Patel Nimish A, Ferguson Berrylin J
Division of Sinonasal Disorders and Allergy, Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15219, USA.
Curr Opin Otolaryngol Head Neck Surg. 2012 Feb;20(1):24-8. doi: 10.1097/MOO.0b013e32834e62ed.
For well over 100 years, it has been appreciated that maxillary dental infections can cause sinusitis. This insight has been largely overlooked with the advent of functional endoscopic sinus surgery (ESS) and its emphasis on the osteomeatal complex. We review several recent case series and reviews of odontogenic sinusitis that characterize and discuss emerging diagnostic modalities in odontogenic sinusitis.
In recent publications on odontogenic sinusitis, up to 40% of chronic bacterial maxillary sinus infections are attributed to a dental source, which is far higher than the previously reported incidence of 10%. Plain dental films and dental evaluations frequently fail to detect maxillary dental infection that can be causing odontogenic sinusitis. However, sinus computed tomography (CT) or Cone Beam Volumetric CT (CBVCT) are far more successful in identifying dental disease causing sinusitis. The microbial pathogens of odontogenic sinusitis remain unchanged from earlier reviews; however, the clinical findings in odontogenic sinusitis are better described in recent reviews. Successful treatment of odontogenic sinusitis requires management of the odontogenic source and may require concomitant or subsequent sinus surgery.
Odontogenic sinusitis is frequently recalcitrant to medical therapy and usually requires treatment of the dental disease. Sometimes dental treatment alone is adequate to resolve the odontogenic sinusitis and sometimes concomitant or subsequent ESS is required. Evaluation of all patients with persistent chronic rhinosinusitis (CRS) should include inspection of the maxillary teeth on CT scan for evidence of periapical lucencies. Unilateral recalcitrant disease associated with foul smelling drainage is especially characteristic of odontogenic sinusitis. High-resolution CT scans and CBVCT can assist in identifying dental disease.
一百多年来，人们已经认识到上颌牙感染可导致鼻窦炎。随着功能性内镜鼻窦手术（ESS）的出现及其对骨窦复合体的重视，这一观点在很大程度上被忽视了。我们回顾了最近的几个病例系列以及牙源性鼻窦炎的综述，这些综述对牙源性鼻窦炎的新兴诊断方式进行了描述和讨论。
在最近关于牙源性鼻窦炎的出版物中，高达40%的慢性细菌性上颌窦感染归因于牙源性病因，这远远高于先前报道的10%的发病率。普通牙片和牙科评估常常无法检测出可能导致牙源性鼻窦炎的上颌牙感染。然而，鼻窦计算机断层扫描（CT）或锥形束容积CT（CBVCT）在识别引起鼻窦炎的牙齿疾病方面要成功得多。牙源性鼻窦炎的微生物病原体与早期综述相比没有变化；然而，最近的综述对牙源性鼻窦炎的临床发现有了更好的描述。成功治疗牙源性鼻窦炎需要处理牙源性病因，可能还需要同时或随后进行鼻窦手术。
牙源性鼻窦炎通常对药物治疗反应不佳，通常需要治疗牙齿疾病。有时仅进行牙科治疗就足以解决牙源性鼻窦炎，有时则需要同时或随后进行ESS。对所有持续性慢性鼻-鼻窦炎（CRS）患者的评估应包括在CT扫描上检查上颌牙齿，以寻找根尖周透亮区的证据。单侧顽固性疾病伴有恶臭引流是牙源性鼻窦炎的特别特征。高分辨率CT扫描和CBVCT有助于识别牙齿疾病。
