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 sinusitis.

Unrecognized periapical abscess is a cause of ESS failure and the radiological report frequently will fail to note the periapical infection. Dentists are unable to recognize periapical abscesses reliably with dental x-rays and exam. In patients with maxillary sinus disease, the teeth should be specifically examined as part of the radiological workup.

Both general otolaryngologists and rhinologists recognize odontogenic sinusitis is common, although often initially misdiagnosed. With increasing awareness of OMS, we believe that otolaryngologists and radiologists will review sinus CT scans for the presence of periapical abscesses and dental pathology. The otolaryngologist should suspect an odontogenic etiology of purulent maxillary CRS in patients failing to improve with antibiotics, regardless of a negative dental workup.

Neuraxial anesthesia has been demonstrated to be safe and effective for children undergoing subumbilical surgery. There is limited evidence regarding the safety of neuraxial anesthesia in pediatric patients with a ventriculoperitoneal shunt. We evaluated a series of 25 patients with indwelling ventriculoperitoneal shunts for complications within 30 days of any procedure performed with a neuraxial technique. One patient required a ventriculoperitoneal shunt revision 5 days after a lumbar catheter placement. The neurosurgeon determined the revision to be likely unrelated to the patient's lumbar catheter. Concerns about the use of neuraxial anesthesia in patients with an indwelling ventriculoperitoneal shunt may be overstated.

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