DEFINITION
Sinusitis that originates from dental origin usually originates from the upper molar teeth extending into the maxillary sinus. It is unilateral and accounts for more than 10% for all sinusitis cases. It usually occurs in patients in the 50’s and accounts for up to 75% of all one-sided sinusitis.
CAUSES
Any tooth infection, including tooth root, tooth extraction and implants. With tooth extraction, there is often a connection or fistula between the oral cavity and the sinus.
PATHAPHYSIOLOGY
The roots of the teeth often protrude into the maxillary sinus, and if diseased, it is easily spread into the sinus.
SYMPTOMS
These are chronic and include unilateral midfacial pain, bad-smelling discharge, a blocked nose and dental pain. There is often a prior history of dental work.
CLINICALLY AND INVESTIGATIONS
The Ear, Nose and Throat Surgeon will examine the nose with a telescope and see pus coming from the maxillary drain area. The dentist will obviously assess all dental pathology. A CT scan would define the tooth, the communication and the sinuses.
BACTERIA
Oral anaerobes often infect the sinus as opposed to the respiratory pathogens that cause normal sinusitis, and this is obviously important when one considers antibiotics.
MANAGEMENT
The dentist and the ENT surgeon will often work in parallel with a greater than 90% resolution. The dentist will, for instance, extract the tooth or do root-canal treatment. The Ear, Nose and Throat surgeon often involves surgery, which is mainly the opening of the maxillary sinus drainage hole. Obviously, this is followed by antibiotics and saline rinses.
DIFFERENTIAL DIAGNOSIS
A tumour, whether benign or malignant, may mimic this condition. One can also have a fungal ball or a mucocoele (blockage of the mucous drainage from the sinus).
COMPLICATIONS
This infection can spread to other sinuses and even outside of the sinuses, in other words, the orbits.