment of chronic maxillary sinusitis of odontogenic origin: a review

Politi M. ¹, Zerman N. ², Sembronio S. ¹, Toro C. ¹, Costa F. ¹

¹ Department of Maxillofacial Surgery University of Udine, Udine, Italy 2 Department of Oral Pathology University of Ferrara, Ferrara, Italy

Odontogenic sinusitis accounts for approximately 10% to 12% of maxillary sinusitis cases. The maxillary sinus (MS) is situated between the nasal and oral cavities and is therefore the most susceptible of all sinuses to invasion by pathogenic bacteria through the nasal ostium or the oral cavity. Sinusitis originating from an odontogenic source differs in its pathophysiology and management from sinusitis due to other causes. It usually occurs when the Schneiderian membrane is disrupted by conditions such as infections originating from the maxillary teeth, or iatrogenic causes such as dental extractions, not properly treated oro antral fistula (OAF), root canal therapy and placement of dental implants. Aspergillus mycetoma (AM) of the MS may also be considered a chronic maxillary sinusitis of odontogenic origin (CMSOO) according to the possible role of iatrogenic dental causes in the pathogenesis of AM. Dental pain, headache, and anterior maxillary tenderness can be present in conjunction with sinusitis-like symptoms such as nasal congestion and discharge with or without a postnasal drip. The diagnosis of sinus disease of odontogenic origin is based on a thorough dental and medical examination that includes the evaluation of the patient’s symptoms and past medical history which are then correlated with the physical findings. A thorough dental and sinus evaluation that uses adequate radiologic studies can assist in establishing the correct diagnosis. Concomitant management of the dental origin and the associated sinusitis will ensure complete resolution of the infection and may prevent recurrences and complications. Surgical treatment of the dental sources of maxillary sinusitis requires an intraoral approach. Treatment of CMSOO with Caldwell-Luc (CL) procedure does not appear the treatment of choice on account of clinical and physiological reasons. Treatment of chronic maxillary sinusitis with endoscopic sinus surgery appears the best surgical treatment in combination with an intraoral approach of the dental source of infection.