Which doctor treats odontogenic sinusitis. Odontogenic sinusitis

Odontogenic maxillary sinusitis associated with inflammation of the tooth root.

One of the types of inflammation in the maxillary sinus is odontogenic sinusitis. It may be acute or chronic course, various symptoms, but there is always a direct connection with various inflammatory diseases of the oral cavity.

According to ICD-10, there is no code that would characterize the odontogenic process. In the classification of diseases, you can find codes corresponding to acute, chronic, polypous sinusitis.

According to the latest recommendations, the name “stomatogenous maxillary sinusitis” is more appropriate, since it can be caused by various pathological processes associated and not associated with medical dental intervention. Therefore, all odontogenic processes can be divided into “true odontogenic” and iatrogenic, that is, associated with dental treatment.

True odontogenic sinusitis

Structure upper jaw such that the bottom of the sinus is at the same time the roof of the alveolar process, a bed for the roots permanent teeth.

Anatomy of the upper jaw.

IN childhood, when the change of teeth has not yet occurred, the permanent teeth are located inside the sinus itself. In some cases, one or more teeth do not replace the milk teeth, but remain in the sinus.

They are called impacted or dystopic (that is, they have not taken their permanent position among the permanent teeth) and are not a pathology in themselves. We will talk more specifically about the tooth in the sinus later.

Model of a child's skull with baby and permanent teeth.

The maxillary sinus is small in volume, but covers almost the entire dentition.

Above which teeth is the maxillary sinus located? Most often, the closest located: second incisor, canine, small molars.

Wisdom teeth are too far away and do not directly participate in the development of “dental” sinusitis. But if the wisdom tooth is affected by caries, damage to the bone of the upper jaw may occur with further inflammation of the sinuses.

Relationship between dentition and sinus cavity (highlighted in green)

A number of factors contributing to the development of sinusitis:

• Anatomical proximity of the roots of the teeth and the sinus cavity;
• Thin cortical plate of the sinus floor
• Communication between the roots of the teeth and the sinus cavity.

The main causes of odontogenic sinusitis (without medical intervention):

• Carious teeth
• Cystogranuloma - tissue change at the apex of the tooth root
• Apical periostitis and bone caries - types of inflammation around the root

The most common cause of the development of a purulent odontogenic process is carious teeth in the upper jaw. Untreated caries leads to the development of inflammation of the bone around the root (periodontitis and osteomyelitis).

Apical periodontitis (around the root apex) causes destruction of the thin cortical plate that separates the dental roots from the sinus cavity at the top. As a result, putrefactive microorganisms easily penetrate the sinus through the tooth canal and cause the development of inflammation. It should be noted that teeth can hurt even with non-odontogenic sinusitis; this is due to the structural features of the upper jaw.

Dental caries of the upper jaw is a common cause of odontogenic sinusitis.

Normally, the maxillary sinuses are ventilated through the anastomosis with the nasal cavity; with inflammation, swelling of the mucous membrane develops, and the anastomosis often closes. This leads to the formation of an oxygen-free (anaerobic) environment in the sinus cavity, in which anaerobic bacteria quickly multiply.

The pathogen factor distinguishes ordinary acute sinusitis from odontogenic one. Anaerobes are more resistant and less treatable than aerobic bacteria. Pus in the sinus does not have a natural outflow (through the anastomosis), so it is often necessary to use surgical treatment methods (puncture).

Not only caries is the cause of the development of the inflammatory process in the sinus.

Cause	Process	Symptoms
Cystogranuloma of the root as a consequence of the carious process.	Cystogranuloma is a pathological formation that occurs after suffering and untreated pulpitis and periodontitis (inflammation of the inside of the tooth). To separate inflammation from healthy tissues, the body forms a membrane (cyst) around the inflammation, which, in bone conditions, has dense walls of several specific layers (granuloma).	Outside of an exacerbation, these formations may not have any symptoms, or the teeth may hurt when biting. If the immune system cannot cope with the inflammatory process, or the correct dental treatment has not been carried out, cystogranuloma grows. The pathological effect of cystogranuloma, which leads to sinusitis: pressure on surrounding tissues, destruction of the bone wall, · development of edema in the sinus.
Development of apical periodontitis	Apical periodontitis is an inflammation of the dentogingival ligament localized around the root apex	An acute process is manifested by pain, a feeling of fullness in the jaw, protruding teeth, and an increased reaction to hot things. Chronic process - often has an asymptomatic course, and may cause unpleasant odor from the mouth. When the process worsens, a fistula may form. Apical periodontitis often ends in the formation of cystogranuloma.

Dental process

A fairly large proportion of inflammatory processes in the nasal sinuses are the consequences of improper or defective dental treatment.

Let us highlight the main manipulations that can lead to an odontogenic process:

• Removal of a tooth
• Canal filling
• Implantation

Tooth extraction

Sinusitis after removal upper tooth develops quite rarely. A qualified dental surgeon can remove a tooth or its roots from the jaw without damaging surrounding tissue. But if there are pathological processes that disrupt the bone structure, perforation of the sinus bottom is possible after removal.

The bone structure is disrupted, for example, with osteoporosis (in older people), and the bone “discharges” and becomes fragile. With cysts, cystogranulomas, and abscesses, a zone of sclerosis (compaction) is formed around the tooth root. In this case, periodontal tissues are very tightly fused to the tooth.

The open maxillary sinus becomes great way for the penetration of microbes. If measures are not taken to close the perforation, a fistula may form between the oral cavity and the maxillary sinus.

Perforation of the maxillary sinus.

Endodontic treatment

Canal filling can be sufficient, insufficient or excessive. The filling material is pumped into the root canal; with proper manipulation, all canals should be filled, and the filling mass should not leave the root zone. If the filling is insufficient, one or more canals may remain untreated, making them a direct route for pathogens to enter the sinus.

But more often the canal is overfilled with filling material. Dental canals are thin, often tortuous, and the dentist needs to apply some force to carefully compact the filling into the canal.

