Bilateral odontogenic sinusitis. A case of sinusitis with dental origin in a patient who has undergone several medical treatments.
The patient reported having seen two otorhinolaryngologists, reporting typical symptoms of sinusitis, pain and pressure in the region of the maxillary sinus, and having undergone several treatments, with no long-term improvement.
On clinical examination, teeth 16 and 26 did not show positive vitality, and tooth 26 presented pain on palpation and percussion. Panoramic and periapical radiographs revealed endodontic treatment performed on tooth 27 and did not provide conclusive images about the relationship between sinusitis and endodontic infection. CT scan revealed images of cortical disruption of the maxillary sinus and thickening of the sinus mucosa around the apices.
Diagnosis: bilateral sinusitis of dental origin or endo-antral syndrome, caused by apical periodontitis on teeth 16 and 27. The teeth were treated endodontically and there was remission of the symptoms.
In: Gonçalves et al. Sinusitis of Dental Origin. Case report. TRANSDISCIPLINARY HEALTH SEMINAR - no. 04 - year 2016
INTRODUCTION
The skull has five pneumatic cavities, called sinuses (ethmoid, sphenoid, frontal, and maxillary). The maxillary sinus is the largest of them, it is formed in the intrauterine life through the invagination of the nasal cavity, and continues its formation afterwards, being responsible for humidifying and warming the inspired air and functions as a resonance box for the voice (Peterson et al., 2005; Brook, 2006; Scuderi et al., 1993).
Odontogenic sinusitis (or maxillary sinusitis) is located in the maxillary sinus, where an inflammation of the membrane occurs. Didactically, it is divided into two forms: 1) traumatic (which involves direct impact on the region, affecting the sinus floor) and 2) non-traumatic.
Several causes are associated with the latter such as: general infections of the organism citing colds, pneumonia,
influenza, among others; as well as odontogenic causes, arising from infectious foci near the sinus, highlighting caries, iatrogenic diseases, odontogenic cysts and periodontal disease (Mehra et al., 1999; Maia-Filho et al., 2007).
Clinically, odontogenic sinusitis can be divided into acute or chronic. The first is based on intense pain irradiated to the hemi-arch, periodontal pain, pain to percussion and/or pressure, swollen turbinates, purulent nasal secretions and oroantral fistula. The second one has weak symptoms and may present headache, sensation of pressure, and also acute symptoms (Horch, 1995).
Many times the roots of premolar and molar teeth are in close contact with the sinus because they are just below the floor, and any involvement in this region can drain into the maxillary sinus, triggering the sinusitis of odontogenic origin in Schneider's membrane represented by inflammatory and/or infectious reaction (Mehra & Murad, 2004; Brook, 2006; Costa et al., 2007).
The microbiology existing in sinus infections consists of a polymicrobial flora, composed of aerobic and anaerobic bacteria (Peterson et al., 2005), the anaerobic ones coming from the oropharynx, periodontal and endodontic infection.
As for aerobes, they are fewer in number. However, both bacterial agents are present in both presentations of sinusitis, acute and chronic (Brook, 2005).
The diagnostic process includes a detailed investigation of the clinical history, a complete physical examination (extra and intraoral) and imaging studies, such as intraoral (periapical) and extraoral (panoramic and tomography) radiographs (Vale et al., 2010). The latter is the most recommended due to its high quality, lower exposure to radiation and high capacity to assess sinus anatomy, allowing the observation of lesions in the mucosa, their extensions and anatomical variations, and bone structures from various perspectives (Nishimura and Ilzuka, 2002).
The treatment consists of eliminating the causal factors and the infection present in the breast (Brook, 2006).
Usually the pharmacological and surgical therapies are combined to solve this pathology (Costa et al., 2007; Vale et al., 2010), because the administration of antibiotics is essential in the therapeutic process preventing complications, highlighting penicillin, due to its broad spectrum (Mathew et al., 2012; Sanchéz et al., 2011). The use of nasal decongestants and hydration drops also help in this process (Harvey et al., 2007).
Bilateral odontogenic sinusitis
