2022 Volume 160 Pages 87-97
The pathophysiology of odontogenic maxillary sinusitis caused by odontogenic infections precipitated by maxillary lesions is not yet clear.
The maxillary lesions include acute maxillary sinusitis, retention cysts of the maxillary sinus, postoperative maxillary cysts and odontogenic cysts. The main clinical symptom is persistent cheek pain, even after the maxillary lesions have improved and there are no lesions in the tooth crown or periodontal tissue. All teeth with odontogenic infections precipitated by maxillary lesions respond with pain to percussion.
The pathological findings of the odontogenic infections are ascending pulpitis and pulpal necrosis precipitated by maxillary lesions, after which, ascending pulpitis and pulpal necrosis cause odontogenic maxillary sinusitis.
When patients complain of persistent cheek pain even after maxillary lesions have improved and there are no lesions of the tooth crown or periodontal tissue, odontogenic infections (i.e. ascending pulpitis and pulpal necrosis) precipitated by maxillary lesions should be suspected.
In cases of odontogenic maxillary sinusitis caused by odontogenic infections precipitated by maxillary lesions, the management of odontogenic maxillary sinusitis involves a combination of medical treatment with dental surgery (endodontics) and/or endoscopic sinus surgery.
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.
Consequently, the treatment strategies for odontogenic maxillary sinusitis are focused on how to manage the inflammatory vicious cycle in the closed maxillary sinus.
