Brook Itzhak
Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA.
Otolaryngol Head Neck Surg. 2006 Sep;135(3):349-55. doi: 10.1016/j.otohns.2005.10.059.
Odontogenic sinusitis is a well-recognized condition and accounts for approximately 10% to 12% of cases of maxillary sinusitis. An odontogenic source should be considered in individuals with symptoms of maxillary sinusitis with a history of odontogenic infection, dentoalveolar surgery, periodontal surgery, or in those resistant to conventional sinusitis therapy. Diagnosis usually requires a thorough dental and clinical evaluation including appropriate radiographs. The most common causes of odontogenic sinusitis include dental abscesses and periodontal disease that had perforated the Schneidarian membrane, irritation and secondary infection caused by intra-antral foreign bodies, and sinus perforations during tooth extraction. An odontogenic infection is a polymicrobial aerobic-anaerobic infection, with anaerobes outnumbering the aerobes. The most common isolates include anaerobic streptococci and gram-negative bacilli, and Enterobacteriaceae. Surgical and dental treatment of the odontogenic pathological conditions combined with medical therapy is indicated. When present, an odontogenic foreign body should be surgical removed. Surgical management of oroantral communication is indicated to reduce the likelihood of causing chronic sinus disease. The management of odontogenic sinusitis includes a 3- to 4-week course of antimicrobials effective against the oral flora pathogens.
牙源性鼻窦炎是一种公认的疾病，约占上颌窦炎病例的10%至12%。对于有上颌窦炎症状且有牙源性感染、牙槽外科手术、牙周手术史的个体，或对传统鼻窦炎治疗有抵抗的个体，应考虑牙源性病因。诊断通常需要进行全面的牙科和临床评估，包括适当的X光片检查。牙源性鼻窦炎最常见的病因包括已穿破施奈德膜的牙脓肿和牙周病、窦内异物引起的刺激和继发感染，以及拔牙时的鼻窦穿孔。牙源性感染是一种需氧菌与厌氧菌混合感染，厌氧菌数量多于需氧菌。最常见的分离菌包括厌氧链球菌、革兰氏阴性杆菌和肠杆菌科细菌。牙源性病理状况的外科和牙科治疗结合药物治疗是必要的。如有牙源性异物，应手术取出。应进行口腔鼻窦瘘的外科处理，以降低引起慢性鼻窦疾病的可能性。牙源性鼻窦炎的治疗包括使用对口腔菌群病原体有效的抗菌药物进行3至4周的疗程。
