Kwiatkowska Marta Aleksandra, Szczygielski Kornel, Brociek-Piłczyńska Agnieszka, Chloupek Aldona, Jurkiewicz Dariusz
Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine-National Research Institute, Szaserów 128, 04-142 Warsaw, Poland.
J Clin Med. 2023 Jan 31;12(3):1103. doi: 10.3390/jcm12031103.
Endodontic disease with formation of periapical lesions (PALs) is one of the most common causes of chronic odontogenic sinusitis (ODS). It requires close collaboration between otolaryngologists and dentists, but the best sequence of management is still unknown. The aim of the present study is to clarify how radiological characteristics of teeth with PALs and previous root-canal treatment (RCT) influence the clinical evolution of the disease and to define the predictive value of its radiological and endoscopic features in determining the need for further surgical intervention. A total of 68 symptomatic patients with ODS with PALs were included in the study. The evaluation was performed by an otolaryngologist and a dentist based on a medical interview, nasal endoscopy, cold pulp testing and tomography images. Patients were prospectively followed for at least 12 months, during which nasal steroids, saline irrigations and RCT were administered. The criteria of disease improvement were: decrease of symptoms, healed sinonasal mucosa in endoscopy and radiological resolution of periapical radiolucency and sinus inflammation. Results showed that 9 (13%) patients improved after conservative treatment and 59 (87%) required further surgical intervention. Patients who improved after medical treatment and RCT were younger ( = 0.043) and had a greater distance from the top of the periapical lesion to the maxillary sinus' floor ( = 0.003). When expansion of PALs and bone destruction toward the maxillary sinus was observed on radiological imaging ( = 0.041), and when more than one tooth root was affected ( = 0.004), patients were more likely to require surgical intervention. In conclusion, the more roots that are affected and the closer the top of the PAL is to the maxillary sinus' floor, the greater the possibility of medical treatment and RCT failure. When the bone destruction extends into the maxillary sinus, patients eventually require both tooth extraction and FESS in order to resolve ODS completely.
伴有根尖周病变（PALs）形成的牙髓病是慢性牙源性鼻窦炎（ODS）最常见的病因之一。这需要耳鼻喉科医生和牙医密切合作，但最佳的治疗顺序仍不明确。本研究的目的是阐明伴有PALs的牙齿的放射学特征以及先前的根管治疗（RCT）如何影响该疾病的临床进展，并确定其放射学和内镜特征在确定是否需要进一步手术干预方面的预测价值。共有68例有症状的伴有PALs的ODS患者纳入本研究。由一名耳鼻喉科医生和一名牙医根据病史采集、鼻内镜检查、冷牙髓测试和断层扫描图像进行评估。对患者进行前瞻性随访至少12个月，在此期间给予鼻用类固醇、盐水冲洗和RCT。疾病改善的标准为：症状减轻、鼻内镜检查中鼻窦黏膜愈合以及根尖周透射区和鼻窦炎症的放射学消退。结果显示，9例（13%）患者经保守治疗后病情改善，59例（87%）需要进一步手术干预。经药物治疗和RCT后病情改善的患者年龄较小（P = 0.043），且根尖周病变顶部到上颌窦底的距离更大（P = 0.003）。当放射学影像上观察到PALs向鼻窦扩展和骨质破坏（P = 0.041），以及当多个牙根受累时（P = 0.004），患者更有可能需要手术干预。总之，受累牙根越多且PAL顶部离上颌窦底越近，药物治疗和RCT失败的可能性就越大。当骨质破坏延伸至上颌窦时，患者最终需要拔牙和功能性鼻内镜鼻窦手术（FESS）才能完全解决ODS。
