Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan.
Wayne State Medical University, Detroit, Michigan.
Am J Rhinol Allergy. 2021 Mar;35(2):164-171. doi: 10.1177/1945892420941702. Epub 2020 Jul 9.
Odontogenic sinusitis (ODS) is a common cause of unilateral sinus disease (USD), but can be challenging to diagnose due to nonspecific clinical presentations, potentially subtle to absent dental pathology on sinus computed tomography (CT), and underrepresentation in the sinusitis literature.
Identify sinonasal clinical variables predictive of ODS in patients presenting with unilateral maxillary sinus opacification on sinus CT.
A prospective cohort study was conducted on 131 consecutive patients with USD and at least partial or complete maxillary sinus opacification on sinus CT. Patients' demographics, sinonasal symptoms (anterior and posterior drainage, nasal obstruction, facial pressure, smell loss, and foul smell), 22-item sinonasal outcome test, nasal endoscopy findings, CT findings, and histopathology were collected. Patients' diagnoses included ODS, chronic rhinosinusitis with or without nasal polyps, and inverted papilloma. Demographic and clinical data were compared between patients with unilateral ODS and non-odontogenic disease using univariate and multivariate analyses.
Of the 131 USD patients, 65 had ODS and 66 had non-odontogenic disease. The following variables were significantly associated with unilateral ODS on multivariate analysis: middle meatal pus on endoscopy (OR= 17.67, 95% CI-5.69, 54.87; p = 0.001), foul smell (OR= 6.11, 95% CI-1.64, 22.82; p=.007), facial pressure (OR= 3.55, 95% CI-1.25, 10.12; p = 0.018), and any frontal opacification on CT (OR= 5.19, 95% CI-1.68, 16.06; p = 0.004). Any sphenoid opacification on CT was inversely related to ODS (OR = 0.14, 95% CI-0.03, 0.69; p = 0.016). The study was adequately powered.
With unilateral maxillary sinus disease, the following features were significantly associated with ODS: foul smell, ipsilateral facial pressure, middle meatal pus on endoscopy, and any frontal sinus opacification on sinus CT. Additionally, any sphenoid sinus opacification on CT was inversely related to ODS. Presence or absence of these clinical variables can be used to increase or decrease one's suspicion of an odontogenic source of sinusitis.
牙源性鼻窦炎（ODS）是单侧鼻窦疾病（USD）的常见原因，但由于其临床表现非特异性，鼻窦计算机断层扫描（CT）上可能存在潜在的轻微至无牙病理学表现，以及在鼻窦炎文献中的代表性不足，因此诊断具有挑战性。
确定在鼻窦 CT 显示单侧上颌窦混浊的患者中，预测 ODS 的鼻-鼻窦临床变量。
对 131 例连续单侧 USD 患者进行前瞻性队列研究，这些患者的鼻窦 CT 至少部分或完全显示上颌窦混浊。收集患者的人口统计学数据、鼻-鼻窦症状（前、后引流、鼻塞、面部压力、嗅觉丧失和恶臭）、22 项鼻-鼻窦结局测试、鼻内镜检查结果、CT 发现和组织病理学。患者的诊断包括 ODS、伴有或不伴有鼻息肉的慢性鼻-鼻窦炎和内翻性乳头状瘤。使用单变量和多变量分析比较单侧 ODS 患者和非牙源性疾病患者的人口统计学和临床数据。
在 131 例 USD 患者中，65 例为 ODS，66 例为非牙源性疾病。多变量分析显示以下变量与单侧 ODS 显著相关：内镜下中鼻甲有脓性分泌物（OR=17.67，95%CI-5.69，54.87；p=0.001）、恶臭（OR=6.11，95%CI-1.64，22.82；p=0.007）、面部压力（OR=3.55，95%CI-1.25，10.12；p=0.018）和 CT 上任何额窦混浊（OR=5.19，95%CI-1.68，16.06；p=0.004）。CT 上任何蝶窦混浊与 ODS 呈负相关（OR=0.14，95%CI-0.03，0.69；p=0.016）。该研究具有足够的效力。
在单侧上颌窦疾病患者中，以下特征与 ODS 显著相关：恶臭、同侧面部压力、内镜下中鼻甲有脓性分泌物和鼻窦 CT 上任何额窦混浊。此外，CT 上任何蝶窦混浊与 ODS 呈负相关。这些临床变量的存在或不存在可以用来增加或减少对鼻窦炎症牙源的怀疑。
