Odontogenic maxillary sinusitis

Maxillary sinusitis can be caused by chronic inflammation in the nasal cavity and badly treated or untreated teeth anatomically connected to the lower sections of the maxillary sinus by their roots. Dental or odontogenic maxillary sinuses are most often unilateral. That is, inflammation in one of the maxillary sinuses results from dental disease or poor dental treatment in 95% of cases.

Maxillary sinusitis is an inflammation of the maxillary sinus.

The inside of this sinus (cavity) is covered by a mucous membrane (epithelium). Inflammation of the nasal mucosa can be purulent or serous.

Sinusitis on X-ray. The right maxillary sinus is filled with fluid.

The inflamed epithelium behaves differently depending on the phase (acute or chronic). The chronic phase is when the mucosal epithelium overgrows and partially turns into polyps or cysts. Sometimes, during tooth extraction, the tooth root gets into the maxillary sinus, and if it is not extracted, it will cause infection of the maxillary sinus.

It can also be caused by filling material pulled behind the apex of the root during endodontic treatment (root canal filling).

Radicular cyst that has grown into the maxillary sinus.

Does maxillary sinusitis hurt? Maxillary sinusitis is terribly unpleasant.

Chronic conditions provoke frequent rhinitis throughout the year. A person with chronic maxillary sinusitis always has difficulties in nasal breathing (on the side suffering from maxillary sinusitis). The condition can be accompanied by headaches, migraines, and neuralgia. Some people complain about unnatural night snoring. Often, after surgery, the patient says that nasal breathing and the ability to sleep normally restores and headaches disappear.

Odontogenic maxillary sinusitis most often occurs on one side and can be right or left-sided. Maxillary sinusitis is related to the fact that, anatomically, teeth are connected by their roots to the lower part of the maxillary sinus cavity. Inflammation of these teeth and subsequent treatment can lead to inflammation of the maxillary mucosa or maxillary sinusitis.

Maxillary sinusitis can be acute, purulent or serous, chronic, polypous, etc. In any case, maxillary sinusitis causes much unpleasant pain, while all the types are associated with diseases of the teeth on the upper jaw.

The main cause is dental diseases and dental treatment that provokes the development of maxillary sinusitis. This is how it happens: for example, after the teeth restoration (filling), the filling mass enters the maxillary cavity, which is an active component for inflammation of the nasal mucosa. This allows introducing infection to the maxillary sinus cavity, when the tooth is treated, but the infection in the maxillary cavity continues to live and develop.

Maxillary sinusitis can also develop as a result of improperly placed dental implants. For example, when a dental implant is 10 mm long, and the bone height is 7 mm, this means that 7 mm of the implant sits in the bone while the remaining 3 mm is in the maxillary sinus cavity. Such an implant hurts the mucous membrane, which leads to chronic inflammation of the maxillary sinus cavity.

It turns out that the implant and the dental crown on it work fine, but maxillary sinusitis occurs. By the way, this is yet another reason for the installation of short plateau-type implants. When placing them, the probability of a maxillary sinus cavity being punctured by the implant tends to zero.

Sinusitis on X-ray.

The causes of maxillary sinusitis can also include sinus-lift surgery (augmentation of the jaw bone volume for a dental implant). The point is that there is Schneider’s membrane between the bone and the maxillary sinus mucosa, which belongs to epithelial layers. During bone augmentation, dentists tear it away from the bone base and put bone material between the maxillary sinus mucosa and the bone to place the implant there afterward, without damaging the Schneider’s membrane. So, at this point, a dome of bone mass is formed in the maxillary sinus, and it is very difficult for the maxillary sinus epithelium to work through the “bump” and evacuate biological fluid from the maxillary sinus, which always leads to hypertrophy of the mucosa. And this results in breathing trouble, rhinitis, etc.

There is also such a diagnosis as a radicular cyst grown into the maxillary sinus cavity. As a result of chronic inflammation, cystic granuloma develops on the tooth top, penetrates the maxillary sinus cavity, and transforms into a large cyst. The cyst enlarges and fills the cavity, causing a lot of discomfort to the patient.

Can a person understand that he/she has odontogenic maxillary sinusitis without attending a specialist? Most often, people visit an ENT physician when they have inflammation in the nose (sinusitis or maxillary sinusitis). That makes sense since a person has problems with the nose: difficulty with breathing, headaches associated with frequent rhinitis, and so on. At this point, the person hardly thinks of teeth, especially since maxillary sinusitis occurs after the tooth has already been treated.

Sinusitis of the right maxillary sinus caused by perforation of the sinus by a dental implant.

Of course, if the doctor is competent, he/she will direct the patient to a maxillofacial surgeon because maxillary sinusitis can only be treated by such a specialist. Answering the question, we can say that a patient is rarely able to independently determine what type of maxillary sinusitis he/she has.

Often, a patient pays the initial visit to an ENT physician. The nose hurts, there is difficulty in breathing, and the ENT doctor says, “You have an allergy.” The specialist starts identifying an allergic component, but there is none. Next, the specialist suggests you have nasal septum deviation. So, you get the septum aligned, but the symptoms still don’t disappear. Headaches — well, let’s see a neurologist; maybe, it’s neuralgia. As the result, people come to a dentist in the last turn, when everything has been ruled out. And when the person comes to the dentist, it turns out that two teeth with missing nerves were treated incorrectly, a cyst has grown into the maxillary sinus cavity, and it is completely dental or maxillofacial history.

First and foremost, a diagnosis is an interview with a patient about his or her medical history. Typically, within the interview, the patient indicates that there has been dental treatment. There is always an underlying cause that precedes maxillary sinusitis.

Of course, we resort to CT or MRI studies when diagnosing maxillary sinusitis. With CT, we can study the condition of the teeth, the jaw, and the maxillary sinus, and we study the condition of the mucosa itself with MRI. This way, we can understand if it is a neoplasm, a cyst, or just a filled-up mucosa of the maxillary sinus. That’s the basic diagnostic routine.

Maxillary sinusitis is already a complication, but delaying treatment can lead to years of migraines, difficulty breathing (dizziness), and the development of a non-specific infection (anaerobic, viral, or fungal infections).

A very severe complication of maxillary sinusitis is pansinusitis, which causes inflammation of all nasal cavities, the lamina (middle nasal cavity), and frontal sinuses. Allergic reactions, allergic rhinitis, and bronchial asthma are aggravated.

First of all, it is necessary to determine the cause of maxillary sinusitis to understand what treatment to perform. Most often, if there are cysts grown into the maxillary cavity or visible/significant changes in the maxillary cavity, a surgical treatment called maxillary sinusotomy (removal of the altered mucosa) is necessary.

Maxillary sinusotomy is a surgical procedure. It is performed on an outpatient basis (in oral surgery). As a rule, if a tooth causes maxillary sinusitis, the surgeon extracts it, enters the maxillary cavity through the extraction pit, and gently removes excess mucosa.

If the tooth was extracted long ago, maxillary sinusotomy is performed with piezotome (ultrasonic scalpel) through the outer wall of the maxillary cavity, which is done in the patient’s mouth. An incision is made over the teeth, and the maxillary sinus cavity is cleaned through the outer wall.

The surgery is painless and minimally traumatic. It is performed under local anesthesia, and the patient does not feel any discomfort after the surgery. On the contrary, nasal breathing improves, headaches disappear (no swelling or bleeding after the surgery), and the patient feels better.