A Review of Odontogenic Maxillary Sinusitis

Background: Odontogenic maxillary sinusitis (OMS) is an infection of the maxillary sinus caused by issues with the posterior maxillary dentition or as a complication of dental procedures. The prevalence of OMS varies widely, with epidemiological data from Indonesia indicating a rate of 0.57%, while studies using computed tomography (CT) report prevalence as high as 26.9%. Anatomical factors such as the proximity of the first maxillary molars to the sinus floor and sinus pneumatization significantly influence susceptibility to OMS. 

Objective: To investigate the causes, diagnostic methods, and management strategies for odontogenic maxillary sinusitis (OMS), with a focus on its microbiological composition, clinical manifestations, and treatment approaches. 

Methods: A comprehensive review of existing epidemiological data, clinical case studies, and imaging techniques for diagnosing OMS was conducted. Specific attention was given to cone-beam computed tomography (CBCT) as the diagnostic standard, as well as the pharmacological and surgical treatments for OMS, including the use of decongestants, antibiotics, corticosteroids, Functional Endoscopic Sinus Surgery (FESS), and Modified Endoscopy-Assisted Maxillary Sinus Surgery (MESS).

Results: OMS is primarily caused by iatrogenic events like oroantral fistula formation, implant displacement, sinus lift procedures, and extrusion of endodontic materials, alongside infections from periapical origins. The condition is often polymicrobial, with anaerobic bacteria (e.g., Peptostreptococcus spp. and Fusobacterium spp.) predominating, and in some cases, fungal infections such as Aspergillus can also occur. Symptoms include nasal obstruction, purulent nasal discharge with a fetid odor, maxillofacial pain, and halitosis. CBCT provides superior diagnostic accuracy for visualizing anatomical changes. Pharmacological treatments are effective in managing the infection, and surgical interventions like FESS and MESS are less invasive and more effective than the traditional Caldwell-Luc procedure. 

Conclusion: Odontogenic maxillary sinusitis is a significant condition that necessitates accurate diagnosis and comprehensive management, involving both medical and surgical interventions. The collaboration between dental and otolaryngology specialists is critical for effective treatment, and advancements in diagnostic imaging like CBCT and minimally invasive surgical techniques have improved patient outcomes. Addressing the odontogenic source of infection is crucial to achieving optimal therapeutic results.