Published on March 15, 2014
Def: inflammation of the lining mucosa of the nose and paranasal sinuses (rhinosinusitis). Causative organisms: strept. Pneumonia, hemophilus influenza and moraxella catarrhalis. Predisposing factors: general low body resistance and local factors leading to obstruction of sinus ostium ( deviated septum, allergic rhinitis)
Routes of infection: 1. Nasal: (extension, FB, pack, infected water, nasogastric tube). 2. Dental: (caries, oroantral fistula) 3. External: fractures Pathology: 1. Catarrhal: viral, congestion, edema--- obstruction. 2. Suppurative: bacterial, pus accumulation.
Pain and tenderness over sinuses nasal congestion and obstruction Headache (increasing on coughing, straining, leaning forward, in the morning) foul odor (dental origin) discharge down the back of the throat (postnasal drip) nasal discharge (mucopurulent, assess for site) fever dental pain
Ethmoid sinusitis (between the eye sockets) •Pain or pressure around the eyes and down the sides of the nose (inner canthus) radiating to the temples Maxillary sinusitis (in the cheekbones) •Pain or tender cheekbone, under or around the eye, or around the upper teeth on one or both sides of the face
Frontal sinusitis (in the forehead and above the eyebrows) Severe headaches in the forehead radiating to the temple. vacuum headache due to negative pressure in the sinus with characteristic periodicity (starts in the morning, increase by mid day and gradually ends by end of day). Sphenoid sinusitis (Deep in the head) Deep headache with pain on top of the head, and behind the eye referred to the occipital region. Double vision or vision disturbances if pressure extends to the optic nerve.
Chronic nasal discharge, congestion or obstruction. Low Grade Headache. Pain or discomfort (pressure) related to the sinus infected. Chronic sore throat. Chronic bad breath. Chronic toothache. Increased cough at night. NB: ethmoid polyps could be seen with chronic ethmoid sinusitis.
1) x-ray PNS (sinus view): opacity or fluid level. 2) CT scan PNS: better, mandatory before endoscopic surgery. 3) Culture and sensitivity: for better antibiotic selection.
Medical: systemic antibiotics, analgesics, mucolytics, nasal decongestant spray and steam inhalation. Surgical: external procedures (old) and endoscopic (functional endoscopic sinus surgery FESS).
The sinus that most commonly becomes infected is the maxillary sinus due to the anatomy that allows drainage of the cavity against gravity. In the maxillary sinus the mucus must move upward to drain from the sinus and to the nasal cavity. This drainage pattern makes the maxillary sinus prone to infection. These infections can cause pain in the upper teeth. The pain can be spontaneous and/ or these teeth may feel sensitive with chewing. (maxillary sinusitis pain can mimic pain of dental origin).
Tooth pain is often the symptom that brings patients to the office after the cold has gone away. If you have sinus pain, especially pain on both sides of the face, as well as tooth pain, than it can be likely that the sinus is the source of the pain. Sinus toothache?
A Sinus problem can also cause you to become a mouth breather. Mouth breathers can develop plaque buildup more quickly than a non-mouth breather because mouth breathing causes your mouth to become dry which is an excellent place for bacteria to grow.
Periapical x-ray of maxillary teeth and sinus floor 10% of sinusitis is due to a dental source. Second premolar and first molar are usually the teeth involved because of its location.
Odontogenic sinusitis may be related to periapical or periodontal disease, as well as to oroantral fistula. The risk is greater in adults than in children because of the continued expansion of the sinus into the alveolar bone after the eruption of the secondary dentition. Symptoms of dental sinusitis are usually facial pain, swelling, tenderness, and discharge from the nose or an oral fistula. The maxillary sinus is often opaque in a plain x-ray film. Anaerobic organisms predominate, and antibiotics should be chosen appropriately. The dental disease needs to be eradicated, otherwise the sinusitis will persist.
Step to evaluate sinus pain versus tooth pain: History of previous episodes of sinusitis. Palpation of maxillary bone over the sinuses. Evaluation of teeth to identify a possible dental origin. X-rays( sinus and dental views).