Role of Endoscopic Sinus Surgery and Dental Treatment in the Management of Odontogenic Sinusitis Due to Endodontic Disease and Oroantral Fistula

Abstract

Background: Odontogenic sinusitis (ODS) is frequently encountered in ENT practice; however, there are no guidelines regarding its management. This study aims to analyse the results of endoscopic sinus surgery versus dental treatment in ODS. Additionally, we aim to demonstrate the benefit of associating endoscopic sinus surgery (ESS) to surgical closure of chronic oroantral fistulas (OAF) by comparing mean time to healing in patients who opted or not for concurrent ESS. Methods: Records of patients with ODS were reviewed. Group one consisted of patients with ODS caused by periapical pathology undergoing either endoscopic sinus surgery (ESS) or dental treatment. Resolution of ODS was considered treatment success and was compared between the two treatment strategies. Group two included patients with ODS and associated chronic oroantral communication. Time to healing was compared between patients undergoing OAF closure alone versus patients receiving associated ESS, using the Log-Rank test to correlate Kaplan–Meier curves. Results: 25 patients from a total of 45 in group one underwent dental treatment alone, and 20 opted for exclusive ESS treatment. The failure rate was 40% for patients treated with ESS compared to 4% (one patient) for dental treatment. ODS resolved in all patients in the second group, but the mean time to healing was half (10 days) when ESS was complementary to OAF closure. Conclusion: The present study represents the first estimator of the role ESS plays in OAF treatment. Nonetheless, it provides proof of the importance of first addressing dental problems in odontogenic sinusitis.

Closure of oro‐antral fistulae in conjunction with functional endoscopic sinus surgery: A systematic review and retrospective analysis

“…One patient was managed with suspected chronic rhinosinusitis with their GP for 5 years prior to referral. Although OMS has previously been acknowledged to have an incidence of 10% of all cases of sinusitis, recent evidence has uncovered that OMS makes up 25–40% of all chronic rhinosinusitis and up to 72.6% of cases with unilateral opacification of the sinus 9,24 . GPs should consider OMS as a differential diagnosis, particularly in cases of unilateral sinusitis.…”

“…All 13 of the patients in the original case series experienced complete resolution of sino‐nasal symptoms 1 month after surgery and the integrity of the flap was maintained. Gâta et al 9 conducted a retrospective review of 31 patients, of which 21 underwent OAF in conjunction with FESS. The remaining 10 patients elected to have closure of the fistula only.…”

“…The aim of this review was, therefore, to determine whether in adult patients with chronic OAFs and radiographic evidence of sinus disease, undergoing OAF closure in conjunction with functional endoscopic sinus surgery provides an effective surgical approach for relief of sinusitis symptoms and permanent closure of the fistula for a minimum of 3 weeks post‐treatment. The primary outcome was total closure of the fistula and relief of sinusitis symptoms 3 weeks after surgery, as this has proven to be sufficient time to produce successful epithelialisation 8,9 . Secondary outcomes included measurement of adverse complications and long‐term success rates.…”

“…The primary outcome was total closure of the fistula and relief of sinusitis symptoms 3 weeks after surgery, as this has proven to be sufficient time to produce successful epithelialisation. 8,9 Secondary outcomes included measurement of adverse complications and long-term success rates. Additional data recorded included patient demographics, causative tooth, size of the defect and post-operative advice/antibiotics given.…”

Odontogenic Sinusitis: From Diagnosis to Treatment Possibilities—A Narrative Review of Recent Data

“…In the case of an osteitic process, the area is drilled by removing the affected bone. The sinus is inspected by endoscope, so that areas with osteitis are removed, the sinusal mucosa is washed with rifampicin, and if the oral communication is very small (0.5–0.8 mm), the communication is closed with a simple mucoperiosteal flap [ 97 ].…”