Chirurgia (Bucur). 2024 Feb;119(1):76-86. doi: 10.21614/chirurgia.2024.v.119.i.1.p.76.
Odontogenic sinusitis is a frequent disease of the maxillary sinus, resulting from a dental inflammatory condition or a foreign body migrated in the sinus cavity. We performed a clinical retrospective study aimed to review the two surgical endoscopic approaches for odontogenic maxillary sinusitis middle and inferior meatotomy, in terms of realistic indications, efficacy, outcomes, and possible complications. In our study, we included a number of 400 patients with odontogenic maxillary sinusitis divided into two groups, treated in our hospital over five years, from January 2019 to December 2023. The patients included in this research were over 18 years old, diagnosed with odontogenic maxillary sinusitis, and underwent either middle meatal antrostomy or inferior meatotomy. We examined the medical records of 400 patients. The vast majority of patients had a history of dental interventions, and the most affected tooth was the first maxillary molar. The symptoms at admission were typical for sinusitis: nasal obstruction, anterior or posterior rhinorrhea, hyposmia to anosmia, cacosmia, and pain or facial pressure. 80% of the patients in the study underwent middle meatal antrostomy, while 20% underwent inferior meatotomy. There were no significant differences between these two approaches in terms of efficacy, complication rates, recovery, or relapses. The complications that occurred after the surgical treatment were minor and with a very low frequency. The most reported were middle meatus synechiae and the persistence of the meatotomy ostium, with mucus recirculation (in patients with inferior meatotomy). Endoscopic surgical treatment of odontogenic maxillary sinusitis can be done as middle or inferior meatotomy, each having specific indications. The maxillary antrostomy is preferred in the majority of cases, as it is a procedure in which the natural ostium of the maxillary sinus is enlarged, thereby maintaining the natural drainage pathway of the sinus. However, the inferior meatotomy is preferred in the case of foreign bodies or maxillary sinus retention cysts localized at the level of the sinus floor or in the alveolar or lateral recesses, or as part of a combined approach (inferior and middle meatotomy), when the ablation of a "fungus ball" is required.
牙源性鼻窦炎是上颌窦的一种常见疾病，由牙齿炎症或异物迁移到窦腔引起。我们进行了一项临床回顾性研究，旨在回顾两种用于治疗牙源性上颌窦炎的内镜手术方法：中鼻甲切开术和下鼻甲切开术，从实际适应证、疗效、结果和可能的并发症方面进行评估。
在我们的研究中，我们纳入了 400 名牙源性上颌窦炎患者，这些患者在过去五年中在我们医院接受治疗，时间范围为 2019 年 1 月至 2023 年 12 月。纳入本研究的患者年龄均在 18 岁以上，诊断为牙源性上颌窦炎，并接受中鼻甲切开术或下鼻甲切开术。
我们检查了 400 名患者的病历。绝大多数患者有牙科干预史，最受影响的牙齿是上颌第一磨牙。入院时的症状是典型的鼻窦炎：鼻塞、前或后鼻漏、嗅觉减退或嗅觉丧失、幻嗅和疼痛或面部压力。研究中的 80%的患者接受了中鼻甲切开术，而 20%的患者接受了下鼻甲切开术。这两种方法在疗效、并发症发生率、恢复或复发方面没有显著差异。手术后发生的并发症轻微且频率非常低。报告最多的是中鼻甲黏连和肉切开口的持续存在，伴有黏液再循环（在下鼻甲切开术患者中）。
牙源性上颌窦炎的内镜手术治疗可以采用中鼻甲切开术或下鼻甲切开术，每种方法都有特定的适应证。在大多数情况下，上颌窦口扩大术（即上颌窦自然口扩大术）是首选方法，因为它可以维持窦腔的自然引流途径。然而，当下颌窦异物或潴留囊肿位于窦底水平或在牙槽或外侧隐窝，或作为联合治疗（中下鼻甲切开术）的一部分，需要切除“真菌球”时，下鼻甲切开术是首选方法。
