Chronic odontogenic rhinosinusitis: optimization of diagnostics and sinus surgical treatment indications

Chronic rhinosinusitis is the inflammation of the mucosal lining of the paranasal sinuses caused mostly by allergies or respiratory infections. The cause of this disease is mainly rhinogenic, but close proximity of the maxillary roots to the sinus floor makes also dental disease a probable cause of chronic rhinosinusitis. This infection may get through the apex of the root, deep periodontal pocket, oroantral fistula, during endodontic treatment or implant surgery. Clinical symptomatology of chronic odontogenic rhinosinusitis is similar to chronic non-odontogenic sinusitis, therefore it is often confused with the latter and treated improperly, what can cause serious complications. Aim of the study To establish most accurate diagnostical radiological method for patients with chronic odontogenic rhinosinusitis, to explore the impact of clinical symptomatology and life quality in chronic odontogenic rhinosinusitis diagnostics, to form clear indications for surgical sinus treatment. Study objectives 1. To explore the clinical efficacy of main radiological methods (CT, OPG, PR) for patients with chronic odontogenic rhinosinusitis. 2. To define the most common clinical symptoms of chronic odonto-genic rhinosinusitis in comparison with chronic non-odontogenic rhinosinusitis. 3. To explore health related life quality in patients with chronic chronic odontogenic rhinosinusitis and to compare it with chronic non-odontogenic rhinosinusitis. 4. To explore the radiological (CT) indications for maxillary sinus surgery in patients with chronic odontogenic rhinosinusitis 5. To explore the changes in clinical symptomatology in patients with chronic odontogenic rhinosinusitis after elimination of dental infection. 6. To form indications for surgical maxillary sinus treatment in patients with chronic odontogenic rhinosinusitis. Novelity of the study Correct identification of dental pathology in CORS is a crucial point in its successful treatment. The properties of main radiological methods that are used for this porpose are widely explored and described in literature [19–21, 35]. On the other hand, another important point is the evaluator of these radiological views, whose work speciality, experience and competence can differ and could have a high impact on the correct diagnosis. In this study, the impact of radiological evaluator for CORS diagnosis is explored for the first time. There is a duobtful difference in clinical symptomatology between CORS and CNRS [22, 25]. On the other hand, the is a lack of studies explor-ing the frequency, severity and impact on HRQL. In thi

Chronic rhinosinusitis with nasal polyps: age and disease severity differences in the levels of inflammatory markers

Background and objectives: The aim of our study was to analyze the concentrations of inflammatory markers in the nasal tissue of patients with chronic rhinosinusitis with nasal polyps (CRSwNPs) and controls of different age groups, as well as to find associations between age, inflammation development, and NPs. Materials and methods: Patients were divided into two groups—patients with CRSwNPs and control subjects who had nasal surgery for another reason beside CRS. Our analysis was performed across three different age groups (18–30 years, 31–50 years, and 51 years and more). Tissue biopsies from the sinus cavity for all study participants were taken and frozen at −80 °C, until use. The concentrations of IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-10, IL-13, IL-21, and IL-22, were quantified using a magnetic bead-based multiplex assay. Results: In the group aged 18–30 years, the levels of inflammatory markers IL-1, IL-2, IL-5, and IL-22 were significantly higher in patients with CRSwNPs than the control subjects. Among patients aged 31–50 years, significantly higher concentrations of IL-2, IL-4, IL-5, and IL-22 were recorded in patients with CRSwNPs, as compared to the control subjects. In the oldest group (aged 51 years and more), patients with CRSwNPs had significantly higher concentrations of IL-2, IL-4, and IL-22, as compared to the control group. In the CRSwNP group, only the concentration of IL-21 was significantly higher among patients aged 31–50 years, as compared with those aged 51 years and older (p = 0.013). Conclusions: IL-2 and IL-22 levels were significantly higher in patients with CRSwNP than the control, across all age groups. Only the concentration of IL-21 was higher among patients with CRSwNP in the middle age group, as compared to the oldest group. IL-2, IL-4, and IL-22 levels correlated with the severity of CRSwNPs. Elevated concentrations of IL-2, IL-4, and IL-22 were determined in patients’ groups with higher sinonasal outcome test (SNOT-22) scores, pointing to more severe clinical symptoms

Association between maxillary posterior teeth periapical odontogenic lesions and maxillary sinus mucosal thickening: a 3D volumetric computed tomography analysis

Background: The detailed relationship between apical periodontitis and maxillary sinus mucosal thickening is still unknown. The aim of this study was to evaluate the association between maxillary posterior teeth periapical odontogenic lesions and maxillary sinus mucosal (MSM) thickening by using volumetric 3D CT analysis. Methods: A total of 83 subjects with apical periodontitis around maxillary posterior teeth and maxillary sinus mucosal thickening were selected. 3D models of maxillary sinus mucosa and apical lesions were reconstructed from CT, and their volume, mean diameter were calculated. Results: Mean MSM thickening was 8.81 ± 12.59 mm with an average volume of 5092.58 ± 7435.38 mm3. Men had higher MSM thickening than women. Mean diameter of apical lesion was 5.94 ± 2.68 mm; average volume was 200.5 ± 197.29 mm3. Mean distance between MSM and apical lesion was 1.83 ± 2.07 mm. Mucosal volume was the highest in the S1 and D1 configuration and the lowest in R3. Reducing the distance between apical lesion and MSM by each millimetre, the volume of MSM increases by 759.99 mm3. Conclusions: Volumetric CT analysis is a circumstantial method to evaluate the association between maxillary posterior teeth apical periodontitis and MSM thickening. This relationship is not related to the size of the apical lesion but depends on their anatomical position and the distance from the maxillary sinus mucosa