2010;51:932-7
原文作者姓名： Lee KC, Lee SJ
通訊作者學校： Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea 報告者姓名(組別)： 陳梅信 （Intern F 組）
報告日期： 100/01/11
內文:
Introduction
1. The origin of sinusitis :
• consider to be primarily rhinogenous
• infection is a major predisposing factor (in some case)
2. Sinusitis with an odontogenic source accounts for 10% of all cases of maxillary sinusitis.
3. Pathogenesis of odontogenic sinusitis
• not clearly understood 4. Incidence in previous studies :
• higher in women
• 3rd - 4th decade 5. Odontogenic sinusitis
• occurs when the Schneidarian membrane is perforated.
6. Cause of odontogenic sinusitis
• Maxillary teeth caries and maxillary dental trauma.
• Iatrogenic causes, such as :
• the placement of dental implants and dental extractions
7. A retrospective study of 27 patients who had various causes of odontogenic sinusitis to determine the clinical features was taken ,such as
• sex, age, etiologic factors, presenting symptoms, therapeutic tools, and radiological findings.
Materials and methods
1. 30 patients who were given a diagnosis of odontogenic sinusitis in Department of
Otorhino- laryngology-Head and Neck Surgery from February 2006 through August 2008.
2. In this study :
• 23 patients were initially diagnosed in our department (85.2%).
• 4 patients were referred from a dentist’s office (14.8%).
• 3 cases of pansinusitis with nasal polyps were excluded .
3. Diagnosis of odontogenic sinusitis based on a thorough dental and medical examination, included
• evaluation of the patient’s symptoms
(according to the American Academy of Otolaryngology-Head and Neck
Surgery(AAO-HNS) criteria, a diagnosis of rhinosinusitis requires at least 2 major factors or at least 1 major and 2 minor factors from a series of clinical symptoms and signs),
• A past dental history, and radiological findings,
•including a paranasal sinus CT scan.
• Consultation with the dentistry department consultation.
4. The patients were retrospectively analyzed according to
• medical records, which includes :
•sex, age, presenting symptom, etiologic factors, surgical and medical treatment, cultures, and radiological results which includes involved sinus and teeth.
Results
1. In this study ,
• male to female ration was 15:12
• higher incidence in male
• age distribution was 4 to 75 years,
• highest in the 4th decade
• follow-up period was between 2 months and 6 months,
• with an average of 4.5 months.
• All patients have no previous history of sinusitis.
(A) A displaced dental implant into the left maxillary sinus causing sinusitis (B) Oro-antral fistula occurred after right 2nd molar tooth extraction
3. Etiology of odontogenic sinusitis:
4. The interval from the dental procedures to the first visit to the outpatient clinic with symptoms
1 month 1-3 months 3 months to 1 year > 1 year
11 5 8 3
40.8% 18.5% 29.6% 11.1%
5. Pre-operative consultation should able to reduce the risk
• 23 patients was diagnosed directly after admission to otorhinolaryngology without dental treatment.
• 4 patients were diagnosed via a post dental treatment consultation.
• 25 did not have a preoperative consultation between a rhinologist and a dentist prior to the dental procedure.
6.Symptom of odontogenic sinusitis
• 1 patient (3.7%) without symptoms was diagnosed incidentally by radiography
• The most common presenting symptom was unilateral purulent rhinorrhea.
• No significant differences between the symptoms of odontogenic sinusitis and that of other types of sinusitis.
7. The distribution of involved teeth in the upper jaw was as follows
8. Intra-operative bacterial cultures were obtained in 14 patients
organisms aerobic anaerobes mixed
case 3(21.4%) 1(7.1%) 3(21.4%)
predominant S. aureus Gram(-) bacilli &
Peptostreptococcus spp.
• No correlation was found between the predisposing odontogenic conditions and the
microbiological findings.
9.The therapeutic modalities of odontogenic sinusitis
•No recurrences were observed during the follow-up period for all patients.
10. Dental implant-related complications
• 10 cases
• 6 males and 4 females with an average age of 52.3 years (range: 35-62 years).
• The interval from the dental implant procedures to the first visit to the outpatient clinic with symptoms
• 1 month in 6 (60%)
• 1 to 3months in 2(20%)
• 3 months to 1 year in 1 (10%)
• over a year in 1 case (10%)
11. Dental extraction-related complications.
• 8 cases
• 4 males and 4 females with an average age of 39.3 years (range: 22-61 years)
DISCUSSION
• male to female ratio was 1.25 : 1.
• no significant difference in the incidence between sexes.
• the average age of the patients was 42.9 ( 4th decade)
2. The most common cause (10 cases) was dental implant-related complications.
3. Main symptom
• unilateral purulent rhinorrhea
• no significant differences between the symptoms of odontogenic sinusitis & that of other types of sinusitis (AAO-HNS criteria for rhinosinusitis)
4. Teeth related cause
• 2nd molar (40.8%) in the upper jaw
• The 2nd molar roots are the closest to the maxillary sinus floor
• History taking with the physical findings and radiological imaging (include CT ) is very important in diagnosis
5. Concomitant management is important in prevent infection , recurrence and complications.
• A combination of medical and surgical approaches is generally required
• Sources elimination in order to prevent a recurrence of sinusitis
• The removal of a foreign tooth root from the sinus,
• Infected tooth extraction or root canal therapy
• Oral administration of antibiotics for 21 to 28 days
• Less invasive transnasal endoscopic sinus surgery was suggested for the treatment of odontogenic sinusitis.
• After rhinologic surgical treatment, proper antibiotic therapy and dental treatments (removal of dental implants or dental caries, closure of oro-antral fistula) for the odontogenic origin have been performed by dentist on all of the patients.
6. Dental implant-related complications
• Foreign body and produces chronic infection
• Infection caused by implants placed very close to the maxillary sinus
• The migration of a dental implant into the maxillary sinus .
• Preoperative evaluations
• patients who suffer from previous symptoms of sinusitis or have predisposing factors
7. Most of the patients with odontogenic sinusitis had unilateral symptoms.
• The possibility of odontogenic sinusitis should always be considered when a patient has unilateral nasal symptoms.
8. The most common cause of odontogenic sinusitis is iatrogenic.
• consultation between a rhinologist and a dentist before a dental procedure takes place .
題號 題目
1 Which of the features about sinusitis is right?
1 Radiographically , the involved sinus has a cloudy , increased density.
2 Frequent complaints of chronic sinusitis include facial pressure , pain , or a sensation of obstruction
3 Maxillary sinusitis is associated with increased pain when the head is held upright and less comfort when the patient is supine .
A:1+2 B : 2+3 C :1+3 D : 1+2 + 3
答案( D) 出處： Oral & maxillofacial pathology , second edition , p184-186
題號 題目
2 Which of the bacteria is associated with sinusitis?
1 Streptococcus species 2 Bacteroides species 3 Veillonella species
A : 1+ 2 B : 2+ 3 C : 1 + 3 D : 1 + 2 + 3
答案( D) 出處： Oral & maxillofacial pathology , second edition , p184-186
