ACTUAL ISSUES OF ODONTOGENIC MAXILLARY SINUSITIS (REVIEW)

Abstract

Odontogenic maxillary sinusitis has now increasing incidence in dental and otorhynolaryngological practice. Its incidence varies from 10-12 % to 50-75 %, according to different authors. Literature study showed that odontogenic maxillary sinusites are mostly unilateral, and significantly differ in complaints, clinical signs, and diagnostic and treatment measures from other types of sinusitis. This should be taken into account, because often odontogenic maxillary sinusitis is misdiagnosed with common sinusitis, and only in 77 % such patients are examined by both dental specialist and otorhynolaryngologist. Study of causes of odontogenic maxillary sinusitis revealed that now iatrogenic impact prevails over other causes, which had been previously considered as main causes of odontogenic maxillary sinusitis. Especially endodontic treatment and implantation surgery are major causes of odontogenic maxillary sinusitis in present time, due to increasing incidence of perforation and damage of sinus by filling materials, bone or tooth particles, and implants. Anatomical structure of dental-sinus border area, and volume of endodontic treatment and implanting procedures, determines last ones as causative triggers due to development of complications and inflammatory processes. Microbial flora is mostly presented by anaerobic microorganisms; at the same time aerobic and fungal organisms are found in the microscopy of histology of patients with odontogenic maxillary sinusitis. At the same time, polymicrobial associations show high resistance to wide spectrum of antimicrobial medications. In past years theory of microbial biofilms is considered leading in explanation of recurrent and persistent odontogenic sinusitis. Such polymicrobial associations are covered with complex shield of different compounds, providing protection and nutrients. This significantly complicates treatments and can cause recalcitrant and recurrent infections.