Pathophysiology of Odontogenic Maxillary Sinusitis

Abstract

The etiopathophysiology of odontogenic maxillary sinusitis has changed over time. Untreated dental diseases (e.g., dental caries) causing odontogenic maxillary sinusitis has become rare recently. In fact, most teeth identified as being associated with odontogenic maxillary sinusitis have already received dental treatment, especially root canal treatment, that is, endodontics.

Inadequate root canal treatment, for example, when the root canals of the teeth are incompletely filled with a filling material during endodontics can cause pulpitis and pulp necrosis at the root apex. Pulp inflammation causes apical lesions (apical periodontitis), resulting in odontogenic infection, such as alveolar ostitis. When odontogenic inflammation is constantly present at the floor of the maxillary sinus, the maxillary sinus is exposed to the potential danger of inflammation.

The inflammatory vicious cycle formed among dental lesions, odontogenic infection and factors that can disrupt the treatment of sinusitis can influence the outcomes of odontogenic maxillary sinusitis. A vicious cycle of inflammation in the closed maxillary sinus can result in intractable 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 and interfere with the treatment of sinusitis, potentially resulting in intractable odontogenic maxillary sinusitis.

The maxillary sinus mucosa in cases of odontogenic maxillary sinusitis is characteristic. From the histopathological point of view, the ciliated columnar epithelium in these cases 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 is successfully restored. Out of the three aforementioned factors that potentially interfere with the treatment of odontogenic maxillary sinusitis, the treatment strategy is focused on how to manage the two remaining factors: infections and occlusion of the ostiomeatal complex.