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 first manifest itself in adolescence, when the milk incisors change to molars. According to statistics, this disease occurs in eight percent of cases among the total mass of all sinusitis.
Why does it occur?
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 (from the fourth to the eighth tooth) are in close contact with the bottom of the paranasal sinuses. Between it and the incisors lies a bone plate. Sometimes this bottom is so thin that the tooth roots are separated from it.soft tissue only.
What is known about this disease?
Sinusitis is today recognized as the most common otolaryngological disease that requires careful diagnosis and the provision of qualified medical care. One of the varieties of this disease is an acute inflammatory process that occurs in the maxillary sinuses. In medicine, this disease is defined as odontogenic sinusitis of the maxillary sinus, which is an inflammation that has spread to the mucous membrane of the sinuses.
What is the danger of the disease?
In the absence of timely therapy, the disease can 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.
Prerequisites for the disease
The causes of odontogenic sinusitis are the inflammatory process resulting from the reproduction of pathological organisms that have penetrated into the maxillary sinus from the oral cavity. Specialists identify the following factors that provoke the onset of this disease:
- Perforation of the bottom of the sinus during tooth filling. Due to the ingress of filling material into 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 occurs against the background of dental procedures. The cause of inflammation is, for example, a broken dental instrument or turundas, 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 such pathologies as periodontal disease, granuloma and 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 the disease.
- Diseases of the jaw bones also act as a cause of inflammation, such as osteomyelitis or periostitis.
Shapes
Depending on the cause of the development of the pathology, non-perforative and perforated odontogenic sinusitis is distinguished. With a perforated form, there is a direct violation of the integrity of the bottom of the maxillary sinuses, and with a non-perforative nature of the course, inflammation can manifest itself against the background of the existing pathology of the teeth, jaw bone tissue or gums.
As a result of inflammation, the aeration drainage function of the maxillary sinuses is disturbed. This leads to stagnation of serous or mucous secretion, which serves as a completely favorable environment for the reproduction of pathogenic organisms, for example, for bacteria and fungi. Increased contact of pathogenic bacteria with the mucosa of the maxillary sinuses is also facilitated by impaired movementepithelium.
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 there are symptoms of an infectious inflammation of the paranasal sinuses. Now let's find out what symptoms can accompany this disease.
Signs of pathology
The symptoms of odontogenic sinusitis depend on the stage of the disease. 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.
- Occurrence of discharge from the nose from the side of inflammation.
- Presence of nasal congestion combined with impaired sense of smell.
- The occurrence of painful sensations of varying degrees of intensity. Possible irradiation of pain in the temples, in the back of the head, in the upper jaw and ear.
- The appearance of pain in the tooth, which may increase when chewing food.
- It is quite likely that the development of edema of the tissues of the cheek, however, this does not always happen and directly depends on the causes of the development of inflammation.
- Sometimes there may be submandibular lymphadenitis with an increase in the size of the lymph nodes and their general soreness.
- Possible symptoms of periostitis, cysts, osteomyelitis and fistula. Other dental diseases that cause symptoms are not excluded.odontogenic sinusitis.
Often, an illness in patients develops as a primary chronic disease, but it can also manifest itself after an acute inflammation suffered by the patient. Patients usually complain of a slight headache and an intermittent feeling of heaviness in the jaw. There may be a discharge from the nose. Sometimes a putrid, fetid odor may come from the nose in acute odontogenic sinusitis.
General decline in performance
Patients against the background of chronic infection suffer from a general decrease in efficiency. This is especially evident in people engaged in mental work. In the event that an excessive amount of discharged pus accumulates in the maxillary sinus, headaches may increase, and at the same time, discomfort along the trigeminal nerve. Gradually, there may be a transition from the chronic phase to the stage of exacerbation of the pathology with the addition of bacterial infections.
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 may be referred for the following medical studies:
- Orthopantomogram.
- Performing an x-ray of the paranasal sinuses.
- Implementation of a CT scan.
- Taking a diagnostic puncture. As part of this procedure, purulent or mucous exudate is examined.
Implementationtherapy
Treatment of such a disease as odontogenic sinusitis (according to ICD 10 - this is the J32.0 code) is reduced to two tasks that need to be implemented as soon as possible. This is:
- Elimination of the primary focus of infection (rescue the patient from dental problems).
- Elimination of inflammation in the maxillary sinus.
In the event that there is an opportunity, dentists strive to save diseased teeth, but it is important to completely eliminate the existing infection that has formed in the root system, and in addition, in soft tissues. It is possible to carry out therapy in a hospital or outpatient setting.
Restoring natural sinus ventilation
Conservative treatment of odontogenic maxillary sinusitis is reduced to the restoration of natural sinus ventilation. For this, the patient is recommended to use topical vasoconstrictor drugs, for example, Galazolin, Nazivin, Naphthyzin, Sanorin, Otilina and others. Oral antibiotics may also be taken. In this case, antibacterial drugs from the category of penicillins, such as Amoxiclav, become medicines. You can also turn to the use of fluoroquinolones, for this, Levofloxacin is suitable along with Moxifloxacin and other drugs. In order to create the maximum concentration of a therapeutic antibiotic in the sinuses, local antibacterial agents are used, for example, Isofra.
Hospitalization
In the event that sinusitis is complicated by a severe headache, and in addition, swelling of the soft tissue of the face or an intracranial disorder, then it is necessary to conduct a mandatory hospitalization of the patient. Unsuccessful conservative treatment is the basis for surgical intervention. When removing the causative incisor, there is a possibility of unwanted opening of the adjacent sinuses. In this case, the fistula that appears can 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. To do this, the sinus is washed by the evacuation method. For disinfection, a disinfectant solution is used, for example, "Furacilin" 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 surgical intervention arises only with the formation of a polyposis form of the disease, as well as with the necrotic nature of the disease and for dental indications. It is important to remember that as part of the treatment, extreme measures are used by doctors only in cases where chronic odontogenic sinusitis is started, and not only the patient's he alth, but also his life is at risk. Therefore, at the first manifestation of a runny nose, as well as against the background of pain in the areajaw, bridge of nose 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 let's find out what consequences may arise if this disease is not treated.
Consequences of pathology
It is important to remember that delay in the treatment of this disease can have extremely life-threatening consequences for the patient. For example, the following complications are possible:
- Appearance of gum abscess.
- Occurrence of polyps, osteomyelitis and spread of infection to another sinus.
- The occurrence of abscesses and phlegmon in the eye area.
- The occurrence of sinus cancer or meningitis.
- The occurrence of intoxication of the body with a complication, for example, on the heart, kidneys, and so on.
Chronic form
Such a course of the considered pathology 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 undulating and in many respects similar to the clinical picture of chronic rhinogenic sinusitis. An 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 an erased symptomatology: periodically, patients have a feelingheaviness in the sinus area, and in the morning there may be serous purulent discharge. Patients may also experience increased fatigue along with a slight rise in temperature.
