Inflammation and infection of paranasal sinuses can often affect more than one sinus, but the maxillary sinus is most frequently involved. Facial pain, fever, and rhinorrhea are some of the main clinical features. The diagnosis could necessitate an extensive clinical, imaging and microbiological workup.
Presentation
Sinusitis is considered to be one of the most frequently encountered ear, nose, and throat (ENT) infections in medical practice and the maxillary sinus is identified as the predominant site where this infection occurs [1] [2] [3]. Based on symptoms duration, maxillary sinusitis can be divided into acute, when inflammation of the mucosal lining of the maxillary sinus lasts less than 30 days, or chronic (> 3 months) [1] [2]. The pathogenesis and appearance of symptoms almost exclusively involve a preceding milder infection of the upper respiratory tract, primarily by viral pathogens (such as rhinoviruses, as well as influenza and parainfluenza viruses) [4] [5]. A number of studies, however, have confirmed that odontogenic infections are an important cause of maxillary sinusitis, accounting for up to 30-40% of cases [4] [6] [7]. In addition to viruses, various bacteria may be responsible for sinusitis. However, respiratory infection-induced sinusitis has a different spectrum of bacteria (Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, or Staphylococcal species) than sinusitis stemming from an odontogenic infection, which is caused by Bacteroides spp., Proteus spp., and coliform bacilli, but also streptococci [2] [3] [6]. Principal manifestations of maxillary sinusitis are a facial pain, mainly in the cheekbones, rhinorrhea, and nasal congestion [2] [3] [4]. Additional signs and symptoms are a foul breath, a postnasal drip, and toothache, which is not a definite indicator of an odontogenic source [4] [8].
Entire Body System
- Inflammation
The maxillary sinuses and the focus of inflammation It is estimated that only about 10% of inflammation foci in the head are cases of maxillary sinusitis. Diseases of tonsils and teeth occur as foci of inflammations much more often. [fulspecialista.hu]
Substantial assistance in the diagnosis of inflammation of the maxillary sinuses provide x-ray images and paranasal sinuses computed tomography (CT). [minclinic.ru]
Based on symptoms duration, maxillary sinusitis can be divided into acute, when inflammation of the mucosal lining of the maxillary sinus lasts less than 30 days, or chronic (> 3 months). [symptoma.com]
Sections of the sinonasal mucosa revealed marked acute and chronic sinusitis with inflammation, congestion, and hemorrhage. [ncbi.nlm.nih.gov]
The complications consist in abscess of the orbit and palpebro-orbital abscess, thrombophlebitis and varioús inflammations of the interior of the eye, such as chorioretinitis, glaucoma, detachment of the retina and papillitis. [jamanetwork.com]
- Swelling
After appropriate surgical intervention, the cyst was removed, and over the ensuing 6 weeks the facial swelling gradually diminished. [pediatrics.aappublications.org]
The nasal conchae and the mucous membrane swell, purulent discharge might occur in the central nasal passage and/or at the base of the nasal cavity, and nasal polyps might develop. [fulspecialista.hu]
Dentistry and Oral Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan. [email protected] Abstract Chronic sinusitis develops when the ostiomeatal complex becomes stenosed by the swelling [ncbi.nlm.nih.gov]
Swelling around the eye is serious, and could rapidly lead to blindness. [livestrong.com]
There are always secondary symptoms associated with maxillary sinusitis, like fever, fatigue, yellowish green nasal discharge, headache and facial swelling. [isinusite.blogspot.com]
- Fever
Common causes of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. [ncbi.nlm.nih.gov]
Facial pain, fever, and rhinorrhea are some of the main clinical features. The diagnosis could necessitate an extensive clinical, imaging and microbiological workup. [symptoma.com]
Hay fever and other allergies. Risks The main risk factors include: Infection. Decreased sense of smell. Mucocele. Infection of the surrounding structures. Infections due to mucous obstruction. Osteomyelitis. [medanta.org]
In case of fever, prescription of antibiotics is recommended only selectively. (b) Subacute maxillary sinusitis. [fulspecialista.hu]
Other signs and symptoms of maxillary sinus infection include fever, redness and swelling around the eye and cheek area, and pain around the upper teeth. Your teeth may even be sensitive to chewing. [livestrong.com]
