Wayne State University School of Medicine, Henry Ford Health System, Detroit, Michigan, U.S.A.
Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, U.S.A.
Laryngoscope. 2019 Sep;129(9):1976-1983. doi: 10.1002/lary.28001. Epub 2019 Apr 23.
Odontogenic sinusitis (ODS) is more common than historically reported, and management recommendations are limited in the literature. Although ODS case series have shown successful outcomes with dental treatment and endoscopic sinus surgery (ESS), no studies have considered the optimal timing of these treatments. The purpose of this study was to analyze times to ODS resolution after primary dental treatment and ESS based on symptom, 22-item sinonasal outcome test (SNOT-22), and endoscopic outcomes.
Prospective cohort study.
Thirty-seven symptomatic ODS patients who failed medical management were offered primary dental treatment or ESS. Eleven patients selected primary dental treatment, and 26 patients selected ESS. The following variables were collected prospectively at every office visit before and after dental treatment or ESS: SNOT-22, presence or absence of cardinal sinusitis symptoms, and presence or absence of middle meatal endoscopy findings (edema, polyps, purulence). Times to resolution of these clinical variables were analyzed with t test, chi-square test, Fisher exact test, McNemar test, and Kaplan-Meier survival analysis.
Patients in the dental treatment and ESS groups showed no significant differences in preoperative sinusitis disease burdens based on symptoms, SNOT-22, endoscopy, and computed tomography. The ESS group experienced faster and more significant improvement in nearly all symptom, SNOT-22, and endoscopic outcomes.
For symptomatic ODS, primary ESS resulted in faster resolution of SNOT-22, sinusitis symptoms, and endoscopic findings in ODS patients compared with primary dental treatment. ESS can be considered first-line therapy for symptomatic ODS, followed by dental treatment when necessary.
2b Laryngoscope, 129:1976-1983, 2019.
牙源性鼻窦炎（ODS）比以往报道的更为常见，且相关文献中对其治疗推荐有限。尽管 ODS 病例系列研究表明，单纯的牙体治疗联合内镜鼻窦手术（ESS）可取得良好的效果，但尚无研究考虑这些治疗的最佳时机。本研究旨在根据症状、22 项鼻-鼻窦结局测试（SNOT-22）和内镜结果分析初次牙体治疗和 ESS 后 ODS 缓解的时间。
前瞻性队列研究。
37 例经药物治疗失败的症状性 ODS 患者接受了初次牙体治疗或 ESS。11 例患者选择了初次牙体治疗，26 例患者选择了 ESS。在牙体治疗或 ESS 前后的每次就诊时，前瞻性地收集了以下变量：SNOT-22、是否存在额窦炎症状以及中鼻道内镜检查结果（水肿、息肉、脓性分泌物）。使用 t 检验、卡方检验、Fisher 确切检验、McNemar 检验和 Kaplan-Meier 生存分析来分析这些临床变量的缓解时间。
牙体治疗组和 ESS 组患者在症状、SNOT-22、内镜和计算机断层扫描检查的术前窦炎疾病负担方面无显著差异。ESS 组在几乎所有症状、SNOT-22 和内镜结果方面的改善速度更快且更显著。
对于有症状的 ODS，与初次牙体治疗相比，初次 ESS 可更快地缓解 SNOT-22、窦炎症状和 ODS 患者的内镜检查结果。ESS 可被视为有症状 ODS 的一线治疗方法，必要时可进行牙体治疗。
2b 级《喉镜》，129：1976-1983，2019 年。