In some cases, if the impact is too strong, the bone plate is damaged, and the filling material ends up in the maxillary sinus; the consequences of this process are different, but most often a chronic inflammatory process develops.

Computed tomography and reconstruction of odontogenic sinusitis. The arrows indicate the filling material.

Chronic odontogenic maxillary sinusitis caused by a foreign body is often a purulent-hyperplastic disease. In this condition, as a result of prolonged inflammation, various structures grow inside the sinus - cysts and polyps. But, unfortunately, the efforts of the immune system to neutralize the foreign substance are not enough; purulent inflammation is constantly maintained in the sinus, with rare intervals outside of exacerbation.

Implantation

Implantation is a complex and lengthy process. In rare cases, at the stage of insertion of the intramaxillary pin, bone tissue is destroyed and the metal pin partially or completely enters the sinus.

Can sinusitis occur with properly installed dental implants? There may be reactive swelling as a result of foreign material in the jaw, but there should be no true inflammation in the sinus.

Migration of a dental implant (indicated by an arrow).

Impacted tooth

A tooth in the sinus is a fairly rare occurrence. When changing teeth in some people, the permanent tooth does not “descend” from the thickness of the alveolar process and remains forever in the sinus. This condition is often asymptomatic and is a diagnostic finding, for example, with panoramic radiography.

The tooth may not be completely “stuck” in the bone; the root may remain in the sinus permanent tooth. What to do in this case? The situation is ambiguous, since removal of the root from the sinus can lead to perforation of the bottom and the formation of a fistula. The tooth whose root enters the maxillary sinus must be absolutely healthy, without any signs of caries.

Some doctors recommend removing dystopic teeth, even if they do not bother you. This statement is valid if there are aesthetic defects: due to a violation of the change of teeth, the bite has changed, a diastema has appeared (a gap between the teeth), and so on.

These problems are corrected using various orthodontic techniques, such as braces.

Installation of braces to reduce impacted canine teeth.

Under unfavorable conditions, for example, with frequent sinusitis (not odontogenic), widespread dental caries, inflammatory processes also begin in the impacted tooth, which makes it a direct source of sluggish infection.

What to do if a tooth is found in the sinus? If there are no complaints, nothing. If there are symptoms of inflammation, or orthodontic or orthopedic treatment is planned, the tooth must be removed. It can interfere with proper implantation and reduce the effectiveness of braces and plates.

Panoramic radiograph of the dentition

Clinical manifestations

The maxillary sinus is a closed bone space; any processes inside it, regardless of the cause, cause local manifestations:

• Headache, mainly in the facial part of the skull
• One- or two-sided nasal congestion
• Purulent or purulent mucous discharge from the nose

The headache is not limited only to the face, it intensifies when bending over and spreads to the teeth. Patients complain that their teeth hurt from sinusitis. What comes first - sinusitis due to a tooth or toothache because of sinusitis?

It all depends on the nature of the process, because even if sinusitis is not caused by teeth, the symptoms and manifestations may be similar. Inflammation of the mucous membrane, especially purulent, diffusely affects the intramaxillary nerves, which leads to pain in the teeth with sinusitis.

Computer tomogram for odontogenic sinusitis:
1 - inflamed mucous membrane and pathological discharge
2 — foreign body
3 - roots of teeth in the sinus

If the diseased tooth is directly connected to the sinus, caries is the root cause of toothache, and the process in the sinus is its consequence

Complications

If toothache with sinusitis intensifies, it means that the disease is progressing and the patient’s condition is worsening. Gradually, the bone is involved in the inflammatory process, first bone caries develops, and then odontogenic osteomyelitis of the upper jaw.

Photo of a child with odontogenic osteomyelitis of the upper jaw and orbital abscess.

Bone destruction leads to the formation of soft tissue abscesses, the development of orbital osteomyelitis, and eye damage. Under unfavorable conditions, the infection spreads further, into the remaining sinuses and inside the skull, and develops intracranial complications, such as a brain abscess.

Unfortunately, even in our time, when dental care available, there are frequent cases of severe complications of sinusitis, including death.

Abscess of the frontal lobe of the brain as a consequence of sinusitis.

How does the treatment process work?

Symptoms and treatment of odontogenic sinusitis largely depend on the underlying cause of the disease. But in any case, two doctors must treat the patient: a dentist and an ENT specialist.

Which doctor should I go to first? Ideally, teeth should be in order before otolaryngological treatment begins, but this is extremely rare. Usually the ENT specialist prescribes treatment acute sinusitis or exacerbation of a chronic disease, and the dentist simultaneously treats or removes diseased teeth.

Treatment Options

All treatment options can be briefly described in the table:

Cause	Treatment method
Caries of the upper jaw	Dental treatment of caries, conservative treatment sinusitis. A puncture of the maxillary sinus may be performed to quickly evacuate pus.
Perforation of the sinus floor	Elimination bone defect, conservative treatment of inflammation
Implant migration	Sinus opening, implant removal, conservative treatment of sinusitis
Filling material in the sinus	Maxillary sinusotomy, removal of a foreign body, conservative treatment of inflammation.
Development of complications	Urgent open maxillary sinusotomy with mandatory opening of all purulent foci and drainage

If perforation occurs during tooth extraction maxillary sinus and sinusitis has developed - required qualified assistance maxillofacial surgeon. In this case, it is necessary to eliminate the defect in the jaw.

To do this, plastic surgery is performed or the defect is closed. soft tissues so that there is no direct communication between the oral cavity and the maxillary sinus. If the perforation is left “as is,” a permanent fistula is formed in its place.

Is it possible to treat “dental” sinusitis conservatively without resorting to surgical methods? It is possible, but a rapid exacerbation of the process is possible, because the source of inflammation has not been removed.

