Odontogenic sinusitis: treatment, causes and symptoms
Odontogenic sinusitis is an infectious and inflammatory process in the maxillary paranasal sinus (in the maxillary sinus), which develops as a result of pathology of the roots of the teeth, bone tissue or the gums of the upper jaw.
Odontogenic sinusitis can manifest for the first time only in adolescence, when milk teeth are replaced by molars. According to statistics, "dental" sinusitis, as it is often called, occurs in 8% of cases among the total mass of sinusitis.
The mechanism of development of the disease is determined by the anatomical proximity of the jaw and sinus. The roots of the teeth of the upper jaw (from 4 to 8 teeth) are in close contact with the bottom of the maxillary paranasal sinus. A bone plate lies between the sinus and the teeth. Sometimes this bottom is so thin that the roots of the teeth are limited from it only by soft tissues.
Content:
- Causes of odontogenic sinusitis
- Symptoms of odontogenic sinusitis
- Treatment of odontogenic sinusitis
Causes of odontogenic sinusitis
The causes of odontogenic sinusitis are rooted in the inflammatory process, which occurs as a result of the multiplication of pathological microorganisms that have entered the maxillary sinus from the mouth.
Experts identify the following factors that trigger the onset of the disease:
- Perforation of the sinus floor during tooth filling. When filling material gets into the maxillary sinus cavity, chronic fungal odontogenic sinusitis often develops.
- Penetration of other foreign bodies into the mandibular sinus. Most often this happens during dental procedures. The cause of inflammation can be a broken dental instrument, turundas, debris of fallen tooth roots. Although penetrating injuries to the sinuses are not excluded, which is less common.
- Diseases of the teeth and gums can trigger the onset of odontogenic sinusitis. These are such pathologies as: periodontal disease, granulomas and cysts of the tooth root, subperiosteal abscesses, fistulas, apical periodontitis. Any purulent foci of large and small molars adjacent to the maxillary sinus can cause the development of the disease.
- Diseases of the jaw bone tissue can also act as a cause of inflammation - this is osteomyelitis or periostitis.
Depending on the cause of the development of the disease, perforated and non-perforated odontogenic sinusitis are distinguished. With perforated sinusitis, there is a direct violation of the integrity of the bottom of the maxillary sinus, and with non-perforated sinusitis, inflammation manifests itself against the background of existing diseases of the teeth, gums or jaw bone tissue.
As a result of the existing inflammation, the aeration and drainage function of the maxillary sinus is impaired. This leads to stagnation of serous or muco-serous discharge, which is a favorable environment for the growth and reproduction of pathogenic microorganisms: bacteria and fungi. An increase in the contact time of bacteria with the cells of the maxillary sinus is also facilitated by the disruption of the movement of the ciliated epithelium. If the disease continues for a long time and without treatment, the mucous membrane of the nasal sinus undergoes irreversible changes, and against the background of suppuration, symptoms of infectious inflammation of the paranasal sinus begin to prevail.
Symptoms of odontogenic sinusitis
The symptoms of odontogenic sinusitis depend on the stage of the disease.
The acute phase is characterized by the following clinical picture:
- An increase in body temperature to high values - up to 38-39 ° C.
- Headaches, general malaise.
- Nasal discharge from inflammation.
- Nasal congestion, impaired sense of smell.
- Painful sensations of varying intensity. Possible irradiation of pain in the temples, upper jaw, occiput, ear.
- Painful sensations in the tooth or teeth that cause sinusitis. Toothaches are worse when chewing food.
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It is possible to develop edema of the soft tissues of the cheeks, although this does not always happen and depends on the cause of the inflammation.
- Sometimes submandibular lymphadenitis is observed with an increase in lymph nodes and their soreness.
- There may be signs of periostitis, osteomyelitis, cysts, fistula or other dental disease that caused the development of odontogenic sinusitis.
Odontogenic sinusitis often develops as a primary chronic disease, but it can manifest itself after acute inflammation. Patients complain of minor headaches, recurrent feeling of heaviness in the upper jaw. The appearance of discharge from the nose from the side of the lesion is possible. Sometimes a putrid, fetid odor comes from the nose.
A patient with a chronic infection suffers from decreased performance. This is especially noticeable in people of mental labor.
If a large amount of discharge accumulates in the maxillary sinus, then headaches and pain along the trigeminal nerve intensify. Gradually, there is a transition from the chronic phase to the stage of exacerbation of the disease with the addition of a bacterial infection.
Treatment of odontogenic sinusitis
Treatment of odontogenic sinusitis comes down to two tasks that must be implemented as soon as possible:
- Eliminate the primary focus of infection (save the patient from a dental problem);
- Eliminate inflammation in the maxillary sinus.
If possible, the dentist strives to preserve a sick tooth, but at the same time completely eliminate the existing infection in the root system, in soft tissues. Treatment is possible in a hospital and on an outpatient basis.
Conservative therapy is reduced to the restoration of normal ventilation of the sinus. For this, the patient is recommended to use local vasoconstrictor drugs: Galazolin, Nazivin, Naphtizin, Sanorin, Otilin, etc. It is possible to take antibacterial drugs orally. In this case, antibacterial agents from the group of penicillins (Amoxiclav) or fluoroquinolones (Levofloxacin, Moxifloxacin, etc.) become the drugs of choice.
To create the maximum concentration of the antibiotic in the nasal sinus, local antibacterial agents are used, for example, Isofra.
If sinusitis is complicated by severe headaches, swelling of the soft tissues of the face, intracranial disorders, then the patient must be hospitalized. Unsuccessful conservative therapy is the basis for surgical intervention. Moreover, during the removal of the causative tooth, there is a possibility of unwanted opening of the adjacent sinus. In this case, the formed fistula can close on its own against the background of treatment with iodine tincture. If overgrowth does not occur, the fistula will be closed with a flap of the soft tissues of the gums or palate.
To eliminate pus from the sinus, it is necessary to drain it. To do this, it is washed by sinus evacuation or by a method called "cuckoo". For disinfection, disinfectant solutions are used - these are Furacilin, Rivanol, potassium permanganate, etc. Antibiotics and proteolytic enzymes are also directly injected into the nasal cavity.
Chronic odontogenic sinusitis is also treated conservatively. The need for surgical intervention is due to the formation of odontogenic polyposis sinusitis, necrotizing chronic sinusitis, as well as for dental indications.
The author of the article: Lazarev Oleg Vladimirovich | ENT
Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)
