Odontogenic sinusitis of the maxillary sinus is an infectious inflammatory process that develops as a result of pathologies of the roots of the teeth, bone tissue or gums of the upper jaw. This disease can manifest itself for the first time in adolescence, when milk incisors change to indigenous. According to statistics, such a disease occurs in eight percent of cases among the total mass of all sinusitis.
Why arises?
The mechanism of development of this disease is explained by the anatomical proximity of the nasal sinus and jaw. The roots of the teeth located in the upper jaw (starting from the fourth to eighth tooth) are in close contact with the bottom of the sinuses. Between him and the incisors lies a bone plate. Sometimes this bottom is so thin that the tooth roots are separated from it only by soft tissues.
What is known about this disease?
Sinusitis is today recognized as the most common otolaryngological disease, requiring careful diagnosis and the provision of qualified medical care. One of the varieties of this ailment is an acute inflammatory process that occurs in the maxillary sinuses. In medicine, this ailment is defined as odontogenic sinusitis of the maxillary sinus, which is inflammation spreading to the sinus mucosa.
What is the danger of an ailment?
In the absence of timely therapy, the disease is able to affect the periosteum with bone tissue. After diagnosing acute or chronic odontogenic maxillary sinusitis, treatment is carried out by a dentist, surgeon or otolaryngologist, depending on the general condition and well-being of the patient. This also takes into account the causes of the disease.
Disease background
The causes of odontogenic sinusitis are the inflammatory process that occurs as a result of the reproduction of pathological organisms that enter the maxillary sinus from the oral cavity. Specialists distinguish the following factors that provoke the onset of this disease:
- Perforation of the sinus floor during tooth filling. Due to the ingestion of filling material in the region of the maxillary sinus, people often develop fungal chronic odontogenic sinusitis of the maxillary sinus.
- Penetration of various foreign bodies into the region of the mandibular sinus. Often this happens against the background of dental procedures. The cause of inflammation is, for example, a broken dental instrument or turunda, fragments of failed tooth roots, and so on. Although penetrating wounds are not excluded, which is much less common.
- Pathologies of the teeth and gums can trigger the onset of such sinusitis. These are primarily pathologies such as periodontal disease, granuloma and a cyst of the tooth root, along with subperiosteal abscesses, fistulas and apical periodontitis. Any purulent foci of small and large molars that are adjacent to the maxillary sinus can cause a disease.
- Diseases of the jaw bone also act as a cause of inflammation, such as osteomyelitis or periostitis.
Forms
Depending on the cause of the development of pathology, nonperforative and perforated odontogenic sinusitis are distinguished. With a perforated form, there is a direct violation of the integrity of the maxillary sinus floor, and with a non-perforated nature of the course, inflammation can occur against the background of existing pathology of the teeth, bone jaw tissue or gums.
As a result of inflammation, the aeration drainage function of the maxillary sinuses is impaired. This leads to stagnation of serous or mucous secretion, which serves as a very favorable environment for the reproduction of pathogenic organisms, for example, bacteria and fungi. Strengthening the contact of pathogenic bacteria with the mucosa of the maxillary sinuses also contributes to the violation of the movement of the epithelium.
In the event that the pathology proceeds for a long time and without therapy, the nasal mucosa undergoes an irreversible change, and against the background of suppuration, symptoms of the presence of infectious inflammation of the maxillary sinuses occur. Now find out what symptoms may accompany this disease.
Signs of pathology
Symptoms of odontogenic sinusitis depend on what stage the disease is at. The acute phase is characterized by the following clinical picture:
- The temperature rises to high levels, namely to thirty-eight or thirty-nine degrees.
- The appearance of headaches along with general malaise.
- The occurrence of nasal discharge from inflammation.
- Presence of nasal congestion in combination with impaired sense of smell.
- The occurrence of painful sensations of varying degrees of intensity. Irradiation of pain in the temples, in the back of the head, in the upper jaw and ear is possible.
- The appearance of painful sensations in the tooth, which can intensify when chewing food.
- It is likely the development of swelling of the tissues of the cheek, however, this does not always happen and directly depends on the causes of inflammation.
- Sometimes submandibular lymphadenitis with an increase in the size of the lymph nodes and their general soreness can be observed.
- Symptoms of periostitis, cysts, osteomyelitis and fistula are possible. Other dental diseases that cause symptoms of odontogenic sinusitis are not excluded.
Often, an illness in patients develops as a primary chronic disease, but it can also occur after acute inflammation suffered by the patient. Patients, as a rule, complain of a minor headache and a periodically appearing feeling of heaviness in the jaw. Perhaps the appearance of discharge from the nose. Sometimes a putrid fetid odor can come from the nose in acute odontogenic sinusitis.
