Faculty Collaboration Database

Diagnosing odontogenic sinusitis of endodontic origin: A multidisciplinary literature review. Am J Otolaryngol 2021;42(3):102925

Date

01/25/2021

Pubmed ID

33486208

DOI

10.1016/j.amjoto.2021.102925

Scopus ID

2-s2.0-85099636889 (requires institutional sign-in at Scopus site)   29 Citations

Abstract

PURPOSE: Endodontic disease is one of the most common causes of bacterial odontogenic sinusitis (ODS). Diagnosing ODS of endodontic origin involves otolaryngologists confirming sinusitis, and dental specialists confirming endodontic sources. The purpose of this study was to conduct a multidisciplinary literature review to highlight clinical and microbiological features of ODS, and the most optimal diagnostic modalities to confirm endodontic disease.

METHODS: An extensive review of both medical and dental literature was performed by rhinologists, endodontists, and an infectious disease specialist. Frequencies of various clinical and microbiological features from ODS studies were collected, and averages were calculated. Different endodontic testing and imaging modalities were also evaluated on their abilities to confirm endodontic disease.

RESULTS: ODS patients most often present with unilateral sinonasal symptoms for over 3 months, purulence on nasal endoscopy, and overt dental pathology on computed tomography (CT). Subjective foul smell, and maxillary sinus cultures demonstrating anaerobes and α-streptococci (viridans group) may be more specific to ODS. For endodontic evaluations, cold pulp testing and cone-beam CT imaging are most optimal for confirming pulpal and periapical disease.

CONCLUSION: Diagnosing ODS requires collaboration between otolaryngologists and dental specialists. Clinicians should suspect ODS when patients present with unilateral sinonasal symptoms, especially foul smell. Patients will generally have purulent drainage on nasal endoscopy, and both sinus opacification and overt dental pathology on CT. However, some patients will have subtle or absent dental pathology on CT. For suspected endodontic disease, endodontists should be consulted for at least cold pulp testing, and ideally cone-beam CT.

Author List

Craig JR, Tataryn RW, Cha BY, Bhargava P, Pokorny A, Gray ST, Mattos JL, Poetker DM

Author

David M. Poetker MD Chief, Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Bacterial Infections
Cone-Beam Computed Tomography
Female
Humans
Male
Maxillary Sinusitis
Middle Aged
Pulpitis
Tomography, X-Ray Computed
Viridans Streptococci