According to the instructions, treatment should be comprehensive:

• Dental care(treatment of caries, endodontic treatment - canal filling, treatment of apical periostitis, removal of cystogranuloma);
• Antibacterial treatment. Antibiotics are used wide range actions, adjusted for the anaerobic nature of pathogens and bone damage. Levofloxacin, metronidazole, and clindamycin are widely used.
• Anti-inflammatory therapy- nimesulide, diclofenac, ibuprofen and other non-steroidal anti-inflammatory drugs. The maxillary sinus and teeth hurt quite badly; NSAIDs not only reduce inflammation, but also relieve pain.
• Vasoconstrictor drops and nasal steroids. These groups of drugs reduce swelling in the nasal cavity and sinuses and promote the evacuation of pathological discharge.
• Agents that dilute secretions and improve secretion: Sinupret, Sinusstrong, Cinnabsin and others. This group of drugs includes the drug Sinuforte (cyclamen extract). Cyclamen roots will not cure sinusitis, but will improve sinus drainage in an integrated approach.

Treatment of odontogenic sinusitis folk remedies monotherapy is an ineffective option. If sinusitis has developed from diseased teeth, the source of suppuration has not been removed - no rinses, compresses or inhalations will have any effect. The problem of odontogenic processes is the involvement of bone structures in inflammation.

Surgery

It is rare that a case of acute (due to sinus perforation during tooth extraction) or chronic odontogenic sinusitis can be treated without surgical intervention.

Incision site for open maxillary sinusotomy.

As a temporary treatment option, puncture of the maxillary sinus or balloon dilatation of the anastomosis is used. These methods allow you to evacuate liquid discharge and alleviate the patient’s condition.

Radical maxillary sinusotomy according to Caldwell-Luc or endoscopic sinoscopy is used in the treatment of chronic sinusitis in the “cold period” or when complications develop. These interventions are especially relevant in the development of a chronic process due to a foreign body in the sinus. With a maxillary sinus, the sinus is opened and the pathological contents are removed.

The video in this article demonstrates endoscopic removal foreign body from the maxillary sinus

Prevention

To prevent the development of an odontogenic process in the sinus, you need to keep your teeth in order. Visiting the dentist twice a year in the absence of complaints is a guarantee of oral health and a guarantee of the absence of consequences in the form of odontogenic sinusitis. If your tooth hurts, you should urgently visit a dentist.

Proper endodontic treatment, correction of prostheses, and x-ray control after filling the canals help avoid foreign bodies getting into the sinus.

Conclusion

Diseased carious teeth, fistulas between the sinus and the oral cavity, a foreign body in the sinus - all these factors can lead to the development of sinusitis. The process can be acute and chronic, with frequent exacerbations or practically asymptomatic.

Treatment of odontogenic sinusitis is almost always complex and interdisciplinary: dental, conservative and surgical. The goal of treatment is to remove the source of infection, clear the sinus of pathological discharge and eliminate inflammation in the bone structures. Prevention of the disease is the timely treatment of caries, daily toilet teeth and oral cavity.

O dontogenic sinusitis is an inflammatory-infectious, less common fungal infection mucous membranes of the epithelium of the nasal passages and, first of all, the maxillary (maxillary) sinuses, caused by dental diseases. The second name of the pathology is maxillary sinusitis.

The pathological process, in most cases, develops due to insufficient attention to the condition oral cavity, or is a complication after dental treatment. Thus, the name of the disease indicates the etiology of inflammation of the maxillary sinuses.

According to medical statistics, odontogenic sinusitis develops relatively rarely. It is observed in approximately 13-15% clinical cases. It occurs mainly in adult patients from 20 to 60 years of age and older.

This is a complex and sometimes life-threatening disease. It requires immediate medical attention, otherwise there is a high risk of developing threatening complications, up to meningitis and cerebral edema due to the penetration of flora into cerebral structures with the bloodstream.

The essence of the pathological process is the penetration of bacteria or viruses into the area of ​​the maxillary sinuses through the molars in the upper jaw.

This is the most common scenario, since the roots of these teeth partially protrude into the maxillary sinuses (sinuses) and may not even be covered by mucous membrane, in other words, this is a direct path from the oral cavity to the sinuses.

Theoretically, any inflammatory process localized in the upper jaw can cause odontogenic sinusitis, since it involves the proliferation of bacteria that are looking for new ways of spreading.

These are carious cavities, inflammation of the gums or fistula, periodontal disease, periodontitis, bacterial lesions of the mucous membranes of the oral cavity, the presence of a cyst.

The second type of reason is the consequences of surgical intervention by a dentist. For example, the removal of the 5th, 6th or 7th tooth often leads to the formation of a through hole (perforation of the bottom of the maxillary sinus) through which microorganisms penetrate and an odontogenic cyst of the maxillary sinus is formed.

Inflammation is also caused by the remains of tooth roots or nerve endings in the gums, penetration of the filling compound into the sinus, careless installation of implants and other dentist manipulations.

What microorganisms provoke the disease?

The disease in question develops across a whole group probable causes. The first and main one is the unfavorable condition of the oral cavity. The mouth is home to a whole group of pathogenic and opportunistic microorganisms and viral agents.

Among them:

• Herpes viruses.

Causes acute forms of sinusitis involving pathological process the entire nasopharynx and oropharynx. The first type of virus (aka HSV) provokes classic, severe forms of the disease with intense mucus discharge, exudation, and swelling.

The second type of agent is found in medical practice relatively rare, as well as the third (varicella-zoster most often provokes chicken pox). The fourth and fifth types ( Epstein-Barr virus and cytomegalovirus) are the most dangerous. They cause purulent generalized lesions of the entire body.

• Mycoplasmas.

Oral-genital sexual contacts are most common in the oral cavity among practitioners. In particular, there are ureaplasmas. Both of them cause weak, sluggish catarrhal forms of sinusitis.

• Pyogenic floras.

The first representative of this flora is viridans streptococcus. It, like mycoplasmas, causes sluggish forms sinusitis involving the oropharynx in the pathological process. It provokes secondary tonsillitis, acute tonsillitis, pharyngitis and other diseases of a similar profile.

