Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment

Abstract

Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multi-disciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.

Fig. 1

The relationship between the maxillary sinus floor and upper teeth. a CT image shows the roots of maxillary molars are located closest to the maxillary sinus floor. b Endoscopic image shows the maxillary sinus floor protrudes toward the oral cavity

Fig. 2

Anatomy and biological fundamentals of maxillary sinus. a Endoscopic image shows the alveolar recess. b Endoscopic observation of the natural opening in maxillary sinus. c The maxilla bone and the infraorbital foramen. d Anterior wall of the maxillary sinus and the infraorbital foramen (arrow indicates infraorbital nerve vascular bundle)

Fig. 3

Cone beam computed tomography (CBCT) images of maxillary sinus mucosa. a Normal mucosa in patients with periodontitis. b Mild mucosal thickness (MT), left maxillary sinus (28-year-old woman, with furcation lesion of Tooth 26). c Moderate MT, left maxillary sinus 41-year-old man, with a vertical infra-bony pocket of Tooth 26 and peak-type MT. d Severe MT, left maxillary sinus (32-year-old man, with the sinus floor gap penetrated by inflammation caused by periodontitis)

Fig. 4

Vascular and lymphatic communication between maxillary sinus and teeth

Fig. 5

The drainage pathway of the maxillary sinus from the sinus floor towards the natural ostium into the middle meatus. IT inferior turbinate, MT middle turbinate, BE bullar ethmoid, U ucinate process, O ostium

Fig. 6

Maxillary sinus ostium obstruction caused sinusitis. a CT image shows maxillary sinus ostium obstruction (arrow) caused sinusitis. b Significant swelling of the mucosa of the middle turbinate and middle meatus can be observed. c The yellow circle points to the ostium and pus can be seen in the maxillary sinus in endoscopic operation. IT inferior turbinate, MT middle turbinate, MM middle meatus; NS nasal septum

Fig. 7

Relative abundance of genera from nasal secretions of OMS and control (people with simple nasal septum deviation). (Porphyromonas, Fusobacterium, Streptococcus and Prevotella were more abundant in OMS than control)

Fig. 8

Formation of the papillary-like folds in maxillary sinus mucosa in OMS. a Endoscopic image of the maxillary sinus mucosa of an OMS patient showing purulent secretion, diffuse edema and remarkably small papillary protrusions. b Tissue section stained by HE demonstrating that a type of papillary-like fold was found in all the maxillary sinus mucosa samples of the OS patients, as well as that the mucosa was still covered with intact pseudostratified columnar ciliated epithelium

Fig. 9

The clinical feature of a typical OMS patient. a Purulent secretion with mucosal swelling and congestion in the right middle nasal meatus under endoscope. b The focal tooth on the right upper jaw under endoscope. c The root of focal tooth protruding into the floor of the maxillary sinus with local discontinuous bone erosion on CT

Fig. 10

Representative sinus CT images of OMS. a, b Definite evidence: CT images show the discontinuity of maxillary sinus floor in the site of dental lesion. c, d Potential evidence: CT images show a thin layer of floor bone remaining between the maxillary sinus floor and oral lesion. e, f Questionable evidence: CT images show a thick layer of floor bone remaining between the maxillary sinus floor and oral lesion

Fig. 11

The standard flowchart for OMS diagnosis and treatment in the clinical treatment process. MS maxillary sinusitis, OMS odontogenic maxillary sinusitis, ESS endoscopic sinus surgery

Fig. 12

Decision-making tree for OMS management in clinical practice.^,,,,, OMS odontogenic maxillary sinusitis, ESS endoscopic sinus surgery, ARP alveolar ridge preservation