Chronic odontogenic sinusitis

An important role in the occurrence of acute sinusitis can play an odontogenic factor. This is also the role of the odontogenic factor in the onset of chronic purulent maxillary sinusitis, as well as some odontogenic complications arising in the maxillary sinus, for example odontogenic cysts.

[1], [2], [3], [4], [5], [6], [7]

Causes of the chronic odontogenic sinusitis

Etiologically and pathogenetically, the onset of chronic odontogenic sinusitis is due to 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. Especially evident is the role of odontogenic infection in cases where the granulating inflammation of the apex of the tooth root, destroying 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 case of joining to this rhinogenic infection or in the presence of insufficiently active function of the drainage opening of the maxillary sinus, the process extends to the entire mucosa of the sinus, assumes a chronic course due to the presence of a constant source of infection in the form of an odontogenic infection. In the presence of a parotid cyst, especially if the tip of the root is in the lumen of the sinus, the odontogenic cyst grows rapidly due to the presence of free space, filling most of the maxillary sinus).

The spread of infection is possible through the system of venous plexus between the tissues of the alveolar process and the mucous membrane of the maxillary sinus. Odontogenic sinusitis can occur as a result of suppurative peri-root cyst, as well as osteomyelitis of the alveolar process and the body of the upper jaw.

The above topografoanatomical data explain the occurrence of fistulas of the maxillary sinus communicating with the oral cavity through the socket of the removed tooth. Prolonged non-healing of the hole after extraction of the 2nd small and 1st and 2nd large molars, and for large maxillary sinuses - 3rd molar indicates the presence of chronic purulent odontogenic sinusitis. The appearance of odontalgia is explained by the generality of innervation of a part of the mucous membrane of the maxillary sinus and teeth with branches from the upper dental plexus formed in the thickness of the alveolar process of the maxilla by the anterior or middle and posterior alveolar branches of the maxillary nerve.

[8], [9]

Treatment of the chronic odontogenic 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 kind of treatment is in the competence of the maxillofacial surgeon, dentist-therapeutist, dentist-parodontologist. The general tactical direction of the treatment process is the realization of two stages: the sanation of the odontological focus of the infection, up to the extirpation of the "causal" tooth, opening of the maxillary sinus in the usual way, and the sanitation operation with the formation of an artificial drainage hole. With the remaining frontal sinus fistula of the maxillary sinus, it is closed with a plastic two-layer method, by scraping the corresponding flaps from the mucous membrane of the vestibule of the oral cavity and the hard palate. This operation is expedient to produce in the "cold" period, when the inflammatory process in the maxillary sinus is eliminated and the odontogenic focus of infection is eliminated.

In the historical aspect, the method of draining the maxillary sinus through the socket of the second small or first-second large molars was proposed in 1707 by U. Cooper. The operation can be performed after the removal of the affected roots of these teeth or after their removal with shakiness III degree in the presence of a basal cyst penetrating the maxillary sinus. After removing the tooth with a trocar or a small chisel of Voyachek, the socket is expanded, the bottom of the maxillary sinus is perforated, and the entrance to it is expanded. Pus and pathological tissues are removed. Usually, if you do not produce the second ethane of surgical intervention such as the Coldwell-Luke operation, the hole will be closed by granulations within the next few days after the operation. To prevent this, W. Kuner suggested inserting into the hole a silver tube (cannula) with a distal edge that was folded outward so that it did not collapse in the maxillary sinus. Through the cannula, the cavity is washed by the patient himself with some antiseptic solution 2 times a day for a long time (up to 1 year). In between the procedures, the tube is closed with a cork to prevent food from getting into it. At present, with fiber optics and microvideo surgery facilities, this operation can be performed to examine the sinus and determine the method of subsequent surgical intervention.