牙源性上颌窦炎的诊疗策略

因解剖关系密切,牙源性感染及口腔操作可引起上颌窦炎的发生.牙源性上颌窦炎约占所有上颌窦炎的40％,好发于40岁以上的中老年人;其诊治需考虑上颌窦炎及牙源性感染或刺激两个方面,涉及两个学科的交互,具有一定的难度.本文总结了牙源性上颌窦炎的发病机制及诊疗方法,同时简介了其他常见的上颌窦疾病,以期帮助口腔医生更好地分辨上颌窦...     

53例牙源性上颌窦炎功能性治疗和疗效评价

目的: 分析牙源性上颌窦炎治疗方法并评价其疗效,为临床诊治提供参考。方法: 回顾2011年1月—2020年12月于上海交通大学医学院附属第九人民医院就诊的53例牙源性上颌窦炎(odontogenic maxillary sinusitis, OMS)患者的临床资料。采用去除各种牙源性病灶、保存窦黏膜和牙槽骨的功能性手术治疗OMS。应用Lund-Mackay评分法定量评价手术前、后上颌窦炎,采用SPSS 17.0软件包中的配对t检验比较手术前、后Lund-Mackay均值差异。另外,评估术后反应及术后并发症情况。结果: OMS常见病因为牙源性囊性病变 (49.05%)、根尖炎 (20.75%)、口腔-上颌窦瘘(16.98%) 和异物 (13.21%)。功能性手术后患者上颌窦炎恢复明显,Lund-Mackay评分术前为3.72±0.51,术后为0.05±0.32,评分显著下降 (P<0.001)。术后反应小,无严重并发症发生。结论: 治疗OMS应着重处理牙源性病灶,行功能性手术,保护上颌窦黏膜。     

牙源性上颌窦炎病因和治疗的回顾性分析

目的:分析牙源性上颌窦炎的病源牙、病因、治疗方法和预后。方法:整理分析2000年1月~2012年12月年于北京大学口腔医院门诊部颌面外科就诊的牙源性上颌窦炎患者的病例。结果:病例共23例,其中11例(47.7%)的病源牙为上颌第一磨牙,18例(78.3%)的病因为慢性根尖炎,治疗方法是病源牙治疗、药物治疗和鼻窦手术的综合治疗,预后良好。结论:第一磨牙为牙源性上颌窦炎最常见病源牙,慢性根尖炎为最常见病因。综合治疗方法效果良好。     

牙源性上颌窦炎病因及诊断

牙源性上颌窦炎（OMS）是由牙源性感染和牙科手术等引起,多为单侧上颌窦炎,伴有鼻腔异味或有异常分泌物流出,且对传统上颌窦炎症治疗无效的一类疾病。认清上颌窦炎症的牙源性因素十分重要,如果仅仅治疗上颌窦疾病而忽略牙的诊治,会导致治疗失败。本文就OMS发病率、病因、临床表现及影像学检查作一综述,为其防治提供一定帮助。     

上颌窦分隔致牙源性上颌窦炎误诊1例

患者 ,中年女性。因左上后牙区肿痛 8个月 ,恶臭脓液溢出 6个月就诊。检查见 :左侧面部肿胀 ,左上第二、三磨牙前庭沟底可见一窦口 ,有稀薄、淡黄色脓液溢出 ,恶臭。X线根尖片示 :左上第二、三磨牙根尖骨质弥漫性破坏。瓦氏位片示 :左上颌窦后外侧壁缺损 ,窦壁模糊 ,窦腔致密影 ,下壁可见向外下突出的软组织影 ,较对侧密度高。印象左上颌窦癌可能。CT检查 :左侧上颌窦内密度增高 ,后外侧骨质破坏 ,窦腔末见扩大。印象 :左上颌窦占位性病变 ,恶性肿瘤可能性大。行上颌窦活检术。病理报告 :送检物为骨组织 ,周围有少许神经纤维 ,及较多淋巴…     

根尖周炎引起的牙源性上颌窦炎的治疗

目的:探讨根管治疗/根管再治疗治疗根尖周炎引起的牙源性上颌窦炎的可行性.方法:临床确诊的根尖周炎引起的牙源性上颌窦炎病例5例,根管治疗/根管再治疗3个月、6个月和12个月复查CBCT.结果:根管治疗/根管再治疗后5例临床病例临床症状消失,3个月和6个月CBCT显示5例临床病例根尖周、上颌窦底和上颌窦内变化不明显,12个...     

