A Change Of Perspective: From Odontogenic Sinusitis To Sinonasal Complications Of Dental Treatment Saibene AM*, Pipolo C*, Lozza P*, Maccari A*, Scotti A*, Portaleone SM*, Chiapasco M**, Felisati G* * Otolaryngology Department, San Paolo Hospital – University of Milan, Milan, Italy ** Oral Surgery Department, San Paolo Hospital – University of Milan, Milan, Italy CONTACT INFORMATION : Alberto M. Saibene, MD – Otolarynology Dept. – San Paolo Hospital – University of Milan MAIL: [email protected]
PATIENTS & METHODS
BACKGROUND Odontogenic sinusitis is traditionally considered a maxillary sinus disease most often resulting from dental conditions such as dental abscesses and extensive periodontal disease. Tooth extractions and infections caused by intra-antral foreign bodies are only occasionally considered as additional etiologies. AIMS
We reviewed the medical and surgical records of 315 patients presenting with sinonasal complications of dental disease or treatment (SCDDT) non responding to medical and dental therapy alone and surgically treated in our institution. We analyzed demographics, etiologies according to Felisati’s classification and, in a selected consecutive series, microbiological features of the disease, in order to compare them to other CRS patients. Table 1 – Patients treated according to Felisati’s
Having diagnosed and treated over classification of SCDDTs. OAC = oro-antral communication. 300 patients suffering from odontogenic sinusitis over the course Class Definition Cases of 12 years we believe that a time Sinusitis following 1a 32 has come for a radical change of preimplantologic surgery perspective on odontogenic sinonasal Sinusitis with conditions, shifting views, definitions, 2a perimplantitis/subperiosteal 30 classification and treatment implant and OAC approaches. Sinusitis following implant 2b 3 The authors present their experience dislocation with OAC and share their views on this change Sinusitis following implant of perspective from the well-known 2c 20 dislocation concept of odontogenic sinusitis 2d Implant dislocation 14 coming to the new concept of sinonasal complications of dental 3a Odontogenic sinustis with OAC 71 treatment. 3b
Out of 315 patients treated, women were more prevalent (176 vs 139) and mean age was 51.7 years. Complcations of classic dental disease and treatment were the most prevalent (see Table 1). Extramaxillary spread of infection was extremely frequent (59.7% of patients – see graph on the right). Mixed aerobe/anaerobe infections were definitely more prevalent in SCDDTs than in control CRS patients (see graph below)
DISCUSSION / CONCLUSION The omnipresence of dental treatments virtually makes every odontogenic sinusitis a complication of the very dental treatment. Such complications, often resulting from implantological and preimplantological procedures spread beyond the maxillary sinus in over 65% of patients and bilaterally in more than 15% of patients. Our observation and literature data also indicate that anaerobic bacterial infections are more prevalent in odontogenic sinonasal conditions. Extramaxillary involvement, protean etiology and frequent anaerobic infection draw the picture of a complex disease that is different from a “common” CRS an requires an adequate diagnostic work up and a tailored surgical and medical treatment.
Endoscopic evaluation coupled with a head CT scan is mandatory for each patient in order to assess the sinonasal involvement. Surgical treatment requires to couple endoscopic endonasal approaches with intraoral approaches in selected cases in order to minimize recurrences. Last, medical treatment following surgery should comprise wide spectrum antibiotics to treat possible anaerobic infections.
REFERENCES/ACKNOWLEDGEMENTS Sinonasal complications resulting from dental treatment: outcome-oriented proposal of classification and surgical protocol.. Felisati G, Chiapasco M, Lozza P, et al. Am J Rhinol Allergy. 2013 Jul-Aug;27(4):e101-6. Drago L, Vassena C, Saibene AM, et al. A case of coinfection in a chronic maxillary sinusitis of odontogenic origin: identification of Dialister pneumosintes. J Endod. 2013 Aug;39(8):1084-7