Workman Alan D, Granquist Eric J, Adappa Nithin D
Division of Rhinology, Department of Otorhinolaryngology: Head and Neck Surgery.
Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Curr Opin Otolaryngol Head Neck Surg. 2018 Feb;26(1):27-33. doi: 10.1097/MOO.0000000000000430.
Odontogenic causes of sinusitis are frequently missed; clinicians often overlook odontogenic disease whenever examining individuals with symptomatic rhinosinusitis. Conventional treatments for chronic rhinosinusitis (CRS) will often fail in odontogenic sinusitis. There have been several recent developments in the understanding of mechanisms, diagnosis, and treatment of odontogenic sinusitis, and clinicians should be aware of these advances to best treat this patient population.
The majority of odontogenic disease is caused by periodontitis and iatrogenesis. Notably, dental pain or dental hypersensitivity is very commonly absent in odontogenic sinusitis, and symptoms are very similar to those seen in CRS overall. Unilaterality of nasal obstruction and foul nasal drainage are most suggestive of odontogenic sinusitis, but computed tomography is the gold standard for diagnosis. Conventional panoramic radiographs are very poorly suited to rule out odontogenic sinusitis, and cannot be relied on to identify disease. There does not appear to be an optimal sequence of treatment for odontogenic sinusitis; the dental source should be addressed and ESS is frequently also necessary to alleviate symptoms.
Odontogenic sinusitis has distinct pathophysiology, diagnostic considerations, microbiology, and treatment strategies whenever compared with chronic rhinosinusitis. Clinicians who can accurately identify odontogenic sources can increase efficacy of medical and surgical treatments and improve patient outcomes.
鼻窦炎的牙源性病因常常被漏诊；临床医生在检查有症状的鼻-鼻窦炎患者时，常常忽视牙源性疾病。慢性鼻-鼻窦炎（CRS）的传统治疗方法在牙源性鼻窦炎中往往无效。最近在牙源性鼻窦炎的发病机制、诊断和治疗方面有了一些新进展，临床医生应了解这些进展，以便更好地治疗这类患者群体。
大多数牙源性疾病是由牙周炎和医源性因素引起的。值得注意的是，牙源性鼻窦炎中很少出现牙痛或牙齿过敏，其症状总体上与CRS非常相似。单侧鼻塞和鼻腔脓性分泌物最提示牙源性鼻窦炎，但计算机断层扫描是诊断的金标准。传统的全景X线片非常不适用于排除牙源性鼻窦炎，不能依靠其来识别疾病。牙源性鼻窦炎似乎没有最佳的治疗顺序；应处理牙源性病因，内镜鼻窦手术（ESS）通常也有必要缓解症状。
与慢性鼻-鼻窦炎相比，牙源性鼻窦炎有独特的病理生理学、诊断考量、微生物学和治疗策略。能够准确识别牙源性病因的临床医生可以提高药物和手术治疗的疗效，并改善患者的预后。
