Odontogenic Sinusitis: Where to Start? The Importance of a Multidisciplinary Approach

Abstract

Introduction: odontogenic sinusitis can be secondary to an adjacent infectious dental pathology or iatrogenic lesions resulting from dental procedures. It accounts for up to 75 % of cases of unilateral maxillary sinus opacification seen in computed tomography. There is a lack of clear consensus regarding the optimal management and the appropriate timing for interventions. The goal is to propose an approach centered on active collaboration between the Otolaryngology and Maxillofacial services and present the action algorithm used.

Materials and methods: retrospective descriptive study of patients with odontogenic sinusitis who received a multidisciplinary approach and combined surgery.

Results: 21 patients underwent combined surgery for dental and nasal treatment. All patients underwent combined surgery. Nasal surgery was performed endoscopically with maxillary antrostomy based on the opacification seen in the computed tomography. In the dental aspect, the affected teeth and odontogenic cysts were removed. Oral-antral communications and fistulas were closed with flaps during the same surgical procedure. All patients resolved without complications.

Discussion: if the origin is a treatable dental infection, the initial approach should include specific dental treatment alongside medical management. There are indications for early endoscopic surgery, such as impact on quality of life or risk of complications. Notably, when both the dental pathology and sinusitis are addressed, a resolution rate of 90 % can be expected, with early symptomatic improvement of the sinus. In our experience, we prefer to perform combined treatment when it is not feasible to treat the dental pathology conservatively and when the responsible dental piece or implant needs to be extracted.

Conclusion: we believe that close collaboration between specialists is essential to achieve optimal outcomes. When surgical intervention is indicated in both fields, simultaneous combined surgery represents a direct, reliable, and curative strategy, with low morbidity, a low incidence of complications, and rapid recovery.