- Surgical Procedure
BACKGROUND: Endoscopic maxillary mega-antrostomy (EMMA) is a revision surgical procedure for recalcitrant maxillary sinusitis in which medical therapy and endoscopic antrostomy have been unsuccessful. [ncbi.nlm.nih.gov]
Out of these, less than half are clinical studies which discuss the complication rate of this surgical procedure. [bmcinfectdis.biomedcentral.com]
B Search terms Amoxicillin, Amoxicillin-Potassium Clavulanate Combination, Caldwell-Luc operation, Child, Doxycycline, Infectious diseases, Maxillary Sinusitis, Otorhinolaryngology, Radiology, Sinusitis, Surgical Procedures, Operative, antimicrobial therapy [ebm-guidelines.com]
Surgical procedures can be required in some chronic cases. There are some common home remedies available for curing acute cases. Nasal irrigation is the way of removing mucus with the help of warm saline water and it can cure sinus infection. [isinusite.blogspot.com]
- Falling
In my experience, patients with chronic sinus disease fall into 1 of 3 categories: 1) Those with strictly anatomic problems preventing the proper flow of air and mucous; 2) those with a hypersensitivity (can be allergic or non-allergic) of the mucous [realself.com]
The concentration of C reactive protein usually increases within 24 hours after onset of the infection and falls quickly after treatment or spontaneous improvement. [bmj.com]
Fall 39 Blickdiagnose Gesichtsschwellung: Fraktur Sinus maxillaris Therapie Laterale Mittelgesichtsfrakturen zählen zu den häufigsten knöchernen Verletzungen des Gesichtsschädels. [osjbuf.co]
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Respiratoric
- Nasal Congestion
Patients with tetraplegia, especially in the acute phase of spinal cord injury, often undergo nasotracheal intubation or nasogastric tube placement, which may result in mucosal irritation and nasal congestion. [ncbi.nlm.nih.gov]
Principal manifestations of maxillary sinusitis are a facial pain, mainly in the cheekbones, rhinorrhea, and nasal congestion. [symptoma.com]
The common symptoms are facial pain or pressure, nasal congestion or discharge and reduced ability to smell. The pain is localized to blocked sinus. Other symptoms generally include: Headache. Bad breath. Fatigue. Cough. [medanta.org]
Allergic fungal sinusitis is a chronic sinusitis in which fungi cause an allergic reaction characterized by marked nasal congestion and the formation of nasal and sinus polyps. [msdmanuals.com]
Nasal congestion is a common one, as is a headache or fever. Nasal discharge also increases when you have maxillary sinus disease, even down the back of your throat. [healthfully.com]
- Sneezing
These included avoidance of blowing the nose, sneezing with the nose obstructed, drinking through a straw, and smoking. The patient in this case report made good progress without recurrence in the immediate postoperative period. [dentistrytoday.com]
Sneezing, sore throat, and muscle aches may be present, but they are rarely caused by sinusitis itself. Muscle aches may be caused by fever, sore throat by post-nasal drip, and sneezing from cold or allergies. [medigoo.com]
Postoperatively the patients were instructed not to blow their nose, to sneeze with the mouth wide open and to avoid drinking with straws, in order not to modify the air pressure inside the maxillary sinus. [bmcinfectdis.biomedcentral.com]
Every time the patient sneezes, air is forced through the defect into the intra-cranial space, and remains trapped there. At a certain moment the amount of air is sufficient to cause mass effect on the surrounding intra-cranial structures. [radiologyassistant.nl]
Gastrointestinal
- Nausea
Accidentally swallowing these products can cause serious symptoms, such as nausea, vomiting, lethargy (sleepiness), tachycardia (fast heart beat) and coma, that may require hospitalization. Antibiotics, are prescribed for 7 to 10 days. [healthcommunities.com]
[…] may be a cough, often worsening at night. 12 Children with acute sinusitis might not be able to relay a history of postnasal drainage or headaches, so cough and rhinorrhea are the most commonly reported symptoms. 13 Other symptoms can include fever, nausea [clevelandclinicmeded.com]
Jaw & Teeth
- Dental Caries
The multivariate analysis included the radiographic features of oroantral fistula, periapical abscess, periodontal disease, projecting tooth root, and dental caries. [ncbi.nlm.nih.gov]
Surgical protocol Before scheduling the dental implant procedure, all patients underwent the treatment of all acute and chronic dental conditions – dental caries, root canal treatments, extraction of unrestorable roots – and a thorough dental cleaning [bmcinfectdis.biomedcentral.com]
