歯性上顎洞炎の治療

抄録

The management of odontogenic maxillary sinusitis (OMS) involves a combination of medical treatment with dental surgery and/or endoscopic sinus surgery. Intractable OMS resulting from a vicious cycle of inflammation in the closed maxillary sinus is difficult to cure using only conservative therapies, such as antibiotic administration and dental treatment.

The inflammatory vicious cycle formed among dental lesions, odontogenic infection and factors that can disrupt the treatment of sinusitis can influence the outcomes of OMS, and 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 OMS. Consequently, the treatment strategies for OMS are focused on how to manage the inflammatory vicious cycle in the closed maxillary sinus.

The ciliated columnar epithelium in cases of intractable OMS 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; therefore, of the three aforementioned factors that could interfere with the treatment of OMS, the treatment strategy is focused on how to manage the two remaining factors: infections and occlusion of the ostiomeatal complex.

The treatment results of intractable OMS are exceptionally good, once the ventilation and drainage of the maxillary sinus are successfully restored after endoscopic sinus surgery. The causative teeth (endodontic treated teeth with periapical lesions) can be preserved with antibiotic treatment alone, without dental retreatment. Consequently, endoscopic sinus surgery can be considered as the first-line therapy for intractable OMS caused by root canal treatment (endodontics), followed by close dental follow-up and dental treatment where necessary.