Maxilary sinusitis of odontogenic region

Maxilary sinusitis

1. MAXILLARY SINUSITIS OF
ODONTOGENIC ORIGIN
By:
Pande Made Indra Premana
Scientific Advisor:
dr.LuhMade Ratnawati,Sp.T.H.T.K.L(K)
Literature Review

2. INTRODUCTION

3. INTRODUCTION
Sinusitis is a common disease
Inflammation of paranasal sinus mucosa
due to bacterial, viral and fungal infections

4. Dentogenous sinusitis
Radiographic, microbiological, and/or clinical
evidence of dental origin
infection of the upper molars (premolars and
molars)
INTRODUCTION

5. INTRODUCTION
•Incidence still very high
•2003: Paranasal sinus disease
ranked 25th out of 50 major
disease or about 102,817
outpatients in hospital.

6. LITERATURE REVIEW

7. ANATOMY
Anatomy of the Nasal Cavity

8. Anatomy of the Nasal Cavity
The nasal cavity is an irregular space between
the palate of the oral cavity and the base of the
skull
Three conchae in the lateral wall of the nasal
cavity namely: superior, middle, and inferior
concha

9. Anatomy of the Nasal Cavity
•These three nasal conchae form 4 slits for
the passage of air
•Sphenoethmoidalrecess
•Superior nasal meatus
•Medius nasal meatus
•Inferior nasal meatus

10. Anatomy of Paranasal Sinuses

11. Anatomy of Paranasal Sinuses
Maxillary sinuses: the largest of the paranasal sinuses
•Canine fossaAnterior wall
•Infratemporal surface of the maxillaPosterior wall
•Lateral wall of the nasal cavityMedial wall
•Floor of the orbit Superior wall
•Alveolar process and palateInferior wall

12. Anatomy of Paranasal Sinuses
•Drain into the
middle meatus
through the
maxillary ostium
through the
hiatus
semilunaris

13. Maxillary Sinus EmbriologyAnd Development
The embryo’s head develops into a structure
with two distinct nasal cavities
The embryo’s head develops into a structure
with two distinct nasal cavities
The lateral nasal walls then invaginateto create
complex folds, known as turbinate and spaces,
known as sinuses
The lateral nasal walls then invaginateto create
complex folds, known as turbinate and spaces,
known as sinuses

14. Maxillary Sinus EmbriologyAnd Development
The maxillary sinus begins t o form in a 3-month-old
fetus as a result of pneumatization of the maxillary
bone.
The paranasal sinuses are immature at birth and
mature with age
The maxillary sinus grows at a rate of 2-3 mm per
year

15. Maxillary Sinus Histology

16. Maxillary Sinus Histology
Walls of the maxillary sinus covered by a mucous
membrane, consists of
•epithelium (lamina epithelium), a basement
membrane, and subepithelial connective tissue
(lamina propria)
The epithelium is ciliated pseudostratified columnar
epithelium.

17. Maxillary Sinus Function
Lightening the
skull
A vocal resonating
box
Humidify of the
inspired air
Increased
olfaction
Increase faciocranial
resistance through
mechanical trauma

18. MAXILLARY SINUSITIS OF ODONTOGENIC ORIGIN
DEFINITION:
•Inflammation of the nasal mucosa and maxillary
sinus caused by the spread of dental infection
Acute
< 12 weeks
Chronic
≥ 12 weeks

19. EPIDEMIOLOGY
10% of all cases of sinusitis originate from the odontogenic
process
United States : 14.1% of the adult population
•10-15% of all cases originate from odontogenic
Most often occurs in the 40-60 year age group with a slight
female predominance

20. EPIDEMIOLOGY
Rhinology
Division of
the RSCM
•January-August -> 69% had
sinusitis
Medan
•13.67% and 71.43% caused by
apical abscess
Bandung
•Dominant in young and elderly
adult population, infection in the
first and second molars

21. ETIOLOGY
InfectionDental caries
Transmission of dental infection
Periapical infection of maxillary teeth
from premolars to upper third molars
IatrogenicDental implants
Tooth extraction,
Dental fillings

22. ETIOLOGY
50%
44%
6%
MICROBIOLOGY
Anaerobic
bacteria
Combination
Aerobic bacteria

23. PATHOPHYSIOLOGY
Before
reach an
adult size
Distance between the
sinus floor and the
maxillary teeth apices
The maxillary teeth
roots may protrude into
the sinus cavity
The apical aspects of dental
roots surrounded by the sinus
mucoperiosteum
These short distance explain
the easy extension of an
infectious process from these
teeth to the maxillary sinus

