The maxillary sinus is in direct contact with the posterior upper teeth.
Maxillary sinusitis is a result of a conflict amidst this rapport.
The treatment requires close collaboration between the dentist in charge and the otorhinolaryngologist.
Causes of maxillary sinusitis:
1.Contributing factors :
*Tooth-sinus rapport :
The sinus floor is discontinued and punctured by numerous vascular holes, which explains the intimate rapport between the sinus and the periodontium of the posterior teeth.
*Iatrogenic factors :
The zinc contained in the dental paste can result in a fungal infection of the sinus called Aspergillosis.
The principal organism responsible is: Aspergillus.
*Anatomical causes:
A deviated nasal septum or nasal obstruction can lead to sinusitis.
*General causes :
Cytotoxic medication, immunosuppressive drugs, corticoids, and prolonged antibiotherapy disturbs the local sinus flora.
2.Etiological factors :
*Infections of dental origin :
-Apical periodontitis.
-Advanced periodontitis: Dental bone loss can lead to the perforation of the sinus floor, and therefore an opening between the sinus and the oral cavity.
*Iatrogenic causes :
-Improper endodontic treatment.
-An implant that perforated the sinus floor.
Diagnosis:
Warning signs
Rhinorrhea: Intermittent, purulent, and foul.
Moderate unilateral pain.
Nasal blockage.
Medical examination
The examination of the face searches for pain when pressure is applied to the anterior wall of the maxillary sinus.
Anterior rhinoscopy reveals congestion of the mucosa and purulent secretions in the middle meatus.
Posterior rhinoscopy shows pus in the nasopharynx, the posterior wall of the pharynx, and the ipsilateral inferior turbinate.
The oral examination searches for cavities, painful dental percussion, dental mobility, and fistulae.
Radiological examination
The radiography reveals a homogeneous opacity of the maxillary sinus.
In the case of sinusitis, a CT scan is the best choice to confirm the diagnosis.
Clinical forms :
Acute sinusitis: A stuffy nose and facial pain that does not go away after 10 days, or symptoms that improve but then return and are worse than the initial symptoms. It responds well to antibiotics and decongestants.
Subacute sinusitis: When the symptoms last four to twelve weeks.
Recurrent acute sinusitis: When the symptoms come back four or more times in one year and last less than two weeks each time.
Chronic sinusitis: Nasal congestion, drainage, facial pain/pressure, and decreased sense of smell for at least 12 weeks.
Aspergillus sinusitis: A fungal infection of the maxillary sinus.
Treatment :
1.Treatment of the sinus:
Medical :
*Local treatment:
Consists of using local vasoconstrictors in the short term.
They ensure the decongestion of the ostium and, therefore, a proper drainage of the sinus.
*General treatment:
Consists of an antibiotic, a non-steroid anti-inflammatory, and a painkiller.
Surgical :
Surgery can be necessary to drain the sinus in complicated cases.
For chronic sinusitis, a middle and/or inferior meatal antrostomy insures that the sinus is properly ventilated.
2.Dental treatment:
The infection of the maxillary sinus is a result of a dental infection.
The causal tooth needs to be treated for the sinus to heal.
If the tooth is not treatable, an extraction is necessary.
