Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan; Department of Otolaryngology-Head and Neck Surgery, Sato Clinic & Hospital, Oita, Japan.
Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
Auris Nasus Larynx. 2021 Feb;48(1):104-109. doi: 10.1016/j.anl.2020.07.021. Epub 2020 Aug 3.
The successful management of odontogenic maxillary sinusitis (OMS) involves a combination of medical treatment with dental surgery and/or endoscopic sinus surgery (ESS). However, there is no consensus for the optimal timing of ESS. Although several studies have emphasized dental surgery as the primary treatment modality for OMS, there is recent evidence to suggest that ESS alone may be an effective treatment approach. The purpose of this study is to retrospectively investigate the pathophysiology of the current intractable OMS and the role ESS, especially ESS preceding dental treatment, plays in its pathophysiology.
Ninety-seven adults (60 males and 37 females, 48 ± 12 years) who underwent ESS for intractable OMS were retrospectively examined.
In a great deal of the cases (85 cases, 87.6%), causative teeth of OMS were periapical lesions after root canal treatment (endodontics). The root canal procedures were not sufficient; hence, the root-canal-treated teeth had periapical lesions causing OMS. In postoperative nasal endoscopy and cone-beam CT scans for all patients, the natural ostiums and the membranous portions of the maxillary sinuses were enlarged and the ostiomeatal complexes remained widely open. The ventilation and drainage of all patients' maxillary sinuses seemed to be successfully restored. Temporary acute sinusitis recurrence after primary ESS for OMS was observed in 10 cases (11.8%) when the patients caught a cold. However, since the natural ostium and the membranous portion of the maxillary sinuses and the ostiomeatal complexes remained widely open, antibiotic administration alone without dental treatment cured the temporary acute sinusitis. Regarding the causative teeth (endodontic treated teeth), in 83 out of 85 cases (97.6%), causative teeth were able to be preserved with only antibiotic treatment and without dental retreatment. In two cases, extraction of the teeth was necessary because the teeth became mobile. Regarding the causative teeth after dental restoration, in 2 out of 2 cases (100%), causative teeth were able to be preserved with antibiotic treatment alone.
ESS is highly indicated for OMS requiring surgery. The treatment results of intractable OMS are exceptionally good once the ventilation and drainage of the maxillary sinus is successfully restored after surgery. Consequently, ESS can be considered the first-line therapy for intractable OMS caused by root canal treatment (endodontics) and dental restoration, followed by close dental follow-up and dental treatment when necessary.
牙源性上颌窦炎（OMS）的成功治疗需要将药物治疗与牙外科手术和/或内镜鼻窦手术（ESS）相结合。然而，对于 ESS 的最佳时机尚无共识。尽管多项研究强调牙外科手术是 OMS 的主要治疗方式，但最近有证据表明单独进行 ESS 可能也是一种有效的治疗方法。本研究旨在回顾性探讨目前难治性 OMS 的病理生理学，以及 ESS 尤其是 ESS 先行于牙治疗在其病理生理学中的作用。
对 97 例接受 ESS 治疗的难治性 OMS 成人患者（60 名男性，37 名女性，48±12 岁）进行回顾性检查。
在大量病例中（85 例，87.6%），OMS 的致病牙为根管治疗后的根尖病变（牙髓病学）。根管治疗不充分；因此，经过根管治疗的牙齿出现根尖病变，导致 OMS。对所有患者进行术后鼻内镜和锥形束 CT 扫描，发现自然窦口和上颌窦的膜性部分增大，窦口复合体保持广泛开放。所有患者的上颌窦通气和引流似乎都得到了成功恢复。10 例（11.8%）患者在接受 OMS 的初次 ESS 后因感冒出现暂时的急性窦炎复发。然而，由于自然窦口、上颌窦的膜性部分和窦口复合体仍然保持广泛开放，单独使用抗生素治疗而无需牙治疗即可治愈暂时的急性窦炎。对于致病牙（根管治疗牙），在 85 例中的 83 例（97.6%）中，仅用抗生素治疗和无需牙再治疗就能保留致病牙。在 2 例中，由于牙齿松动，需要拔牙。对于牙修复后的致病牙，在 2 例中（100%），仅用抗生素治疗就能保留致病牙。
对于需要手术的 OMS，ESS 是高度指征。一旦手术成功恢复上颌窦的通气和引流，难治性 OMS 的治疗效果就非常好。因此，ESS 可被视为根管治疗（牙髓病学）和牙修复引起的难治性 OMS 的一线治疗方法，随后进行密切的牙科随访，并在必要时进行牙科治疗。