Eyes
- Redness of Eye
A computed tomography (CT) scan is able to determine the extent and severity of sinusitis but is done mainly when people have symptoms of complications (such as a red, bulging eye) or when people have chronic sinusitis. [msdmanuals.com]
Skin
- Skin Rash
The most commonly reported adverse effects in antibiotic groups were: gastrointestinal problems (for example, diarrhea, abdominal pain, vomiting) and skin rash. [cochranelibrary.com]
- Eruptions
The maxillary sinus can very occasionally be absent or hypoplastic but usually is the first to develop, showing two main growth spurts at 0–3 years and the second at 7–12 years, corresponding with the development and eruption of the permanent dentition [nature.com]
Face, Head & Neck
- Epistaxis
4: Some signs and symptoms that may be suspicions for maxillary sinus malignancy Figure 9: A non-healing upper right extraction site with a spindle cell squamous carcinoma arising from the maxillary sinus Figure 10: Left sided nasal obstruction with epistaxis [nature.com]
Nasal symptoms may include epistaxis, allergic rhinitis and postnasal drip. [oralhealthgroup.com]
This should include a thorough discussion of possible risks such as orbital injury, blindness, nasolacrimal duct injury, epiphora, epistaxis, cerebrospinal fluid leak, meningitis and brain abscess, and of course persistent rhinosinusitis. [medigoo.com]
The nose should be examined for a deviated nasal septum, nasal polyps, and epistaxis. Foreign bodies and tumors can mimic symptoms of sinusitis and should be in the differential diagnosis, especially if the symptoms are unilateral. [clevelandclinicmeded.com]
It causes non-specific symptoms like nasal congestion or epistaxis. Biopsy is necessary to make the diagnosis and because more than 10% of inverted papillomas harbor a squamous cell carcinoma. [radiologyassistant.nl]
- Unilateral Facial Pain
Acute maxillary sinusitis was defined by: a history of URTI lasting seven to 30 days, with at least two clinical signs or symptoms (sinus pain at palpation, postnasal drip, purulent nasal discharge, nasal obstruction, unilateral facial pain, maxillary [cochranelibrary.com]
Neurologic
- Headache
When asked about sinusitis, the patient mentioned occasional episodes of pus taste and intermittent crises of headache lasting for one week. The patient has been edentulous for 20 years. [ncbi.nlm.nih.gov]
Topics range from the standard diagnosis and treatment of acute sinusitis in children and adults to state-of-the-art discussions of imaging techniques, unique material on smell disorders, the role of allergies in sinus disease, sinus headaches, and the [books.google.com]
Workup
Although sinusitis is a common entity in practice, its diagnosis may be difficult to attain due to the nonspecific signs and symptoms that are seen in a myriad of illnesses and infections. But because of its rather high frequency, a clinical suspicion must be present in all patients with unexplained rhinorrhea, fever, and facial pain, especially if a chronic course is reported. Physicians should inquire about the onset and duration of symptoms, after which a complete physical examination, with an emphasis on the ENT exam, is necessary. Identification of areas sensitive to pain is an important part of the exam, but it is not uncommon for sinusitis to be misdiagnosed as tension or migraine headaches, as both can cause tenderness and pain in the sinonasal area [4]. For this reason, detection of pus in the middle nasal meatus on anterior rhinoscopy is considered as a key sign of acute bacterial maxillary sinusitis [1] [4]. Once clinical findings suggest sinusitis as the probable diagnosis, imaging studies could be employed. Plain radiography of the sinuses can show an air-fluid level but computed tomography (CT) could be necessary in difficult cases [7] [9]. Ultrasonography has been evaluated as a possible method in the assessment of this infection and seems to be superior to plain X-rays [5]. A panoramic X-ray is recommended if an odontogenic source is suspected [4] [8]. In addition to clinical and imaging studies, a microbiological investigation is an important step as well. But because swab cultures or cultivation of nasal secretions often provide inadequate results, this part of workup is reserved only for individuals who do not respond to therapy or those at risk for a more severe form of infection (eg. immunocompromised patients) [1] [2].
