title: Root Cause Analysis: An Examination of Odontogenic Origins of Acute Maxillary Sinusitis in Both Immunocompetent & Immunocompromised Patients.
abstract: OBJECTIVE
  Dental and periodontal diseases represent important but often overlooked causes of acute sinusitis. Our goal was to examine the prevalence of potential odontogenic sources of acute maxillary sinusitis according to immune status and their associations with sinusitis.
  
  
  METHODS
  A retrospective review of maxillofacial computed tomography studies from 2013 to 2014 was performed. Each maxillary sinus and its ipsilateral dentition were evaluated for findings of acute sinusitis and dental/periodontal disease.
  
  
  RESULTS
  Eighty-four patients (24 immunocompetent, 60 immunocompromised) had 171 maxillary sinuses that met inclusion criteria for acute maxillary sinusitis. Inspection of dentition revealed oroantral fistula in 1%, periapical lucencies in 16%, and projecting tooth root(s) in 71% of cases. Immunocompromised patients were more likely to have bilateral sinusitis than immunocompetent patients (67% vs 33%, P = 0.005). A paired case-control analysis in a subset of patients with unilateral maxillary sinusitis (n = 39) showed a higher prevalence of periapical lucency in association with sinuses that had an air fluid level-29% of sinuses with a fluid level had periapical lucency compared with 12% without sinus fluid (P = 0.033).
  
  
  CONCLUSIONS
  Potential odontogenic sources of acute maxillary sinusitis are highly prevalent in both immunocompetent and immunocompromised patients, although the 2 patient populations demonstrate no difference in the prevalence of these potential odontogenic sources. Periapical lucencies were found to be associated with an ipsilateral sinus fluid level. Increased awareness of the importance of dental and periodontal diseases as key components of maxillofacial computed tomography interpretation would facilitate a more appropriate and timely treatment.
authors: From the Departments of *Radiology and †Biostatistics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Jennifer L
authors: JL
authors: McCarty
authors: Ryan M
authors: RM
authors: David
authors: Shelly Y
authors: SY
authors: Lensing
authors: Rohan S
authors: RS
authors: Samant
authors: Manoj
authors: M
authors: Kumar
authors: Rudy L
authors: RL
authors: Van Hemert
authors: Edgardo J C
authors: EJC
authors: Angtuaco
authors: Ryan T
authors: RT
authors: Fitzgerald
mesh_terms: D000208:Acute Disease; D005147:Facial Bones / Q000000981:diagnostic imaging; D006801:Humans; D007121:Immunocompetence / Q000276:immunology*; D016867:Immunocompromised Host / Q000276:immunology*; D008437:Maxilla / Q000000981:diagnostic imaging; D015523:Maxillary Sinusitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D010510:Periodontal Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D012189:Retrospective Studies; D060891:Root Cause Analysis / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014076:Tooth Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology