Odontogenic sinusitis is a common cause of unilateral sinus disease with maxillary sinus opacification

Abstract

Background: Unilateral sinus disease (USD) carries a broader differential diagnosis than bilateral sinus disease, including various inflammatory and neoplastic conditions. Odontogenic sinusitis (ODS) is a common cause of unilateral maxillary sinusitis, but few studies have examined its incidence among all USD etiologies. The main purposes of this prospective study were to determine the incidences of ODS and other etiologies causing USD with complete maxillary sinus opacification on computed tomography (CT), and to compare CT features of ODS and non-odontogenic USD patients. In addition, clinical features of the ODS cohort are described.Methods: A prospective case series of 134 patients with USD with complete maxillary sinus opacification on CT was conducted from August 2015 to November 2018. Based on nasal endoscopy, sinus CT, and dental examination and imaging, patients were categorized as having unilateral ODS or non-odontogenic USD. Patients with nonodontogenic USD were categorized as inflammatory or neoplastic. Demographic and clinical data were reported for ODS patients. Results:Of the 134 patients, 45% had ODS, 36% had nonodontogenic inflammatory conditions, 17% had inverted papilloma, and 2% had malignancies. Of the 60 ODS cases, 86.7% were associated with middle meatal purulence on nasal endoscopy. On CT, 88.3% had extramaxillary sinus disease extension, and 65.5% of CT reports made no mention of dental pathology. Conclusion:ODS caused nearly 50% of all USD cases with maxillary sinus opacification on CT, and was the most common individual etiology. ODS was frequently associated with anterior ethmoid and frontal sinus disease on CT, and middle meatal purulence on nasal endoscopy. C 2019 ARS-AAOA, LLC.

Odontogenic infection as a predisposing factor for pathologic disorder development in maxillary sinus

“…The presence of unilateral sinus opacification and/or failure of conventional treatment to ameliorate maxillary sinusitis might be an indication of odontogenic contamination (Nunes et al, 2016;Turfe, Ahmad, Peterson, & Craig, 2019;Workman, Granquist, & Adappa, 2018), such as the presence of necrotic pulp microorganisms, which are enclosed within the root canal and sequestered from the host defence mechanisms and antimicrobial action. Moreover, the drainage of maxillary sinus content might be anatomically compromised (de Carvalho et al, 2018).…”

“…The OIs assessed in this study might be a silent aetiological factor, for example asymptomatic patients with persistence of chronic maxillary rhinosinusitis; thus, they need broader investigation. Odontogenic sinusitis is commonly reported in medical literature and its occurrence is underestimated (Turfe et al, 2019;Workman et al, 2018). Thus, randomized controlled trials must be done to raise the level of scientific evidence.…”

Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach—Long-Term Outcome and Literature Review

“…There are several differential diagnoses of unilateral sinus disease with or without polypoid masses in the nasal cavity and middle meatus, e.g. asymmetric manifestation of bilateral chronic rhinosinusitis, odontogenic sinusitis, (antro)choanal polyp, otherwise undefined isolated nasal polyps and benign or malignant tumors [1,2,3,4]. Tumors can mimic inflammatory lesions due to superficial edema hiding the typical endoscopic appearance of such tumors.…”

Comparison of bacterial maxillary sinus cultures between odontogenic sinusitis and chronic rhinosinusitis

“…ODS is a distinct type of sinusitis that presents more commonly unilaterally 5,10‐15 . Despite multiple studies showing ODS accounting for 45% to 75% of unilateral maxillary sinus opacification, 5,10‐15 its diagnosis can be elusive because patients have nonspecific sinonasal symptoms and minimal dental complaints 8,12,14 . Additionally, because radiologists and dentists frequently miss the diagnosis, 8,10,12,15‐18 otolaryngologists are often responsible for recognizing ODS.…”

“…Despite multiple studies showing ODS accounting for 45% to 75% of unilateral maxillary sinus opacification, 5,10‐15 its diagnosis can be elusive because patients have nonspecific sinonasal symptoms and minimal dental complaints 8,12,14 . Additionally, because radiologists and dentists frequently miss the diagnosis, 8,10,12,15‐18 otolaryngologists are often responsible for recognizing ODS. However, ODS has not been discussed in sinusitis guidelines, 12,19,20 and diagnostic protocols have not been established.…”