鼻内窥镜微创手术治疗牙源性上颌窦炎的临床观察

目的探讨慢性牙源性上颌窦炎应用鼻内窥镜手术的治疗效果。方法回顾性分析41例慢性牙源性上颌窦炎患者的临床资料，其中采用柯-陆氏手术治疗24例，采用鼻内窥镜下联合进路中鼻道上颌窦造口术17例，比较两种方法的治疗效果。结果采用柯一陆氏术式者面颊肿胀、面颊麻木、上牙槽酸痛的发生率分别是100．0％、37．5％、33.3％，鼻内窥镜手术组未见上述表现；柯-陆氏术式第一次手术拔牙率37．5％(9／24)，5例再次手术者均拔除患牙，总拔牙率58．3％(14．／24)，鼻内窥镜手术组拔牙率35．3％(6／17)，11例经根管治疗的牙齿保存良好；柯-陆氏手术组3年内复发率为37．5％(9／24)，而鼻内窥镜手术组术后3～6个月鼻道窦口复合体完全恢复通畅，随访1～3年未见复发。结论鼻内窥镜微创手术能最大限度减少上颌窦粘膜及骨质的损伤，利于术后恢复，在保留鼻窦正常生理功能、保存牙齿及减少复发率等方面明显优于传统的柯一陆氏手术。     

乳磨牙根尖周炎伴牙源性上颌窦炎及眶下间隙感染1例

牙源性上颌窦炎及眶下间隙感染作为乳磨牙急性根尖周炎的并发症较罕见。如不及时治疗,可引起眶周蜂窝织炎、海绵窦血栓,甚至死亡。     

Diagnostic value of 2D and 3D imaging in odontogenic maxillary sinusitis: a review of literature

This review aims to explore whether 3D imaging offers an added value in diagnosis of odontogenic sinusitis. Odontogenic maxillary sinusitis accounts for approximately 10-12% of maxillary sinusitis cases. Proper diagnosis of odontogenic sinusitis is based on a thorough dental and medical examination and crucial to ensure therapeutic efficacy. To establish the odontogenic cause of maxillary sinusitis, 2D and 3D imaging modalities may be considered, each presenting distinct advantages and drawbacks. The available research indicates that 2D imaging modalities may often mask the origin of odontogenic maxillary sinusitis. This limitation is particularly evident in the maxillary molar region, stressing the need for 3D cross-sectional imaging. The advent of low-dose cone beam computed tomography in dentistry may be particularly useful when odontogenic maxillary sinusitis is not responsive to therapy. Yet, it seems that more research is needed to validate its use in odontogenic maxillary sinusitis.     

Pathophysiology of sinusitis of odontogenic origin

Sinusitis of odontogenic origin, which is frequently encountered in routine otolaryngological and dental clinical practice, has been described as a reactive maxillary inflammation secondary to maxillary tooth infection or trauma to an odontogenic disease of maxillary bone, dental extractions, implant placement, or endodontic treatment impairing the integrity of the Schneiderian membrane. The aim of the present review was to investigate and discuss the most recent pathophysiological findings, predisposing odontogenic factors, microbiology, and the possible involvement of bacterial biofilms (BB) in the development of sinusitis. The narrative literature review showed that there might be a correlation between the bacteria present in pathological teeth in communication with the sinus and those found in infected sinus. The formation of a BB might be also involved in the etiopathogenesis of sinusitis of odontogenic origin. In conclusion, the true origin of odontogenic sinusitis is still unresolved. In clinical terms, the choice of suitable therapy depends on the characteristics of the biofilm. Further microbiological studies are required to better investigate the role of BB.     

Odontogenic sinusitis: a comprehensive review

Odontogenic sinusitis (OS) is a highly prevalent, underappreciated and underdiagnosed disease that has been known for over 100 years. Apical periodontitis, periodontal disease and iatrogenic extrusion of foreign bodies into the sinus are the main causes of OS. Although the prevalence of sinus pathosis of dental origin is still controversial, otolaryngologists recognize that in the presence of recalcitrant sinusitis, a dental origin should be considered and properly treated. Currently, cone-beam computed tomography is the gold-standard imaging technique to assess the relationship between dental conditions, especially apical periodontitis and sinus diseases, and whenever this association is detected, patients should be seen by both a dentist and an otolaryngologist in order to achieve complete recovery. This article reviews the current concepts regarding the definitions, diagnosis and management of OS from a clinical point of view.     

