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Maxillary Sinusitis

Maxillary Sinusitides

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].

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]
  • Symptoms of sinusitis can include fever, weakness, fatigue, cough, and congestion. There may also be mucus drainage in the back of the throat, called postnasal drip.[icdlist.com]
Fever of Unknown Origin
  • We report 2 acute tetraplegic patients who presented with fever of unknown origin. After extensive work-up, they were diagnosed with occult maxillary sinusitis.[ncbi.nlm.nih.gov]
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]
  • Symptoms include sinus pain, pressure, nasal congestion, and drainage of fluids. Surgery is needed to open the affected sinus and remove the fungal debris.[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]
Bad Taste
  • In our series the mean age was 53 years (range, 21-70 years), mean duration of symptoms was 2.6 years (range, 1 month to 15 years), rotten smell or bad taste was present in 10 of 21 (48%) patients, dental pain was present in 6 of 21 (29%) patients, and[ncbi.nlm.nih.gov]
Ptosis
  • A 24-year-old woman presented with left-sided ptosis, diplopia, sensory impairment on the left side of her face and diminished hearing in her left ear.[ncbi.nlm.nih.gov]
Epistaxis
  • 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]
Pelvic Pain
  • Resolution of the acute maxillary sinusitis after operative intervention and termination of the above-mentioned medication, resolution of pelvic pain after therapy with leuprolide after 4 weeks.[ncbi.nlm.nih.gov]
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]
  • The most common presenting signs and symptoms were moderate-to-severe nasal obstruction (80.4%), pain on sinus palpitation (76.8%), facial pain (74.5%), rhinorrhea (70.4%), and headache (63.6%).[ncbi.nlm.nih.gov]
  • The clinical signs of infection were: headache, locoregional pain, cacosmia, inflammation of the oral buccal mucosa and rhinorrhea or unilateral nasal discharge. A mucosal fistula was observed during inspection in one patient.[ncbi.nlm.nih.gov]
  • 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.[symptoma.com]
  • 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]
Neglect
  • As a consequence a detailed investigation of BRONJ of the maxilla and in particular of involvement of the maxillary sinus has largely so far been neglected.[ncbi.nlm.nih.gov]

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].

Penicillium
  • The Penicillium genera, encompassing about 225 different species of fungi, are naturally present in the environment. These genera are poorly linked to human disease, except for Penicillium marneffei causing septicemia in immunocompromised hosts.[ncbi.nlm.nih.gov]

Treatment

  • The long-term administration of antibiotic medicine and/or treatment of the causative tooth are the usual initial treatments. These initial treatments are not always effective, and the reason is not well understood.[ncbi.nlm.nih.gov]
  • […] root-canal treatment of the causal tooth and antibiotic therapy).[ncbi.nlm.nih.gov]
  • CONCLUSION: MEMM is an effective and acceptable alternative treatment for chronic maxillary sinusitis refractory to standard medical treatment and endoscopic surgical treatment.[ncbi.nlm.nih.gov]
  • A secondary objective was to assess the cost effectiveness of Sinfrontal versus standard treatment with antibacterials.[ncbi.nlm.nih.gov]
  • INTERPRETATION: Treatment with chloramphenicol eye drops appears to represent a treatment option for some patients with symptoms indicative of acute maxillary sinusitis.[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]
  • PURPOSE: The aims of this study were to evaluate the incidence of maxillary sinusitis associated with the sinus elevation procedure and to analyze the influence of maxillary sinusitis on the prognosis of dental implants.[ncbi.nlm.nih.gov]
  • However, many studies have shown that symptoms used to diagnose sinusitis often do not predict prognosis or response to antibiotic treatment. Sneezing, sore throat, and muscle aches may be present, but they are rarely caused by sinusitis itself.[medigoo.com]

Etiology

  • In these three patients, maxillary sinusitis of odontogenic origin responded well to the eradication of dental etiology.[ncbi.nlm.nih.gov]
  • The otolaryngologist should suspect an odontogenic etiology of purulent maxillary CRS in patients failing to improve with antibiotics, regardless of a negative dental workup.[ncbi.nlm.nih.gov]
  • A model to predict the inflammatory response in the maxillary sinus in the presence etiological factors of dental origin was constructed.[ncbi.nlm.nih.gov]
  • Other etiological factors for odontogenic unilateral sinusitis were periapical (23/130 cases; 18%) and periodontal pathology (13/130 cases; 10%).[ncbi.nlm.nih.gov]
  • Au.) infection of the maxillary sinus has been reported as an incidental finding on routine antrostomy; however, it has also been noted in several studies as the significant organism in the etiology of chronic sinusitis.[ncbi.nlm.nih.gov]

Epidemiology

  • 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]
Sex distribution
Age distribution

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]
  • 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]
  • Blacklow Lippincott Williams & Wilkins, 2004 - 2515 من الصفحات The Third Edition of this definitive reference provides comprehensive guidelines on the diagnosis, treatment, and prevention of every infectious disease seen in current clinical practice.[books.google.com]
  • Care is taken to engage the uncinate process parallel to the lateral nasal wall to prevent injury to the lamina papyracea.[emedicine.medscape.com]
  • Surgical treatment of maxillary chronic sinus inflammation with strictly defined indications and correctly chosen method leads to a significant reduction in the duration of the disease, preventing the serious consequences and complications.[minclinic.ru]

References

Article

  1. 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.
  2. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011
  3. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
  4. Bell GW, Joshi BB, Macleod RI. Maxillary sinus disease: diagnosis and treatment. Br Dent J. 2011;210(3):113-118.
  5. 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.
  6. Mehra P, Murad H. Maxillary sinus disease of odontogenic origin. Otolaryngol Clin North Am. 2004;37(2):347-364.
  7. 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.
  8. Simuntis R, Kubilius R, Vaitkus S. Odontogenic maxillary sinusitis: a review. Stomatologija. 2014;16(2):39-43.
  9. 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.

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Last updated: 2019-06-28 11:24