title: Clinical and radiologic findings in a case series of maxillary sinusitis of dental origin.
abstract: BACKGROUND
  Maxillary sinusitis of dental origin (MSDO) has been described for decades, but tends to be overlooked as a possible cause of chronic sinusitis by both clinicians and radiologists. The incidence of MSDO in published series is reported to be from 10% to 40% in bacterial sinusitis. We present this series to highlight clinical and radiologic indicators of MSDO.
  
  
  METHODS
  Databases from the authors' otolaryngology and endodontic practices were reviewed to identify patients who had been seen mutually. Sixty-seven (67) patients were identified. Both authors then reviewed the clinical records and associated computed tomography (CT) scans and determined that 31 patients had MSDO and 2 of had bilateral MSDO, for a total of 33 cases. The clinical and radiologic features related to these cases were then tabulated.
  
  
  RESULTS
  The clinical characteristics of the 33 cases of MSDO were as follows: sinus pain (88%), postnasal drainage (64%), congestion (45%), maxillary toothache (39%), and foul drainage (15%). Radiographic CT findings of MSDO showed periapical abscess in 18 cases (55%), periodontal abscess in 3 cases (9%), and no obvious dental pathology in 12 cases (36%). The extent of associated sinusitis was variable from mucoperiosteal thickening to florid unilateral sinusitis involving multiple sinuses. Eighteen maxillary sinuses (55%) were found to have either patent maxillary infundibula or prior surgical antrostomy. Twenty-four patients (77%) had unilateral maxillary sinus disease.
  
  
  CONCLUSIONS
  MSDO should be considered highly likely when radiographic evidence of dental pathology is associated with maxillary sinus disease. Regardless of negative CT evidence of dental pathology, MSDO should be suspected when unilateral maxillary sinus disease is seen, particularly when associated with a patent infundibulum. When MSDO is suspected, a clinical endodontic examination should be performed to rule out or treat an odontogenic etiology.
authors.affiliation: Spokane ENT Clinic, Spokane, WA; University of Washington, Department of Otolaryngology-Head and Neck Surgery, Seattle, WA.
authors.forename: Al
authors.initials: A
authors.lastname: Pokorny
authors.forename: Roderick
authors.initials: R
authors.lastname: Tataryn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D015523:Maxillary Sinusitis / Q000150:complications / Q000000981:diagnostic imaging; D008875:Middle Aged; D012189:Retrospective Studies; D009057:Stomatognathic Diseases / Q000150:complications*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
keywords: cone beam CT scan; dental infection; endodontics; maxillary sinusitis; odontogenic sinusitis; periapical abscess; root canal therapy; sinusitis of dental etiology