Chronic Odontogenic Rhinosinusitis: Optimization of Surgical Treatment Indications

Abstract

Background The treatment of chronic odontogenic and nonodontogenic rhinosinusitis is different. It requires the elimination of odontogenic cause and optimal sinus surgical treatment. To date, there are no clear indications when sinus surgical treatment is necessary. Objective Our aim was to define clear indication(s) for sinus surgical treatment in patients with chronic odontogenic rhinosinusitis after elimination of odontogenic cause. Methods A group of 96 patients with chronic odontogenic rhinosinusitis caused by apical periodontitis completed a Sino-Nasal Outcome Test 22 (SNOT-22) questionnaire with incorporated additional symptom “malodor” before treatment. Moreover, they were distributed according to computed tomography (CT) radiological criteria such as degree of periapical pathology, anatomical ratio between maxillary lateral teeth and sinus floor, sinus mucosal thickening, and ostiomeatal complex condition. The elimination of odontogenic cause was performed by extracting causative tooth. Questionnaire was filled again 2 weeks, 3 months, and 6 months after treatment. All data were analyzed to search the clear indications for sinus surgical treatment. Results Of 96 patients, 74 (77.1%) patients had full resolution of symptoms after dental cause was eliminated. For other 22 (22.9%) patients, symptoms persisted and sinus surgical treatment was indicated. In recovered group, mean SNOT-22 score was different between all periods of measuring, while within nonrecovered group, small differences were seen only when compared to before treatment. No statistically significant correlation between radiological criteria and rhinosinusitis healing after tooth extraction was found ( P > .05). Statistically significant correlation was found between the disappearance of malodor/SNOT-22 score reduction after elimination of dental cause and healing success ( P < .005). Conclusions Our study revealed that extraction of causative tooth is an effective treatment of chronic odontogenic rhinosinusitis caused by apical periodontitis. CT criteria are not valuable indicator for sinus surgery, but persistence of malodor after 2 weeks is the strongest indication for this type of treatment.

Diagnosing odontogenic sinusitis: An international multidisciplinary consensus statement

“…ODS has received significantly less attention in the literature compared to rhinosinusitis, and no formalized diagnostic criteria have been established. 17 ODS treatment and outcomes are very different from rhinosinusitis, 10,11,[32][33][34][35][36] and the diagnostic approach to ODS should also be different. Until higher levels of evidence allow for validated ODS diagnostic criteria, this international multidisciplinary CCS serves as a valuable segue to such criteria.…”

“…Although treatment outcomes are highly successful when both the dental source and sinusitis are treated, 10,11,[32][33][34][35][36] if otolaryngologists miss the dental source or dental providers miss the sinusitis, patients may suffer unnecessarily from ongoing dental or sinonasal symptoms. This highlights the importance of otolaryngologists and dental providers being able to suspect ODS based on clinical features, as described earlier in the Suspecting ODS subsection, additionally to otolaryngologists confirming the sinusitis and dental providers confirming the maxillary dental pathology (Fig.…”

The Prevalence of Odontogenic Pathology in Patients With Bilateral Rhinosinusitis

“…11 In addition, it has been reported that extraction of causative tooth is an effective treatment of chronic odontogenic sinusitis caused by apical periodontitis. 16 We used a combination of otorhinolaryngological and dental treatment for patients with sinusitis and apical lesions. We performed surgery after conservative treatment, if the outcome was thought to be poor.…”

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

“…While RCTx has been used successfully for ODS, it has only been reported in case reports, 39,40 or small series, 14,41,42 and success rates cannot be determined. The average published success rate for primary dental extraction for ODS due to AP is about 60% 32,42–45 . However, this success rate should be viewed with caution for multiple reasons.…”