Grygorov S, Poberezhnik G, Grygorova A
Kharkiv National Medical University, Ukraine.
Georgian Med News. 2018 Mar(276):46-50.
Odontogenic maxillary sinusitis has now increasing incidence in dental and otorhynolaryngological practice. Its incidence varies from 10-12 % to 50-75 %, according to different authors. Literature study showed that odontogenic maxillary sinusites are mostly unilateral, and significantly differ in complaints, clinical signs, and diagnostic and treatment measures from other types of sinusitis. This should be taken into account, because often odontogenic maxillary sinusitis is misdiagnosed with common sinusitis, and only in 77 % such patients are examined by both dental specialist and otorhynolaryngologist. Study of causes of odontogenic maxillary sinusitis revealed that now iatrogenic impact prevails over other causes, which had been previously considered as main causes of odontogenic maxillary sinusitis. Especially endodontic treatment and implantation surgery are major causes of odontogenic maxillary sinusitis in present time, due to increasing incidence of perforation and damage of sinus by filling materials, bone or tooth particles, and implants. Anatomical structure of dental-sinus border area, and volume of endodontic treatment and implanting procedures, determines last ones as causative triggers due to development of complications and inflammatory processes. Microbial flora is mostly presented by anaerobic microorganisms; at the same time aerobic and fungal organisms are found in the microscopy of histology of patients with odontogenic maxillary sinusitis. At the same time, polymicrobial associations show high resistance to wide spectrum of antimicrobial medications. In past years theory of microbial biofilms is considered leading in explanation of recurrent and persistent odontogenic sinusitis. Such polymicrobial associations are covered with complex shield of different compounds, providing protection and nutrients. This significantly complicates treatments and can cause recalcitrant and recurrent infections.
牙源性上颌窦炎在牙科和耳鼻喉科临床实践中的发病率目前呈上升趋势。根据不同作者的研究，其发病率在10% - 12%至50% - 75%之间。文献研究表明，牙源性上颌窦炎大多为单侧，在症状、临床体征以及诊断和治疗措施方面与其他类型的鼻窦炎有显著差异。这一点应予以考虑，因为牙源性上颌窦炎常常被误诊为普通鼻窦炎，只有77%的此类患者会同时接受牙科专家和耳鼻喉科医生的检查。对牙源性上颌窦炎病因的研究表明，目前医源性影响超过了其他曾被视为牙源性上颌窦炎主要病因的因素。特别是牙髓治疗和种植手术是当前牙源性上颌窦炎的主要病因，这是由于填充材料、骨或牙颗粒以及种植体导致上颌窦穿孔和损伤的发生率增加。牙 - 窦边界区域的解剖结构以及牙髓治疗和种植手术的数量，因并发症和炎症过程的发展而决定了后者成为致病诱因。微生物菌群主要由厌氧微生物组成；同时，在牙源性上颌窦炎患者的组织学显微镜检查中也发现了需氧和真菌生物。与此同时，多微生物联合体对广谱抗菌药物表现出高度抗性。在过去几年中，微生物生物膜理论被认为是解释复发性和持续性牙源性鼻窦炎的主导理论。这种多微生物联合体被不同化合物组成的复杂屏障所覆盖，提供保护和营养。这显著使治疗复杂化，并可能导致顽固性和复发性感染。
