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Odontogenic sinusitis: developments in diagnosis, microbiology, and treatment

Workman, Alan, D.a; Granquist, Eric, J.b; Adappa, Nithin, D.a

Current Opinion in Otolaryngology & Head and Neck Surgery: February 2018 - Volume 26 - Issue 1 - p 27–33
doi: 10.1097/MOO.0000000000000430
NOSE AND PARANASAL SINUSES: Edited by Samuel S. Becker and Nithin D. Adappa
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Purpose of review Odontogenic causes of sinusitis are frequently missed; clinicians often overlook odontogenic disease whenever examining individuals with symptomatic rhinosinusitis. Conventional treatments for chronic rhinosinusitis (CRS) will often fail in odontogenic sinusitis. There have been several recent developments in the understanding of mechanisms, diagnosis, and treatment of odontogenic sinusitis, and clinicians should be aware of these advances to best treat this patient population.

Recent findings The majority of odontogenic disease is caused by periodontitis and iatrogenesis. Notably, dental pain or dental hypersensitivity is very commonly absent in odontogenic sinusitis, and symptoms are very similar to those seen in CRS overall. Unilaterality of nasal obstruction and foul nasal drainage are most suggestive of odontogenic sinusitis, but computed tomography is the gold standard for diagnosis. Conventional panoramic radiographs are very poorly suited to rule out odontogenic sinusitis, and cannot be relied on to identify disease. There does not appear to be an optimal sequence of treatment for odontogenic sinusitis; the dental source should be addressed and ESS is frequently also necessary to alleviate symptoms.

Summary Odontogenic sinusitis has distinct pathophysiology, diagnostic considerations, microbiology, and treatment strategies whenever compared with chronic rhinosinusitis. Clinicians who can accurately identify odontogenic sources can increase efficacy of medical and surgical treatments and improve patient outcomes.

aDivision of Rhinology, Department of Otorhinolaryngology: Head and Neck Surgery

bDepartment of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Correspondence to Nithin D. Adappa, MD, Division of Rhinology, Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Medical Center, 5th Floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104, USA. Tel: +1 215 662 2360; fax: +1 215 14 0071; e-mail: Nithin.Adappa@uphs.upenn.edu

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