The second typical representative is Staphylococcus aureus. Somewhat less commonly, Staphylococcus hemolytic. Both are highly resistant to antibiotics and difficult to treat. They cause complex forms of sinusitis with a necrotic component.

• Rotaviruses. Record holders for the number of cases of otolaryngological problems.
• Adenoviruses. Slightly less common.

How do they get into the mouth?

They are transported into the oral cavity in several possible ways. The nutritional factor is most often important. In other words, bacteria and viruses enter the mouth with food. Most often with unwashed vegetables, fruits, dirty or infected products, spoiled food.

The second most important factor is household or contact-household. Often pathogenic microorganisms “settle” in the body during childhood, when young patients are most active in “pulling” their hands and dirty objects into their mouths. This may have a very negative impact in the future.

Airborne path. When breathing through the mouth, viruses and bacteria can enter the oral cavity. It is enough to spend some time in a poorly ventilated room with an infected or potentially sick person to become a carrier of bacteria yourself.

Sexual path. Or rather, oral-genital. Especially often we are talking about sexually transmitted infections.

Bacteria and viruses from the mouth are transported into the nasopharynx through the blood and lymph flow (lymphogenous and hematogenous routes).

Why immune defense is not effective

It lies in immunity. The more active the work protective system, the less likely it is to develop sinusitis. Why does immunity decrease?

There are many reasons:

• Heavy physical activity.
• Stress (distress).
• Alcohol abuse.
• Tobacco smoking.
• Regular diseases of infectious-inflammatory type. Acute respiratory infections, acute respiratory viral infections and their varieties.
• Hypothermia on a regular basis.
• Other factors, including chronic diseases of the endocrine profile, cardiological profile, and other types.
• The third group of factors are trigger reasons. That is, those that provoke the immediate onset of the pathological process. Among them:
• Traumatic lesions of the upper organs respiratory tract.
• Untreated runny nose of various origins.
• Damage to the nasal septum.
• Polyposis of the upper respiratory tract, adenoids.

Together, these reasons in different combinations determine the onset of the disease.

Varieties and stages

Odontogenic sinusitis can be classified on three grounds.

The first concerns the prevalence of the disease process. Accordingly, they distinguish:

• One-sided defeat.
• Bilateral damage to the maxillary sinuses. It is the most severe form of the disease. As a rule, it develops inevitably if the sinus is affected on one side. Of course, in the absence of proper treatment.

The second classification is based on the severity of the pathological process.

• Acute odontogenic sinusitis with the most intense symptoms is distinguished.
• Chronic odontogenic sinusitis. It develops with a minimal set of manifestations and is characterized by a sluggish course.
• Subacute form of the disease. Occupies an intermediate position between acute and chronic. Most often, the whole complex of symptoms occurs, but of less intensity compared to acute sinusitis.

Finally, the third classification covers the primary symptom. The following forms can be distinguished:

• Catarrhal odontogenic sinusitis. The prevailing symptom is swelling of the mucous membranes with impaired nasal breathing. Considered the least dangerous form pathology, at the same time the most uncomfortable for the patient, since respiratory activity is possible only through the mouth.
• Atrophic form of the disease. Atrophy is characterized by a decrease in the activity of the mucous tissues of the epithelium of the nasal passages. The leading symptom is impaired nasal breathing, decreased sense of smell, sometimes to its complete absence.
• Polypous form. It is characterized by the development of special neoplasms, polyps, in the nose. They block the nasal passages and prevent normal breathing.
• Purulent form. It is typical for her to highlight huge amount yellow-green mucus from the nose.
• Finally, the hyperplastic form. The predominant manifestation is nasal congestion.

The stages of the pathological process are as follows:

• Subacute stage. Characterized by a full range of symptoms with minimal intensity.
• Acute stage. Determined by development pathological symptoms from the respiratory system (described below) in full and at maximum intensity.
• Chronic stage. Lasts several months. It is typical for her to develop a minimal runny nose with impaired nasal breathing. Hyperthermia is almost absent.

Symptoms

The first and most characteristic symptom of odontogenic sinusitis is pain. It is localized in the area of ​​the upper teeth and gums, as well as the cheeks and eyes.

It intensifies at night when a person takes horizontal position. It also becomes more intense when bending over and chewing food.

The nature of the discomfort is pulling, pressing, aching. The pain radiates (gives) to the eyes, head, jaws. Swelling of the gums and cheeks is possible, on the side from which the inflammation occurs.

The following symptoms develop progressively. The most common clinical picture is:

• Discharge of exudate from the nose. In the first 3-5 days the mucus is clear. Then it thickens and becomes purulent, yellow color with a pungent odor of necrosis (tissue death).
• Feeling of fullness in the bridge of the nose. It is caused by intense swelling, the development of catarrhal phenomena, and stagnation of mucus in the area of ​​the nasal sinuses.
  Fatigue, decreased performance to a minimum.
• Hyperthermia. Body temperature rises to 38-39 degrees Celsius during an acute process. The chronic and subacute phases occur at low thermometer readings.
• Manifestations of general intoxication of the body. This headache, nausea, dizziness, fatigue, feeling of body wobbliness, loss of normal appetite. It is characterized by the release of a large amount of bacterial waste products into the blood.
• Deterioration of cognitive functions, up to short-term memory loss (in complex cases).

Other manifestations are also possible, such as symptoms of tonsillitis, pharyngitis, and secondary sinusitis.

Diagnostics

Diagnosis is carried out by ENT doctors. To make and verify the diagnosis, an oral interview with the patient, anamnesis collection, examination of the nasal passages with a rhinoscope, panoramic x-ray upper jaw and maxillary sinuses.

If the images show signs of sinusitis, bacteriological culture of the mucus on nutrient media is prescribed to determine sensitivity to antibiotics. The complex of research data is quite enough.