Overall performance degradation
Patients with chronic infection suffer from a general decrease in performance. This is especially evident in people engaged in mental work. In the event that an excessive amount of pus is accumulated in the maxillary sinus, headaches can intensify, and at the same time, uncomfortable sensations along the trigeminal nerve. Gradually, a transition from the chronic phase to the stage of exacerbation of pathology with the addition of bacterial infections can occur.
For this reason, the symptoms of odontogenic sinusitis of the maxillary sinus should not be ignored.
Diagnostics
As part of the diagnosis of this disease, the patient can be referred to the following medical studies:
- Carrying out an orthopantomogram.
- X-ray of the paranasal sinuses.
- Implementation of a computer tomogram.
- Taking a diagnostic puncture. As part of this procedure, purulent or mucous exudate is examined.
Therapy
The treatment of a disease such as odontogenic sinusitis (according to ICD 10 is code J32.0) reduces to two tasks that need to be implemented as soon as possible. It:
- Elimination of the primary focus of infection (ridding the patient of dental problems).
- Elimination of inflammation in the maxillary sinus.
In that case, if possible, dentists seek to preserve diseased teeth, but it is important to completely eliminate the existing infection that has formed in the root system, and in addition, in the soft tissues. It is possible to conduct therapy in a hospital or as an outpatient.
Restoring sinus ventilation
Conservative treatment of odontogenic maxillary sinusitis reduces the restoration of sinus ventilation. For this, the patient is recommended to use local vasoconstrictor drugs, for example, Galazolin, Nazivin, Naftizin, Sanorina, Otilina and others. It is also possible to take antibacterial drugs orally. In this case, antibacterial drugs from the penicillin category, such as Amoxiclav, become medicines. You can also turn to the use of fluoroquinolones, for this, “Levofloxacin” along with “Moxifloxacin” and other drugs are suitable. In order to create the maximum concentration of therapeutic antibiotic in the sinuses, local antibacterial agents, for example, Isofru, are used.
Hospitalization
In the event that sinusitis is complicated by a severe headache, and in addition, swelling of the soft tissue of the face or intracranial disorder, it is necessary to carry out mandatory hospitalization of the patient. Unsuccessful conservative treatment is the basis for surgical intervention. When the causal incisor is removed, there is the likelihood of unwanted opening of the adjacent sinuses. In this case, the fistula that appears may close on its own due to the treatment with iodine tincture. In situations where its healing does not occur, the fistula will have to be closed with soft tissues of the palate or gums.
In order to eliminate pus from the sinuses, it is necessary to drain them. For this, the sinus is washed by the evacuation method. For disinfection, a disinfectant solution is used, for example, “Furatsilin” or “Rivanol”, “Potassium permanganate” and so on. An antibiotic and proteolytic enzymes are also injected directly into the nasal cavity.
How is chronic odontogenic sinusitis treated?
Chronic illness is also treated conservatively. The need for surgery arises only with the formation of the polyposis form of the disease, as well as with the necrotic nature of the disease and for dental reasons. It is important to remember that in the framework of treatment, doctors use extreme measures only when chronic odontogenic sinusitis is started, and not only the patient’s health, but also his life is at risk. Therefore, at the first manifestation of a runny nose, and also against the background of pain in the area of the jaw, nose bridge or mouth, it is best to immediately contact a specialist. A timely diagnosis along with the prescribed treatment will help to avoid a number of serious consequences.
Now we find out what consequences may arise if there is no treatment for this disease.
The consequences of pathology
It is important to remember that delaying the treatment of this disease can have extremely dangerous consequences for the patient's life. For example, the following complications are possible:
- The appearance of abscess gums.
- The occurrence of polyps, osteomyelitis and the spread of infection to the other sinus.
- The occurrence of abscesses and phlegmon in the eye area.
- The appearance of cancer of the sinus mucosa or meningitis.
- The occurrence of intoxication of the body with a complication, for example, on the heart, kidneys and so on.
Chronic form
A similar course of the pathology under consideration is a consequence of the acute nature of the course of the disease. It also occurs as a primary subacute or chronic process. The course of this disease without a perforation is wave-like and in many ways similar to the clinical picture of chronic rhinogenic sinusitis. Exacerbation often occurs after hypothermia, otolaryngological diseases or may coincide with an exacerbation of chronic periodontitis.
The clinical picture is in many ways similar to the acute process. During periods of remission, chronic sinusitis has erased symptoms: periodically, patients have a feeling of heaviness in the sinus area, and in the morning there may be serous purulent discharge. Patients may also experience increased fatigue along with a slight increase in temperature.