Single-step surgical treatment of odontogenic maxillary sinusitis: A retrospective study of 98 cases

PurposeThe aim of this study was to review clinical and radiological presentation, surgery, and results of treatment in patients with chronic odontogenic maxillary sinusitis (OMS) treated with a single surgical procedure, including endoscopic sinus surgery (ESS) and oral surgical approaches to treat the odontogenic source of infection.Materials and methodsA retrospective case series analysis of 98 patients was performed. All the patients received ESS. 88 patients required oral surgical approaches.ResultsNasal symptoms were present in 58 patients (59.2%). Nasal endoscopy was positive in 65 patients (66.3%). A positive nasal endoscopy was significantly associated with nasal symptoms (p < 0.05). 60 patients (61.2%) had OMS of iatrogenic origin. Total opacification of the maxillary sinus was the most common radiological presentation (74.5%) and was significantly associated with nasal symptoms (p < 0.05). 91 patients (92.9%) had complete clinical and radiological resolution of the OMS.ConclusionsIatrogenic origin, sinonasal symptoms and positive clinical endoscopy are common in patients with OMS. Nasal symptoms were significantly associated with total maxillary sinus opacification and positive endoscopic clinical examination. Combining treatment of the odontogenic source of infection via an oral surgical approach and of the sinus inflammation by ESS appears to be sufficient for successfully treating patients with OMS.     

Clinical implications of taste thresholds in patients with odontogenic maxillary sinusitis

Patients with odontogenic maxillary sinusitis (OMS) often complain of reduced taste sensitivity as well as nasal obstruction. The filter paper disc method (the conventional gustatory test) was applied to nine patients who underwent sinus surgery to open the inferior nasal meatus and sinus drainage, on three different days: 1 day prior to surgery, 7 days postoperative, and 28 days postoperative. The same test was applied to nine non-clinical participants with or without clipping the nose to interfere with smooth nasal airflow on two different days. Acquired recognition thresholds for the four basic tastes of sweet, salty, sour, and bitter were assessed. In OMS patients, the recognition thresholds for all four tastes were markedly decreased at 7 and 28 days postoperative, and subjective taste sensitivity and the elimination of nasal obstruction was improved. The mean recognition threshold for the four tastes correlated negatively with taste satisfaction scores. Clipping the nose in non-clinical participants induced increases in gustatory detection and recognition thresholds. Despite the small sample size and different ages and sexes of the study subjects, it was demonstrated that nasal obstruction in OMS patients and nose clipping in non-clinical subjects reduce taste reactivity, and surgical intervention to promote nasal airflow recovers impaired taste reactivity.     

Evaluation of odontogenic maxillary sinusitis using cone-beam computed tomography: three case reports

Introduction

Ten to twelve percent of all cases of maxillary sinusitis derive from odontogenic origin. The purpose of this study was to report the use of cone-beam computed tomography (CBCT) scanning in elucidating dental pathology as an etiology of maxillary sinusitis.

Methods

Intraoral periapical radiographs and CBCT scanning were performed in the evaluation of three patients presenting with pain, sinus congestion, or respiratory complaints. In the first case, extractions of impacted third molar and adjacent nonrestorable tooth were performed. In the second two cases, endodontic therapy was done. Radiologic follow-up with CBCT scanning or medical computed tomography scanning was performed 6 to 12 months after dental procedures were performed.

Results

All three patients presented with severe sinusitis that resolved after appropriate dental treatment. The first patient also showed marked improvement of chronic bronchitis after completion of dental treatment. In all patients, complete or near total resolution of sinusitis, including eradication of mucous retention cyst, was confirmed by post-treatment CBCT or computed tomography scanning.

Conclusions

These cases show the utility of CBCT scanning in evaluating patients presenting with concurrent sinus and dental complaints. In these three patients, maxillary sinusitis of odontogenic origin responded well to the eradication of dental etiology.     

Intentional replantation for the management of maxillary sinusitis

AIM: To present a case that emphasizes the importance of the use of intentional replantation as a technique to successfully treat a periapical lesion and an odontogenic maxillary sinusitis through the alveolus at the same time. SUMMARY: This case report presents a patient with odontogenic maxillary sinusitis secondary to periapical disease of a maxillary molar that had previously received root canal treatment. The molar was extracted, with drainage and rinsing of the maxillary sinus. The apices were resected extra-orally, the retrograde cavities prepared with ultrasound and retrograde fillings of silver amalgam placed. The tooth was then replanted. After 2 years, the patient was asymptomatic, periapical radiography showed no evidence of root resorption and computed tomography scanning demonstrated the resolution of maxillary sinusitis. Key learning points: *When root canal treatment or periapical surgery cannot be undertaken or has failed, intentional replantation may be considered. *This alternative treatment may be predictable in certain cases.