Treatment

Treatment of odontogenic sinusitis is predominantly conservative. Surgical techniques are used when there is a threat of cerebral edema, if there is severe purulent sinusitis. Thus, operations are not always required. In most cases, drug therapy is used.

Specialized medicines:

• Anti-inflammatory non-steroidal origin. Used to relieve generalized and local inflammation.
• Anti-inflammatory corticosteroid drugs. Dexamethasone, Prednisolone. They are used in a small number of cases for the same purposes, when the first medications are ineffective.
• Vasoconstrictors in the form of nasal drops. Used to relieve a runny nose and relieve the main symptoms of sinusitis.
• Antibacterial drugs. Prescribed in the vast majority of cases. Required to destroy pathogenic flora and viral agents.
• Bacteriophages. They destroy bacteria and are used if the patient has resistance (resistance) to antibiotics or contraindications to their use.

In severe cases, it is necessary to rinse the maxillary sinuses with a yamic catheter, but not puncture. Puncture is an outdated technique and should only be used in potentially fatal cases (it is also advisable to avoid it). If the cause is dental problems, the intervention of a dentist is required. If necessary, an operation is performed to remove hopelessly affected teeth, followed by closing the communication (perforation) between the bottom of the sinus and the socket extracted tooth.

Dentistry. Odontogenic sinusitis

In contact with

Sinusitis is an insidious disease. Numerous factors lead to the onset of the disease: hypothermia, infection and injury. In some cases, trouble arises due to an unexpected reason. An example of this is odontogenic sinusitis. How to eliminate pathology?

Description of the disease

Odontogenic sinusitis is an inflammation of the maxillary sinus that occurs as a result of the spread of infection from the upper teeth.

The disease has symptoms similar to other forms of sinusitis, the only difference is the cause of its occurrence.

The pathology is often called maxillary or dental sinusitis.

Classification: acute, chronic and other forms of sinusitis

Based on the location of inflammation, the following types of pathology are distinguished:

• one-sided (left or right) – occurs depending on the location of the diseased tooth;
• bilateral sinusitis - formed in the absence of treatment and the spread of the pathological process.

According to the type of course of the disease, there are 2 forms:

• acute odontogenic sinusitis - duration of development from several days to 3 weeks;
• chronic (more than 6 weeks) – characterized by stages of exacerbation and remission.

In addition, according to pathogenesis, the following types are distinguished:

1. No perforation of the sinus floor.
2. With perforation resulting from:
   • injuries;
   • destruction of the sinus floor by a tumor;
   • lesions of the upper jaw;
   • destruction of an odontogenic nature: after tooth extraction, cysts, resection of the upper parts of the roots.

Among perforated forms of sinusitis, there are additionally distinguished conditions in which the disease occurs due to the penetration of a foreign body:

• intraosseous implant;
• dentist's instrument;
• filling material;
• tooth root.

Reasons for the formation of odontogenic sinusitis: poor hygiene, diseased tooth, cyst

The occurrence of odontogenic sinusitis is associated with the penetration of infection from a diseased tooth. This happens in the following cases:

1. Poor oral hygiene. Inadequate dental care and untimely visit dentistry lead to the formation of caries, and in advanced cases - to nerve necrosis. The resulting inflammation spreads, resulting in penetration into the maxillary sinus.
2. Poor quality filling. Some tooth roots are located close to the maxillary sinus, so if it is necessary to treat deep areas, the doctor may accidentally introduce filling material into it.
3. Extracted tooth. As a result of removal, a channel is formed through which infections penetrate, and if the root is located close to the sinus, then the development of inflammation is a matter of time.
4. Diseases. These include periodontitis, periodontal disease and other pathologies. Incorrect treatment pulpitis leads to the spread of infection.
5. Pathological formations. Common cause the occurrence of odontogenic sinusitis is a cyst, especially when it suppurates.

Patients at risk include:

• have undergone many operations on the upper jaw;
• having problems with the immune system.

Symptoms of sinusitis: chronic course, period of exacerbation

In most cases, patients complain of the following symptoms:

• increased body temperature;
• headache;
• weakness and fatigue;
• deterioration of sense of smell;
• painful sensations in the area of ​​the sinuses;
• chills;
• nasal congestion;
• sleep problems.

During the period of exacerbation, these symptoms intensify, and the condition worsens with the emergence of new manifestations:

• pain when tapping on the affected tooth;
• unpleasant sensations when pressing on the sinus area.

The chronic form is manifested by discomfort at the site of the inflamed cavity, however unpleasant symptom occurs periodically. The patient feels normal, deterioration occurs during an exacerbation - signs characteristic of acute form.

With perforated sinusitis, patients complain of fluid entering the nasal cavity when the head is held upright while eating. Subsequently, other manifestations arise.

Establishing diagnosis

During diagnosis, it is necessary to distinguish the odontogenic form of sinusitis from the rhinogenic one. For this purpose, the following methods are used:

Differential diagnosis - table

Disease	Periodontitis	Pulpitis	Trigeminal neuralgia
Symptoms	pain; swelling of the gums; weakness; sleep disturbance; swelling of the face; enlarged lymph nodes.	paroxysmal pain, often when exposed to irritants; gain pain syndrome at night.	spasm of the facial muscles; pale skin; swelling of the face; pain depending on the affected nerve: optic nerve (bridge of the nose, upper eyelid); mandibular nerve (lower jaw, lower lip, chin); maxillary nerve (upper jaw, top part cheeks); salivation; lacrimation.

How to treat pathology: removal of the traumatic factor

The patient is treated by two specialists - a dentist and an otolaryngologist. Only a comprehensive technique will allow you to obtain positive result. In addition, it is important to get rid of the cause of sinusitis, otherwise therapy will not lead to recovery. For this purpose, the oral cavity is sanitized and the traumatic factor is eliminated - a diseased tooth, penetrated filling material, a cyst and other objects.

