Simuntis Regimantas, Kubilius Ričardas, Padervinskis Evaldas, Ryškienė Silvija, Tušas Paulius, Vaitkus Saulius
Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Eivenių street 2, 44307, Kaunas, Lithuania.
Department of Otolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Eur Arch Otorhinolaryngol. 2017 Oct;274(10):3651-3658. doi: 10.1007/s00405-017-4678-5. Epub 2017 Jul 21.
The objective of the study was to compare the ability of dental, ENT and radiology specialists to identify the dental cause of maxillary sinusitis with conventional computed tomography, dental and panoramic radiographs. Out of 34 dental records from subjects treated at ENT and Oral and Maxillofacial Surgery Department, LUHS Kaunas Clinics, 22 females and 12 males with the diagnosis of odontogenic maxillary sinusitis, periapical (DPA), panoramic (DPR) and computed tomography (CT) images of posterior maxilla were selected for further studies. In total, 39 sinuses with an odontogenic and 37 sinuses with only rhinogenic cause (control group) were included in the study. Sinuses with mucosal thickening less than 3 mm were excluded from the research. Each image was evaluated by 5 endodontologists, 5 oral surgeons, 6 general dentists, 6 otorhinolaryngologists and an experienced oral radiologist. DPR and DPA views were not evaluated by ENT specialists. The dental cause of maxillary sinusitis was marked according to the given scale. Intraclass correlation coefficient and ROC curve statistical analysis were performed. The best accuracy was observed when CT views were evaluated by experienced oral radiologist and oral surgeons: the AUC was 0.958 and 0.859, respectively. DPR views showed the best accuracy when evaluated by oral surgeons (0.763) and DPA-by endodontologists (0.736). The highest inter-rater agreement was observed between experienced oral radiologist and oral surgeons/otorhinolaryngologists (0.87/0.78) evaluating CT. Sensitivity and specificity of CT were 89.7 and 94.6%, DPR-68.2 and 77.3%, DPA-77.9 and 67%. Identification of dental cause of maxillary sinusitis sometimes is a challenge, which depends on radiological method and, more importantly, on evaluator's experience.
本研究的目的是比较牙科、耳鼻喉科和放射科专家通过传统计算机断层扫描、牙科和全景X线片来确定上颌窦炎牙源性病因的能力。在立陶宛考纳斯临床大学医院耳鼻喉科及口腔颌面外科治疗的34例患者的牙科记录中，选取了22名女性和12名男性，他们被诊断为牙源性上颌窦炎，选取上颌骨后部的根尖片（DPA）、全景片（DPR）和计算机断层扫描（CT）图像进行进一步研究。该研究共纳入39个牙源性鼻窦和37个仅由鼻源性病因引起的鼻窦（对照组）。黏膜增厚小于3毫米的鼻窦被排除在研究之外。每张图像由5名牙髓病医生、5名口腔外科医生、6名普通牙医、6名耳鼻喉科医生和一名经验丰富的口腔放射科医生进行评估。耳鼻喉科专家不评估DPR和DPA视图。根据给定的量表对上颌窦炎的牙源性病因进行标记。进行组内相关系数和ROC曲线统计分析。当经验丰富的口腔放射科医生和口腔外科医生评估CT视图时，观察到最佳准确性：AUC分别为0.958和0.859。当由口腔外科医生评估时，DPR视图显示出最佳准确性（0.763），而当由牙髓病医生评估时，DPA视图显示出最佳准确性（0.736）。在评估CT时，经验丰富的口腔放射科医生与口腔外科医生/耳鼻喉科医生之间观察到最高的评分者间一致性（0.87/0.78）。CT的敏感性和特异性分别为89.7%和94.6%，DPR为68.2%和77.3%，DPA为77.9%和67%。确定上颌窦炎的牙源性病因有时是一项挑战，这取决于放射学方法，更重要的是取决于评估者的经验。
