Spokane ENT Clinic, Spokane, WA; University of Washington, Department of Otolaryngology-Head and Neck Surgery, Seattle, WA.
Int Forum Allergy Rhinol. 2013 Dec;3(12):973-9. doi: 10.1002/alr.21212. Epub 2013 Aug 27.
Maxillary sinusitis of dental origin (MSDO) has been described for decades, but tends to be overlooked as a possible cause of chronic sinusitis by both clinicians and radiologists. The incidence of MSDO in published series is reported to be from 10% to 40% in bacterial sinusitis. We present this series to highlight clinical and radiologic indicators of MSDO.
Databases from the authors' otolaryngology and endodontic practices were reviewed to identify patients who had been seen mutually. Sixty-seven (67) patients were identified. Both authors then reviewed the clinical records and associated computed tomography (CT) scans and determined that 31 patients had MSDO and 2 of had bilateral MSDO, for a total of 33 cases. The clinical and radiologic features related to these cases were then tabulated.
The clinical characteristics of the 33 cases of MSDO were as follows: sinus pain (88%), postnasal drainage (64%), congestion (45%), maxillary toothache (39%), and foul drainage (15%). Radiographic CT findings of MSDO showed periapical abscess in 18 cases (55%), periodontal abscess in 3 cases (9%), and no obvious dental pathology in 12 cases (36%). The extent of associated sinusitis was variable from mucoperiosteal thickening to florid unilateral sinusitis involving multiple sinuses. Eighteen maxillary sinuses (55%) were found to have either patent maxillary infundibula or prior surgical antrostomy. Twenty-four patients (77%) had unilateral maxillary sinus disease.
MSDO should be considered highly likely when radiographic evidence of dental pathology is associated with maxillary sinus disease. Regardless of negative CT evidence of dental pathology, MSDO should be suspected when unilateral maxillary sinus disease is seen, particularly when associated with a patent infundibulum. When MSDO is suspected, a clinical endodontic examination should be performed to rule out or treat an odontogenic etiology.
牙源性上颌窦炎（MSDO）已被描述了几十年，但临床医生和放射科医生往往忽略其作为慢性鼻窦炎的一个可能病因。在已发表的系列中，MSDO 的发病率在细菌性鼻窦炎中报告为 10%至 40%。我们呈现此系列以突出 MSDO 的临床和影像学指标。
作者的耳鼻喉科和牙髓病学实践的数据库进行了回顾，以确定相互就诊的患者。共确定了 67 名患者。两位作者随后回顾了临床记录和相关的计算机断层扫描（CT）扫描，并确定 31 名患者患有 MSDO，其中 2 名患者双侧 MSDO，总计 33 例。然后列出了与这些病例相关的临床和影像学特征。
33 例 MSDO 的临床特征如下：窦痛（88%）、后鼻漏（64%）、充血（45%）、上颌牙痛（39%）和恶臭引流（15%）。MSDO 的放射学 CT 发现 18 例（55%）有根尖脓肿、3 例（9%）牙周脓肿和 12 例（36%）无明显牙病。相关鼻窦炎的程度从黏膜骨膜增厚到单侧窦炎累及多个窦腔不等。18 个上颌窦（55%）发现上颌窦口通畅或曾进行过经上颌窦口入路手术。24 名患者（77%）患有单侧上颌窦疾病。
当影像学上发现与上颌窦疾病相关的牙病病理时，应高度怀疑 MSDO。无论 CT 证据是否有牙病病理，当发现单侧上颌窦疾病时，尤其是伴有上颌窦口通畅时，应怀疑 MSDO。当怀疑 MSDO 时，应进行临床牙髓检查以排除或治疗牙源性病因。