Medication method: antibiotics, antihistamines, mucolytics and other agents

To eliminate inflammation and alleviate the patient’s condition, the following groups of drugs are used:

1. Vasoconstrictor drops (Rinazolin, Naphazolin, Tizin, Naphthyzin). Eliminate swelling of the mucous membrane and improve the outflow of exudate.
2. Antihistamines (Diazolin, Loratadine, Suprastin). Reduce swelling.
3. Nonsteroidal anti-inflammatory drugs (Ibuprofen, Analgin, Nurofen). Reduce pain and eliminate inflammation.
4. Antibacterial drops and preparations (Miramistin, Bioparox, Augmentin, Isofra, Sumamed, Amoxiclav). Eliminate the infection. Drugs in this group should be selected after the detection of pathogenic bacteria.
5. Mucolytics (Mucodin, Rinofluimucil). Reduce the viscosity of mucus, providing quick cleansing of the sinuses.

Gallery of medications for sinusitis

Isofra is an antibacterial agent for local application Rinofluimucil reduces the viscosity of mucus, which leads to rapid clearing of the sinuses
Diazolin reduces swelling Ibuprofen relieves inflammation and pain Naphazolin improves the outflow of mucus

Physiotherapy

Physiotherapeutic treatment methods improve the patient’s condition and help quickly recover from the disease. The following methods are used:

• inhalation - provide penetration medicinal substances, eliminating painful symptoms;
• UHF therapy - increases the outflow of mucus;
• electrophoresis - delivers medicinal components to the site of inflammation;
• Magnetic therapy - reduces swelling of the mucous membrane.

Surgery for sinusitis: puncture, endoscopic intervention

To prevent complications and eliminate the chronic form of odontogenic sinusitis, surgical intervention methods are used. The doctor may use the following methods:

5-6 days after the operation, you need to start rinsing the sinuses, but first consult with a specialist.

Traditional medicine: is it possible to use such treatment?

Folk remedies should be used as part of complex therapy- apply only them and ignore methods official medicine dangerous for the patient's condition. In addition, such recipes relieve the symptoms of sinusitis, but not the cause of inflammation.

Inhalations with propolis

Inhalation is effective for sinusitis. To prepare the composition you need:

1. Heat 2 liters of water and bring to a boil.
2. Add propolis tincture to the container - 2 tsp.

The duration of the procedure is 10–15 minutes. During the event, you need to cover yourself with a towel and inhale through your nose. It is not recommended to use the presented method of treatment for people suffering from allergies to propolis and other bee products.

Healing ointment

An ointment with honey is suitable to eliminate inflammation. The product includes:

• vegetable oil;
Honey has a beneficial effect on the immune system

Predictions and consequences

With timely initiation of treatment, the prognosis is favorable. Lack of intervention leads to complications, which include:

• cyst;
• osteomyelitis of the upper jaw;
• meningitis;
• orbital phlegmon;
• inflammation of the tooth socket (perforated type).

Preventive actions

To avoid worsening the situation, you need to adhere to several rules:

• consult a doctor and begin treatment when the first signs of inflammation appear;
• strengthen immune system and eat right;
• Monitor your oral health and visit the dentist at least once every six months.

Features of the treatment of sinusitis - video

It is impossible to get rid of odontogenic sinusitis without eliminating the cause - an inflamed tooth, so you will need complex treatment. If you follow the doctor's recommendations, a positive result is guaranteed - you can forget about the pathology for a long time.

The article talks about one of the complications of tooth extraction – sinusitis. The mechanism of occurrence of the pathology and treatment methods are described.

The maxillary sinus in humans is located directly above the gum. Sinusitis after tooth extraction is caused by the penetration of an infectious agent into the sinus. This complication occurs infrequently, but is quite severe.

The roots of molars (molars) are located very close to the wall of the maxillary sinus, and sometimes grow into it. Therefore, dental caries, injuries, various medical manipulations with teeth can provoke the spread of the inflammatory process.

If the wall of the maxillary sinus is damaged, then an infection or a foreign object (a tooth fragment) can enter through the wound and inflammation can begin, in other words, odontogenic sinusitis.

Classification and manifestations of pathology

According to the duration of the disease:

• spicy- no more than three weeks;
• subacute- duration of illness up to 6 weeks;
• chronic- the disease lasts more than 6 weeks.

Depending on the location of the inflammation:

• pathology on the left;
• pathology on the right;
• bilateral pathology.

When pathology develops due to an extracted tooth, unilateral sinusitis most often develops, but if left untreated, the infection can spread to both sides.

In any case, the disease manifests itself with the same symptoms, but in acute pathology they are more pronounced:

• nasal congestion;
• profuse mucous or purulent runny nose;
• pain from the extracted tooth (localized in the cheek or under the eye);
• throbbing headache;
• pain when tapping on the cheekbones;
• fever;
• general intoxication syndrome - fever, chills, weakness

A distinctive feature of odontogenic sinusitis is its connection with previous dental procedures.

Diagnostics

Diagnosis is carried out by an ENT doctor, and, if necessary, by a dentist. It is based on an analysis of the medical history, examination data, instrumental and laboratory examination.

1. Anamnesis collection. The doctor listens to the patient’s complaints, asks about the dental procedures performed, and finds out how long ago the manifestations of the disease began.
2. Inspection. Swelling of the cheek is detected, upper lip, redness of the skin over the site of inflammation. Palpation reveals pain in the area of ​​the maxillary sinuses. During rhinoscopy, swollen and reddened mucous membrane is noticeable.
3. X-ray of the maxillary sinuses. The image reveals a darkening of the cavity, and fragments of the tooth roots are visible.
4. CT. Determines perforations and the presence of root fragments in the sinus as accurately as possible.
5. Sinus puncture. Diagnostic and medical procedure, allowing you to both identify the contents of the sinuses and rinse them with antiseptic solutions.
6. General blood analysis. An increase in leukocytes and an increase in ESR are detected, which confirms the presence of an active focus of infection.

Also held differential diagnosis with allergic and rhinogenic sinusitis.