24. DIAGNOSIS
Anamnesis
Physical Examination
Supporting Examination

25. DIAGNOSIS-ANAMNESIS
•Unilateral purulent rhinorrhea,
foul smell that suddenly appear,
post nasal dripping, halitosis
Acute
•Nasal obstruction,
hyposmia/anosmia, headache,
facial tenderness, dull cheek pain
Chronic

26. DIAGNOSIS-PHYSICAL EXAMINATION
Inspection
Palpation
Rhinoscopy
Nasoendoskopi.

27. DIAGNOSIS-INSPECTION
●First molars (55%),
●Second molars (34%)
●Second premolars (8%)
●First premolars (3%)
Intra-oral examination

28. DIAGNOSIS
PALPATION ●Tenderness
RHINOSCO
PY
●Purulent discharge
NASO
ENDOSCOPY
•Abnormalities not seen on
anterior rhinoscopy
•Minimal purulent discharge in
the middle meatus
•Polyps

29. DIAGNOSIS-SUPPORTING EXAMINATION
Sinuscopy
Microbiology and Resistencytest
Radiologic Imaging

30. DIAGNOSIS-RADIOLOGIC IMAGING
CT Scan
Plain radiography
Transillumination

31. DIAGNOSIS-WATERS

32. DIAGNOSIS-PANORAMIC

33. DIAGNOSIS-CT SCAN

34. DIAGNOSIS-MICROBIOLOGY AND RESISTENCY TEST
Zirket al. 70%
showed anaerobic
and 30% showed
aerobic.
Generally
polymicrobial
Predominantly
anaerobic
Peptostreptococcus,
Prevotella, and
Fusobacterium.

35. DIAGNOSIS-SINUSCOPY
secretions, polyp tissue and the
state of the sinus mucosa
Puncture through the medial
wall of the maxillary sinus
through the inferior meatus.

36. MANAGEMENT
•Consultation to the dental and mouth
Eliminate causative factors
•Antibiotic
Eliminate Infection
•Surgery
Evacuate secretions from the maxillary sinus

37. MANAGEMENT
•7-14 days
•Culture and resistance
•First Line-Penisillin
•Amoxicillin-clavulanic acid, metronidazole,
cephalexin, ceftriaxone, erythromycin and
clindamycin
Antibiotic

38. MANAGEMENT
Surgery
(evacuate
secret)
•Antrostomi meatus inferior
•Caldwell-Luc
•FESS

39. COMPLICATION
IntracranialOrbital

40. DISCUSSION

41. DISCUSSION
Dentogenousmaxillary sinusitis causedby the spread of dental
infection
•Apical periodontitis in the maxillary
first molar
Akhlagiet al
•Dental caries and pulp infectionRomadhonaet al
•65.7% iatrogenicLittle et al
•Dental implants and tooth
extraction
Lee et al

42. DISCUSSION
Microbiology
•Polymicrobial with mostly anaerobic
organisms
•Peptostreptococcus, Prevotella, and Fusobacteria
Lee et al
•121 documented cases
•70% of cases caused by anaerobic bacteria
Zirket al

43. DISCUSSION
Epidemiology
•Incidence 3,67%
•Apical abcess(71,43%).
Medan
•Young and elderly adult
•Equal number of male and female
•First and second molars
Bandung

44. DISCUSSION
Clinical Presentation
•One-sided purulent rhinorrhea, foul-smelling
and sudden onset
Hoskinson
et al
•18 of 30 patients
•one-sided purulent rhinorrhea
•Foul odor, pain in the cheek, nasal congestion on one side,
swelling of the upper gums and post nasal drip
Lee et al

45. DISCUSSION
Diagnosis
Anterior rhinoscopy or nasal endoscopy
or sinusoscopy
purulent discharge but are still less
The gold standard: CT scan

46. DISCUSSION
Principle of the management of
Eliminate the causative factors
Evacuate secretions from the maxillary
sinus.
Consultation to the teeth and mouth

47. DISCUSSION
Therapy
•Culture and bacterial resistance
•Penicillin
•Amoxicillin-clavulanic acid, metronidazole, cephalexin,
ceftriaxone, azithromycin and clindamycin.
Antibiotic
•52% of patients improved with medical and dental
treatment
•48% required endoscopic sinus surgery
Zirk et al
(Restrospe
ctive)

48. DISCUSSION
•Dentogenousmaxillary sinusitis is an
inflammation of the nasal mucosa and maxillary
sinus
•Caused by the spread of dental infection
•One-sided purulent rhinorrhea, foul-smelling and
sudden onset
•Comprehensive management of the sinus and
dental abnormalities is required

49. THANKYOU