Treatment
[…] root-canal treatment of the causal tooth and antibiotic therapy). [ncbi.nlm.nih.gov]
Prognosis
PURPOSE: The purpose of this study was to evaluate the prognosis and treatment of infection of the maxillary sinus associated with dental implants. [ncbi.nlm.nih.gov]
Prognosis The prognosis is good after treatment. The documents contained in this web site are presented for information purposes only. [orpha.net]
Treatment and prognosis The condition is benign but may result in diplopia. Treatment involves the creation of a drainage route for the sinus. This can be with a nasal antral window or maxillary antrostomy. [radiopaedia.org]
The patients underwent iliac bone graft to close the lateral window of sinus showed worse prognosis. Also, ostium maintained patency without balloon catheter in all patients with patent ostium preoperatively. [ksdm1966.com]
Etiology
In these three patients, maxillary sinusitis of odontogenic origin responded well to the eradication of dental etiology. [ncbi.nlm.nih.gov]
Epidemiology
Summary Epidemiology Its prevalence is unknown but around 100 cases have been reported in the literature so far. Clinical description The progressive enophthalmos may occasionally be associated with cheek pain, diplopia and blurred vision. [orpha.net]
This hypothesis has not been shown to be erroneous and a spirochaetal infection of the central nervous system could explain the specific pathological, immunological, and epidemiological features of MS. --------- Multiple sclerosis associated with sinusitis [mscrossroads.org]
Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 129 (3 Suppl.), S1 –S32. [CrossRef] [Google Scholar] 4. Brook, I. ( 1989 ;). Bacteriology of chronic maxillary sinusitis in adults. [jmm.microbiologyresearch.org]
This is because sinusitis in children differs from that in adults, for example regarding anatomy, diagnosis, epidemiology and microbiology (Hsin 2010). Newborns have maxillary sinuses the size of a bean. [cochranelibrary.com]
Pathophysiology
This type of sinusitis differs in its pathophysiology, microbiology, diagnostics and management from sinusitis of other causes, therefore, failure to accurately identify a dental cause in these patients usually lead to persistent symptomatology and failure [ncbi.nlm.nih.gov]
Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 129 (3 Suppl.), S1 –S32. [CrossRef] [Google Scholar] 4. Brook, I. ( 1989 ;). Bacteriology of chronic maxillary sinusitis in adults. [jmm.microbiologyresearch.org]
Two explanations may apply: firstly, symptoms and signs are often defined according to pathophysiological conditions, but this method is not applicable here as many patients without acute maxillary sinusitis had the same symptoms and signs as patients [bmj.com]
To determine appropriate care for a patient presenting with maxillary sinusitis symptoms, the dental clinician must understand the anatomy, pathophysiology and microbiology of the maxillary sinuses. [oralhealthgroup.com]
Biofilms in chronic rhinosinusitis: Pathophysiology and therapeutic strategies. World Journal of Otorhinolaryngology-Head and Neck Surgery 2015;1: 219–229. View Article Google Scholar 9. Savolainen S, Ylikoski J, Jousimies-Somer H. [journals.plos.org]
Prevention
Then the anterior and inferior edge of the middle turbinate is trimmed to prevent its adhesion to the lateral nasal wall or narrowing of the middle meatus. [ncbi.nlm.nih.gov]
Prevention Prevent maxillary sinus disease by strengthening your immune system. A balanced diet and fitness routine does wonders for helping you to fight off any infection, including all types of sinusitis. [healthfully.com]
Sinusitis Prevention Routinely using nasal lavage can prevent mucus from building up, which provides a friendly environment for bacteria and viruses. [healthcommunities.com]
Prevention The following may help prevent sinusitis: Practice good hand hygiene. Avoid smoking and second-hand smoke. Keep vaccinations up to date. Stay away from people with colds and other respiratory infections. [medicalnewstoday.com]
References
- Yehouessi-Vignikin B, Vodouhe SJ. Maxillary sinusitis: 1752 cases at the ear-nose-throat department of a teaching hospital in Cotonou, Benin. Eur Ann Otorhinolaryngol Head Neck Dis. 2013;130(4):183-187.
- Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011
- Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
- Bell GW, Joshi BB, Macleod RI. Maxillary sinus disease: diagnosis and treatment. Br Dent J. 2011;210(3):113-118.
- Fufezan O, Asavoaie C, Cherecheş Panta P, et al. The role of ultrasonography in the evaluation of maxillary sinusitis in pediatrics. Med Ultrason. 2010;12(1):4-11.
- Mehra P, Murad H. Maxillary sinus disease of odontogenic origin. Otolaryngol Clin North Am. 2004;37(2):347-364.
- Patel NA, Ferguson BJ. Odontogenic sinusitis: an ancient but under-appreciated cause of maxillary sinusitis. Curr Opin Otolaryngol Head Neck Surg. 2012;20(1):24-28.
- Simuntis R, Kubilius R, Vaitkus S. Odontogenic maxillary sinusitis: a review. Stomatologija. 2014;16(2):39-43.
- Guerra-Pereira I, Vaz P, Faria-Almeida R, Braga A-C, Felino A. CT maxillary sinus evaluation-A retrospective cohort study. Med Oral Patol Oral Cir Bucal. 2015;20(4):e419-e426.