Treatment methods

Therapeutic tactics depend on the course of the disease. Treatment chronic form is carried out in a clinic, while acute purulent sinusitis requires a hospital stay.

Treatment of odontogenic sinusitis after tooth extraction begins with removing the source of infection and establishing drainage to remove pus. The cavity is washed with an antiseptic solution and hypertonic saline solutions.

An oral antibiotic must be prescribed. The course of treatment is 7-10 days. After this, the patient is advised to carefully observe the hygiene of the nasal and oral cavity and not to become overcooled.

If perforation of the maxillary sinus occurs during tooth extraction, treatment depends on the duration and extent of the injury. A small fresh defect is covered with a plastic plate.

Old injuries, with the formation of fistulas and purulent discharge, first require careful sanitation of the sinus. Then part of the gum is removed and bone grafting is performed.

Prevention

There are no specific preventive measures against odontogenic sinusitis. It is only necessary to treat your teeth in a timely manner and follow the dentist’s recommendations after a tooth extraction.

Sinusitis after tooth extraction can be very dangerous. The most common complications include inflammation of the orbit, meningitis, and sepsis. Treatment should be carried out as early and fully as possible.

Questions for the doctor

After removing the upper 6, a root remained in the maxillary sinus. Is it dangerous?

Olga R. 42 years old, Omsk.

When removing the upper teeth, root particles can get into the maxillary sinus, which, unfortunately, happens quite often. In this case, it is necessary to remove the tooth root from the maxillary sinus, as a serious disease may develop - sinusitis. The intervention is carried out using endoscopic instruments under local anesthesia.

is an inflammation of the mucous membrane of the maxillary sinus, caused by the spread of the pathological process from the primary source of infection located in the upper jaw. The main manifestations of the disease are a pronounced headache, which intensifies when the head is tilted, nasal discharge of a purulent or serous nature, lacrimation, and intoxication syndrome. Diagnosis is based on the collection of anamnestic data, general examination, rhinoscopy, sinus puncture and radiation methods visualization. Treatment includes antibiotic therapy, rinsing with antiseptics, surgical sanitation of the sinus cavity and primary lesion.

General information

Odontogenic sinusitis is a common disease. The prevalence ranges from 3 to 52%, on average the pathology occurs in 35-43% of the population. This type of lesion of the maxillary sinus accounts for about 14% bacterial infections requiring treatment in the Department of Dental Surgery. This type of sinusitis accounts for 20-24% of the total inflammatory diseases maxillary facial area.

Among all forms of sinusitis, from 80 to 96% have an odontogenic etiology. Statistically, the disease is more often observed in people with a pneumatic type of structure of the maxillary sinus, which is associated with the thinness of the bone walls and its penetration into the alveolar process. Men and women suffer equally often.

Causes

This form of sinusitis is a complication of the inflammatory process in the area of ​​the teeth or upper jaw. Almost always caused by mixed pathogenic microflora, which may include staphylococci, streptococci, diplococci, enterococci, gram-positive and gram-negative bacilli, and yeast fungi. Conditions most often complicated by odontogenic sinusitis include:

• Diseases of molars and premolars. Usually these are infectious lesions of the teeth of the upper jaw, odontogenic periostitis and osteomyelitis, chronic periodontitis, purulent periodontitis and suppurating jaw cysts.
• Endodontic therapy. The disease can occur as a result of dental treatment of premolars and molars, during which the apical foramen is perforated, filling material, elements of an intraosseous implant, etc. are introduced into the sinus cavity.
• Injuries. Traumatic injuries to the teeth and/or upper jaw, which are accompanied by perforation of the wall of the maxillary sinus and the formation of a hematoma, are the least common cause of the development of this form of sinusitis.

Pathogenesis

The pathogenesis of odontogenic sinusitis is associated with the spread of bacterial microflora and its metabolic products (toxins) into the cavity of the maxillary sinus from the primary foci of infection - affected teeth or lesions in the upper jaw. This becomes possible due to the structural features of the alveolar processes of the 6th and 7th (in rare cases, 5th and 8th) upper teeth, which are delimited from the sinus only by a thin bone wall. As a result of purulent melting or mechanical perforation of the septum, infectious agents penetrate into the sinus cavity and cause inflammation of the mucous membranes.

Subsequently, the natural inlet of the sinus becomes obstructed. This causes disruption of ventilation and the accumulation of large amounts of catarrhal or purulent exudate inside the bone cavity. The absorption of oxygen by the mucous membranes leads to the emergence of negative pressure, which increases swelling, the development of hypercapnia and hypoxia, and the formation of a large amount of under-oxidized products. A favorable environment is created for the further proliferation of anaerobic microflora, and a vicious circle is formed.

Classification

Taking into account the duration of the course, all odontogenic sinusitis is divided into three main clinical variants:

• Spicy. The duration of the disease is less than 21 days.
• Subacute. This option typically lasts from 21 days to 6 weeks.
• Chronic. A protracted form of the disease in which clinical symptoms persist for 6 weeks or more.

Depending on the nature of the odontogenic lesion of the maxillary sinus, the following forms of pathology are distinguished:

• Closed. Characterized by the development of inflammation without a direct connection between primary focus and maxillary sinus. Main reasons - chronic periodontitis and suppuration of cysts that have grown into the sinus.
• Open. The spread of microflora from the oral cavity occurs due to purulent melting of one of the walls of the cavity of the maxillary sinus. Includes perforated sinusitis and complications of osteomyelitis of the upper jaw.

Based on the nature of the morphological changes in the mucous membrane of the maxillary sinus, it is customary to distinguish the following options:

• Catarrhal. It manifests itself by filling the sinus cavity with serous exudate and severe swelling of the mucous membranes.
• Purulent. The formation of a large number of purulent masses is noted, inflammatory and destructive changes inner membranes of the sinuses.
• Polypous. The main difference from other options is the formation of seals on the mucous membrane of the sinus, from which polyps later form.
• Purulent-polyposis. It is a combination of purulent and polypous forms.

