2022 Volume 160 Pages 1-22
A knowledge of the clinical histoanatomy of the teeth, maxilla and maxillary sinus is very important for a clear understanding of the pathophysiology of odontogenic maxillary sinusitis.
In order to maintain the normal functions of the maxillary sinus, ventilation and drainage of the maxillary sinus via the natural ostium and ostiomeatal complex need to be preserved. The maxillary sinus is ventilated via the natural ostium, which is approximately 5 mm in diameter, and drained by the mucociliary transport system of the maxillary sinus epithelium. Consequently, lesions around the natural ostium and ostiomeatal complex disrupt the ventilation and drainage of the maxillary sinus, potentially resulting in maxillary sinusitis.
In regard to factors that could interfere with the treatment of maxillary sinusitis, impaired mucociliary function, bacterial and virus infections, occlusion of the ostiomeatal complex, or a combination of these three factors can perpetuate an inflammatory vicious cycle in the closed maxillary sinus, which could result in intractable maxillary sinusitis.
The ciliated columnar epithelium in cases of intractable odontogenic maxillary sinusitis is neither severely damaged nor irreversibly injured. As a result, the mucociliary function of the epithelium is almost certain to recover once the ventilation and drainage of the maxillary sinus are successfully restored. Consequently, out of the three aforementioned factors that potentially interfere with the treatment of odontogenic maxillary sinusitis, the treatment strategy is focused on the two remaining factors: infections and occlusion of the ostiomeatal complex.
The treatment goal of paranasal sinusitis, including maxillary sinusitis, is to sufficiently restore and improve the ventilation and drainage function of each sinus and to normalize the sinus epithelium, and thereby achieve cure of the sinusitis. Control of the aforementioned factors that could interfere with the treatment should be undertaken simultaneously.
