Douglas Jennifer E, Patel Tapan, Rullan-Oliver Bianca, Ungerer Heather, Hinh Lisa, Peterson Edward L, Kohanski Michael A, Kennedy David W, Palmer James N, Adappa Nithin D, Craig John R
Department of Otorhinolaryngology-Head & Neck Surgery, 6569University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Department of Public Health Sciences, 2971Henry Ford Health, Detroit, Michigan.
Am J Rhinol Allergy. 2022 Nov;36(6):808-815. doi: 10.1177/19458924221114941. Epub 2022 Jul 25.
Orbital, intracranial, and osseous extra-sinus complications can arise from bacterial or fungal sinusitis. Odontogenic sinusitis (ODS) can cause extra-sinus complications, but its prevalence remains poorly characterized.
To determine the frequency of ODS as a cause of operative extra-sinus infectious complications and describe clinical features of all complicated sinusitis cases.
A multi-institutional retrospective review was performed on all operative sinusitis-related extra-sinus complications from 2011 to 2020. ODS was diagnosed by sinus computed tomography (CT) and dental evaluations when available. Demographics, complication types, sinusitis etiologies, and various clinical features were analyzed.
Forty-five patients were included (mean age 55.5 years, 56% male). Of the extra-sinus complications, 40% were orbital only, 22% intracranial only, 13% osseous only, and 25% involved combined complications. The 2 most common causes of extra-sinus complications were ODS (40%) and mucopyocele (27%). When invasive fungal etiologies were excluded, and only unilateral maxillary opacification on CT was considered, nearly 60% of extra-sinus complications were due to ODS. Unilateral maxillary sinus opacification on CT was present in 100% of complicated ODS compared to 44% of nonodontogenic cases, and oral anaerobes were only identified in ODS cases. No complicated ODS patients underwent dental interventions during hospitalization.
ODS was the most common cause of operative extra-sinus infectious complications. Clinicians should consider ODS high on the differential diagnosis of all patients presenting with complicated sinusitis, especially when sinusitis is unilateral and invasive fungal infection is not suspected.
细菌性或真菌性鼻窦炎可引发眶部、颅内及鼻窦外骨质并发症。牙源性鼻窦炎（ODS）可导致鼻窦外并发症，但其患病率仍未得到充分描述。
确定ODS作为手术性鼻窦外感染并发症病因的频率，并描述所有复杂性鼻窦炎病例的临床特征。
对2011年至2020年期间所有与鼻窦炎手术相关的鼻窦外并发症进行多机构回顾性研究。ODS通过鼻窦计算机断层扫描（CT）及必要时的牙科评估进行诊断。分析了人口统计学、并发症类型、鼻窦炎病因及各种临床特征。
纳入45例患者（平均年龄55.5岁，56%为男性）。在鼻窦外并发症中，仅累及眶部的占40%，仅累及颅内的占22%，仅累及骨质的占13%，合并并发症的占25%。鼻窦外并发症最常见的两个病因是ODS（40%）和黏液囊肿（27%）。排除侵袭性真菌病因且仅考虑CT上单侧上颌窦混浊时，近60% 的鼻窦外并发症由ODS引起。100% 的复杂性ODS患者CT上存在单侧上颌窦混浊，而非牙源性病例中这一比例为44%，且仅在ODS病例中鉴定出口腔厌氧菌感染。住院期间，没有复杂性ODS患者接受牙科干预。
ODS是手术性鼻窦外感染并发症最常见的病因。临床医生在对所有患有复杂性鼻窦炎的患者进行鉴别诊断时，应高度考虑ODS，尤其是当鼻窦炎为单侧且不怀疑侵袭性真菌感染时。