Symptoms of odontogenic sinusitis

Acute sinusitis

From a clinical point of view, it is advisable to distinguish two forms of the disease - acute and chronic. At acute version First, there appears an acute pulsating paroxysmal headache, heaviness or a feeling of fullness in the area of ​​the right or left upper jaw. Painful sensations can also be localized in the area of ​​teeth and imitate pulpitis. The pain intensifies when lowering the head.

Subsequently, a syndrome of general intoxication occurs, which is characterized by chills, general weakness, weakness, fever up to 38.5-39.5 ° C and chills. The process of chewing food becomes sharply painful, the teeth feel much longer than they actually are. In many patients, nasal breathing is impaired, the ability to distinguish odors is lost, photophobia and increased lacrimation develop. A unilateral runny nose is detected, which is accompanied by the release of a large amount of mucus and/or purulent masses.

Chronic sinusitis

With chronic odontogenic sinusitis, the clinical picture develops gradually. The course of the pathology is wavy, exacerbations occur after hypothermia or acute illnesses. viral diseases upper respiratory tract. The primary symptom is intense unilateral headache or a pronounced feeling of heaviness. This symptom is almost immediately accompanied by pain in the maxillary region with irradiation into the orbit, temporal and frontal region, and adjacent upper teeth.

Nasal discharge can have a different character and volume - from copious to scanty, from serous to purulent. The greatest amount of discharge is usually observed in the morning and gradually decreases throughout the day. A characteristic symptom is increased suppuration when pressed. lower jaw to the chest. In non-purulent forms and the formation of fistulas, there may be no discharge.

Complications

The most common complications of odontogenic sinusitis include meningitis, orbital cellulitis, and venous sinus thrombosis. Their occurrence is due to the spread of pathogenic flora through the anterior facial and orbital veins into the orbital cavity, sigmoid sinus And venous system brain. In severe cases, in the absence of timely treatment, diffuse osteomyelitis of the upper jaw develops, which leads to bone destruction and the formation of a pronounced cosmetic defect. Less commonly, patients experience sepsis, myocardial and kidney damage. Generalization of infection is associated with the entry of bacterial agents and their toxins into the systemic bloodstream.

Diagnostics

Diagnosis of odontogenic sinusitis is based on a comprehensive analysis of anamnestic information, clinical and auxiliary methods research. Diagnosis and management of the patient are usually carried out jointly by an otolaryngologist and an oral and maxillofacial surgeon. Full list diagnostic measures includes:

• Collection of complaints and medical history. When interviewing a patient, along with detailing specific complaints, it is important to clarify the presence of existing or previously suffered dental diseases, the essence of recently performed therapeutic measures in the upper jaw.
• General inspection. Allows you to identify swelling of the paranasal area and cheeks, redness skin on the sore side. With palpation and percussion of the maxillary sinus and zygomatic bone, increased pain is observed.
• Anterior rhinoscopy. A visual examination of the nasal cavity from the side of the affected sinus reveals hyperemia and swelling of the mucous membrane of the middle and/or inferior turbinate. Exudate may be released from under the free edge of the middle concha.
• Probing of the maxillary cavity. An addition to rhinoscopy, which allows one to determine the presence of purulent contents in the maxillary sinus when its natural drainage hole is blocked.
• Puncture of the maxillary sinus. It combines diagnostic and therapeutic purposes, as it allows you to identify even a small amount of pathological content in the sinus, and then rinse with antiseptic agents.
• X-ray of the paranasal sinuses. The x-ray reveals darkening of the sinus cavity and the presence of a horizontal fluid level. To establish the etiology, an X-ray of the teeth on the affected side is performed.
• Lab tests. IN general analysis blood, leukocytosis is detected, a shift in the leukocyte formula to the left, increase in ESR. In the presence of purulent discharge, a bacteriological study is performed to determine the specific pathogen and its sensitivity to antibiotics.

Differential diagnosis is carried out with rhinogenic and allergic sinusitis, cancer of the maxillary sinus. The first two diseases are characterized by the involvement of both maxillary sinuses in the pathological process and lack of connection with dental pathologies or manipulations. The development of clinical symptoms in rhinogenic sinusitis occurs against the background of diseases of the nasal cavity, in the allergic version - after contact with an allergen or during a seasonal exacerbation. At malignant tumor symptoms progress gradually, intoxication syndrome and discharge of purulent masses or serous exudate from the nose are absent.

Treatment of odontogenic sinusitis

Therapeutic tactics largely depend on the variant of the disease. Treatment of the acute form in the absence of severe dental pathology is carried out in a clinic. At chronic inflammation maxillary sinus often requires hospitalization in a hospital followed by surgery. The main therapeutic measures include:

• Antibacterial therapy. It is used regardless of the form and etiology of sinusitis. Before obtaining the results of bacterial culture, broad-spectrum antibiotics are prescribed, after which drugs to which the cultured microflora has shown sensitivity are prescribed.
• Washing with antiseptics. Introduction antiseptic solutions performed through a formed defect in the lower jaw or by diagnostic puncture using a Kulikovsky needle. After lavage, drainage of the sinus cavity is installed.
• Surgery. It is used for chronic and polypous forms of lesions. Surgery(sinusrotomy) is performed using the Caldwell-Luc technique. Its essence lies in the sanitation of the sinus cavity, excision of the pathologically altered mucous membrane and the formation of an artificial anastomosis with the nasal cavity.

Prognosis and prevention

The prognosis for odontogenic sinusitis depends on timeliness and rationality therapeutic measures. With properly selected therapy, treatment of the acute form of the disease takes 7-14 days, and the outcome is recovery. In the chronic version, complex treatment can last up to 3 weeks, followed by remission or complete recovery.

Preventive measures include timely sanitation of foci of infection, prevention of injuries to the facial area, and compliance with the recommendations of a dentist or maxillofacial surgeon after surgical interventions.