Chronic Rhinosinusitis of Odontogenic Origin

Chronic rhinosinusitis (CRS) is a heterogeneous disease process primarily considered to be of nasal origin. Highlighted in this case, CRS may result from an odontogenic infection. An 82-year-old man presented with 6-month history malodor and purulent drainage. He endorsed recurrent frontal headaches, anosmia, dysgeusia, but denied odontalgia. had been treated 2 courses oral antibiotics without durable benefit. Physical examination showed poor dentition, left-sided rhinorrhea, the absences oroantral fistula (OAF). The mucopurulence was found emanating left osteomeatal complex (OC) on endoscopy. Cultures drainage grew coagulase-negative staphylococcus as part mixed respiratory flora. On computed tomography imaging, periapical abscess associated opacification his maxillary sinus demonstrated (Figure 1, A). infection seen extending resulting anterior ethmoid B C). etiology chronic (OCRS) attributed direct infiltration bacteria dental infection, can also secondary interventions including tooth extraction (complicated by OAF), floor elevations, or implant displacement.1Molteni M. Bulfamante A.M. Pipolo C. Lozza P. Allevi F. Pisani A. et al.Odontogenic sinusitis sinonasal complications treatments: retrospective case series 480 patients critical assessment current classification.Acta Otorhinolaryngol Ital. 2020; 40: 282-289Crossref PubMed Scopus (7) Google Scholar Owing anatomical proximity between root(s), 10% 30% cases are believed caused underlying infection.1Molteni Odontogenic frequently shows extension beyond via spread through OC. At time presentation, our cases, it common see sinuses involved. posterior sphenoid often spared because these drain independently Wuokko-Landen al2Wuokko-Landén Blomgren K. Välimaa H. Acute rhinosinusitis—are we forgetting possibility origin? A study 385 patients.Acta Otolaryngol. 2019; 139: 783-787Crossref (11) compared microbiology OCRS that acute (ARS), finding significant flora differences. samples typically consistent dental-alveolar abscess, anaerobic gram-negative rods viridans group streptococci most commonly identified. pathogens ARS (S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) were not OCRS. Staphylococcus aureus only discovered 5.5% cases.2Wuokko-Landén These organisms important consider when initiating antibiotic treatment for suspected Management depends severity disease. For mild disease, teeth sufficient cure problem antibiotics. severe characterized ipsilateral sinuses, combination endoscopic surgery, extraction, antibiotics, systemic steroid necessary. Molteni al1Molteni report low rate postoperative (<1%). Of complications, 62.5% sinusitis, 25% OAF, 12.5% bleeding.1Molteni When evaluating complaints, rhinological nonrhinological etiologies should considered. In unilateral diagnostic differential includes neoplastic, fungal, processes. demonstration infectious pathways hallmark