Chronic odontogenic maxillary sinusitis

The odontogenic factor can play an important role in the development of acute sinusitis. The same role is played by the odontogenic factor in the development of chronic purulent sinusitis, as well as some odontogenic complications that occur in the maxillary sinus, such as odontogenic cysts.

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Causes chronic odontogenic maxillary sinusitis.

Etiologically and pathogenetically, the occurrence of chronic odontogenic sinusitis is caused by the spread of pathogens from infected teeth, which is facilitated by the anatomical features of the bottom of the maxillary sinus and the roots of the 2nd small and 1st and 2nd large molars. The role of odontogenic infection is especially evident in cases where granulating inflammation of the apex of the tooth root, having destroyed the bone septum between the bottom of the maxillary sinus and the periapical space, involves adjacent areas of the mucous membrane of the sinus in the inflammatory process. In the case of joining rhinogenic infection or in the presence of insufficiently active function of the drainage opening of the maxillary sinus, the process spreads to the entire mucous membrane of the sinus, takes a chronic course due to the presence of a constant source of infection in the form of odontogenic infection. In the presence of a periradicular cyst, especially if the apex of the root is located in the lumen of the sinus, the odontogenic cyst, due to the presence of free space, quickly increases in size, filling most of the maxillary sinus).

The infection can also spread through the venous plexus system between the tissues of the alveolar process and the mucous membrane of the maxillary sinus. Odontogenic sinusitis can occur as a result of a suppurating periradicular cyst, as well as osteomyelitis of the alveolar process and the body of the maxilla.

The above topographic anatomical data explain the cases of occurrence of fistulas of the maxillary sinus, communicating with the oral cavity through the socket of the extracted tooth. Long-term non-healing of the socket after extraction of the 2nd small and 1st and 2nd large molars, and in case of large sizes of the maxillary sinus - the 3rd molar indicates the presence of chronic purulent odontogenic sinusitis. The occurrence of odontalgia is explained by the commonality of innervation of part of the mucous membrane of the maxillary sinus and teeth by branches coming from the superior dental plexus formed in the thickness of the alveolar process of the upper jaw by the anterior or middle and posterior alveolar branches of the maxillary nerve.

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Treatment chronic odontogenic maxillary sinusitis.

Treatment of chronic odontogenic sinusitis is exclusively surgical, its tactics are determined by the nature of the inflammatory odontogenic process and the degree of involvement of the maxillary sinus in this process. Usually, this type of treatment is within the competence of a maxillofacial surgeon, a dentist-therapist, a dentist-periodontist. The general tactical direction of the treatment process consists of implementing two stages: sanitation of the odontogenic focus of infection, up to the extirpation of the "causal" tooth, opening the maxillary sinus in the usual way and performing a sanitizing operation with the formation of an artificial drainage hole. If the alveolar fistula of the maxillary sinus persists, it is closed by a plastic two-layer method, by cutting out the appropriate flaps from the mucous membrane of the vestibule of the oral cavity and the hard palate. This operation is advisable to perform in the "cold" period, when the inflammatory process in the maxillary sinus is eliminated and the odontogenic focus of infection is also eliminated.

In the historical aspect, the method of drainage of the maxillary sinus through the socket of the second premolar or first or second molar was proposed in 1707 by W. Cooper. The operation can be performed after removal of the affected roots of the indicated teeth or after their removal with grade III loosening in the presence of a periradicular cyst penetrating the maxillary sinus. After tooth extraction with a trocar or a small Vojaczek chisel, the socket is widened, the bottom of the maxillary sinus is perforated, and the entrance to it is widened. Pus and pathological tissues are removed. Usually, if the second stage of surgical intervention such as the Caldwell-Luc operation is not performed, the socket closes with granulations in the coming days after the operation. To prevent this, W. Kuhner proposed inserting a silver tube (cannula) with a distal edge rolled outward into the socket so that it does not fall into the maxillary sinus. The patient himself washes the cavity through the cannula with some antiseptic solution 2 times a day for a long time (up to 1 year). In between procedures, the tube is closed with a stopper to prevent food from getting into it. Currently, with the availability of fiber optics and microvideo surgery, this operation can be performed to examine the sinus and determine the method of subsequent surgical intervention.