Differential diagnosis of sinusitis of dental origin using computed tomography.paper published in the APCD Journal, with Prof. Frederico Laperriere (BH) and Prof. Dr. Frederico Martino (Univ. of Maryland USA)
INTRODUCTION
The involvement of the maxillary sinus with endodontic pathologies has long been described by endodontists and otolaryngologists. Infection originating from the root canal is widely recognized as causing inflammation of the sinus mucosa after destruction of its cortical bone. This capacity to cause injury is as greater as the proximity of the apices to the inferior cortical of the sinus. This distance varies greatly from patient to patient, and even on different sides of the same individual. In several cases, the root apex protrudes into the maxillary sinus with minimal or no bone coverage, covered only by the sinus membrane.
The odontogenic origin of sinusitis is reported in about 10 to 12% of cases. On the other hand, sinusitis without endodontic cause is often reported by patients and even confused by dental surgeons, as odontogenic, highlighting the importance of the correct interpretation of clinical findings and examinations by the health professionals involved.
The set of signs and symptoms that define the picture of sinusitis of endodontic origin, is called endo-antral syndrome and is characterized by: endodontic infection in a tooth near the maxillary sinus, periapical radiolucent image related to the affected tooth, loss of lamina dura around the apex corresponding to the radiographic inferior border of the maxillary sinus, radiopaque image in the maxillary sinus over the apex of the involved tooth, and varying degrees of radiopacity in the image of the maxillary sinus affected by inflammation compared to the maxillary sinus on the opposite side.
CLINICAL CASE 1
A 56-year-old male patient presented to the dental surgeon reporting pain when chewing. During anamnesis, the patient reported recurrent sinusitis with no apparent cause. He also reported having had endodontic treatment on tooth 16 5 years ago. The clinical examination revealed a small edematous area on the gingiva in the mesiobuccal root region of tooth 16, and pain on percussion test. The periapical radiographic examination revealed satisfactory endodontic treatment performed on teeth 15 and 16. A CT scan revealed in tooth 16 the presence of another untreated mesiobuccal root canal, periapical bone rarefaction confined to the mesiobuccal root, disruption of the inferior cortical bone of the maxillary sinus adjacent to this root and partial masking of the image of the maxillary sinus. It is noteworthy that none of these findings were observed in the periapical radiographic examination.
CLINICAL CASE 2
Female patient, 40 years old, attended the dental service referred by another colleague due to extensive caries in tooth 17. In the anamnesis she did not report any symptoms related to endodontic or sinus pathology. Clinical examination revealed extensive caries in the mesial region and negative response to pulp vitality tests. Periapical radiographic examination revealed an extensive radiolucent image in the crown and diffuse periapical bone rarefaction apparently over the palatal root. CT scan revealed bone and lamina dura loss contiguous to the periapical region of the three roots and extensive disruption and pulling away of the inferior cortical bone of the maxillary sinus, besides a radiopaque image compatible with inflammation of the sinus mucosa around the whole affected area.
CLINICAL CASE 3
Male patient, 41 years old, came to the office reporting pain to the touch on tooth 26. In the anamnesis he reported that the tooth had been endodontically treated for more than 10 years. Clinical examination revealed pain on percussion. Radiographic examination revealed unsatisfactory endodontic treatment and the presence of a radiolucent image on the MV root. CT scan showed a small diffuse radiolucent image in the apex region of the palatal canal and an extensive radiolucent image circumscribed by cortical bone involving the buccal roots, with thickening of the mucous membranes of the maxillary sinus in the region contiguous to the lesion, in addition to an untreated MV2 canal.
https://ferrariendodontia.com.br/perfuracao-radicular-cirurgia/
