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MAXILLARY SINUSITIS CAUSED BY

DENTAL INFECTIONS

Anang Prasetiyono, drg SpBM

Introduction
Maxillary Sinusitis :
-Inflammation of sinus mucosal lining
-10-15% dental origin
-dental symptom

Serious Complications

Anatomy of maxillary sinus

Pathophysiology
Trauma, infection,
allergic

Increase mucus
secretory

Inflammation of mucosa
of maxillary sinus / nasal

Hyperplasia &
Hypertrophy
Sinonasal mucosa
Accumulation
of bacteria

Obstruction of
Sinus Ostium

Decrease drainage &


Accumulation of fluids
and debris

infection

Pathophysiology

Etiology
-Trauma,

infection, allergic
Odontogenic :
* acute/

chronic periapical /periodontal


diseases
* iatrogenic : overfill endodontic material
* trauma from surgery of teeth/ maxilla
oroantral fistula

Etiology
Bacteriae :
Streptoccocus aerob, Peptococcus
anaerob, Peptostreptococcus,
Porphyromonas, Provotella, Eubacterium
spp

Chronic :
Porphyromonas (Bacteroides) species,
Veillonela, Corinebacterium,
alpha-hemolytic Streptococcus,
Staphylococcus, Streptopyogenes

Clinical signs
Acute :
rapidly developing sense of pressure, pain,
fullness in affected sinus
- discomfort rapidly increase, facial swelling,
erytema, malaise, fever, drainage of foulsmelling mucopurulent material into the nasal
cavity & nasopharyng
- dental origin : unilateral pain, usually vague in
origin, pain increase when patient bends over
- vital teeth may be sensitive to percussion

Clinical signs
Chronic :
Failed treatment from acute phase, recurence, > 3
months
Symptoms like acute
Hipersecretion mucopurulen
Rarely caused by odontogenic infection
Predisposition : allergic, nasal septum deviation

Diagnosis maxillary
sinusitis
Anamnesis
Clinical examination :
- tapping of lateral walls of sinus
externally
- intraoral palpation on the lateral
surface of maxilla between the
canine fossa and zygomatic
buttress

Radiographic :
an air-fluid level in the sinus
thickened mucosa on any or all of the sinus walls
complete opacification of the sinus cavity

Therapy of maxillary sinusitis


Non-surgical :
- bed rest
- adequate fluid intake
- drainage and irrigation
- painless with analgetics
- eliminate focal infection
- nasal decongestants : pseudoephedrin & ephedrine 5 %
- mucolitic agents
- antibiotic (Amoxicillin, Amoxicillin-Clavulanat, Trimethoprim,
Sulfamethoxazole, Cephalosporin, Doxiciclin, Erythromycin,
Clindamycin)

Surgical :
- surgical drainage intranasal antrostomy
- Caldwell-Luc approach
- closure oroantral fistula

Caldwell-Luc

Closure oroantral fistula

Complications
Orbita :

Edematous reaction
Orbita cellulitis
Subperiosteal abcess
Orbita abcess
Sinus cavernosus thrombosis

Cranial :
Acute meningitis
Duramater abcess

Conclusion
Maxillary sinusitis : inflammatory of sinus
mucosal dental infection
Treatment : Antibiotic, irrigation & drainage of
sinus, eliminating cause factors
Non-adequate treatment serious
complication at orbita and cranial
The dentist should know symptom & clinical
examination

THANK YOU