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. 2017 Dec 11;2(6):442-446.
doi: 10.1002/lio2.130. eCollection 2017 Dec.

When Maxillary Sinusitis Does Not Heal: Findings on CBCT Scans of the Sinuses With a Particular Focus on the Occurrence of Odontogenic Causes of Maxillary Sinusitis

Malin Vestin Fredriksson  1 , Anders Öhman  2 , Lennart Flygare  3 , Krister Tano  1
Affiliations

When Maxillary Sinusitis Does Not Heal: Findings on CBCT Scans of the Sinuses With a Particular Focus on the Occurrence of Odontogenic Causes of Maxillary Sinusitis

Malin Vestin Fredriksson et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objectives: This study sought to investigate the proportion of patients with suspected sinusitis referred for radiological examination who have radiologically verified sinusitis of odontogenic origin and to describe this type of sinusitis.

Study design: This investigation is a retrospective study.

Methods: A total of 303 sinus examinations involving cone beam computed tomography (CBCT) performed at Sunderby Hospital, Luleå, Sweden in 2012 were independently reviewed by two radiologists. The number of cases of maxillary sinusitis and the correlation between maxillary sinusitis and odontogenic infections were determined.

Results: Overall, 24% of the verified cases of sinusitis were odontogenic. An odontogenic origin was identified in 40% of unilateral maxillary sinusitis cases but only 6% of bilateral maxillary sinusitis cases (p = 0.0015). Forty-nine out of 54 patients with periapical destruction had adjacent mucosal swelling in the maxillary sinus, but only 15 of these patients satisfied the criteria for sinusitis.

Conclusion: The present study confirms the close relationship between odontogenic infections and unilateral maxillary sinusitis. Level of Evidence 4.

Keywords: computed tomography; dental infection; periapical abscess; radiology; sinusitis.

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Figures

Figure 1
Figure 1
Unilateral odontogenic sinusitis of the right maxillary sinus and ethmoidal cells on the same side. Tooth number 17 (second molar on the right side of the upper jaw) has been extracted due to periapical infection. There is a loss of bone between the extraction socket and the maxillary sinus. Fluid level is found in the maxillary sinus.
Figure 2
Figure 2
Flow chart showing the distribution of sinus pathology among patients that was examined with Cone Beam Computed Tomography (CBCT) during 2012 at Sunderby Hospital. Referees are shown by arrows on the right. ENT, Ear, nose, and throat specialist; GP, General Practitioner; Others, Dentists or specialists other than ENT
Figure 3
Figure 3
Dental pathology at CBCT Adjacent mucosal swelling nearby a periapical‐ or an extensive marginal destruction.
Figure 4
Figure 4
Distribution of sinusitis over the year according to examination month. A more even distribution is seen in the group of odontogenic sinusitis then in the group of non‐odontogenic sinusitis.
Figure 5
Figure 5
Fluid level, including mucosal swelling, in the maxillary sinus. Grade 1: Fluid level, less than 1/3 of the maxillary sinus is congested. Grade 2: Fluid level, 1/3‐ 2/3 of the maxillary sinus is congested. Grade 3: Fluid level, more than 2/3 of the maxillary sinus is congested. * = The proportion of patients with grade 3 congestion was higher (p = 0.04) in the odontogenic group.
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