Rhinosinusitis is a common health problem accounting for a large number of medical visits in the office, hospitalizations, and productivity loss in most of the world (Fokkens WJ et al., 2020). Rhinosinusitis can be caused by a variety of etiologic factors, e.g., allergens, viral, bacterial or fungal infections, autoimmune diseases, foreign bodies, trauma, and dental pathology. Odontogenic sinusitis, which represents about 10% - 40% of all sinusitis cases, is caused by dental infection spreading to the paranasal sinuses (Puglisi S et al., 2011; Little R et al., 2018). Some authors have reported an increasing incidence of odontogenic sinusitis during the past 10 years most likely due to an increasing number of dentoalveolar procedures worldwide, in particular implant surgery (Arias-Irimina O et al., 2010; Mehra P et al., 2008). Another explanation for the increased incidence of odontogenic sinusitis is the increased use of endoscopic sinus surgery (Psillas G et al., 2021).
Symptoms of odontogenic sinusitis are similar to those of non-odontogenic sinusitis; they include foul smelling or foul tasting, rhinorrhea, malodorous secretions, facial pain, pressure, and nasal congestion. Unfortunately, the diagnosis of odontogenic sinusitis is often delayed because of several reasons: (1) a dental etiology is not suspected on the basis of clinical presentation, (2) appropriate imaging is not done or (3) because the condition is overlooked or misinterpreted at imaging. As odontogenic sinusitis most often withstands standard medical treatment for rhinosinusitis, recognition of the odontogenic etiology is crucial for successful patient management. Treatment of odontogenic sinusitis namely requires a multidisciplinary approach, which includes a combination of antibiotic therapy for 10 - 14 days, dental surgery and/or endoscopic sinus surgery. In addition, as odontogenic sinusitis is mainly caused by polymicrobial infections with predominantly anaerobic microorganisms, antibiotic treatment has to be adapted accordingly.
Imaging represents one of the three diagnostic pillars of odontogenic sinusitis; it is accompanied by a thorough clinical examination (including patient history) and rhinoscopy or nasal endoscopy. Standard dental X-rays, computed tomography (CT) and cone beam CT (CBCT) can be all used to diagnose odontogenic sinusitis, whereas magnetic resonance imaging (MRI) is reserved for cases with unclear CT findings or suspected complications not revealed by CT.
The purpose of this master thesis is to review the current literature on odontogenic sinusitis focusing on the role of imaging for its diagnosis. Firstly, the epidemiology and the pathophysiology of odontogenic sinusitis are briefly presented followed by an analysis of the advantages and disadvantages of the different imaging modalities currently employed for the diagnostic workup. Secondly, the radiologic criteria for the diagnosis of odontogenic sinusitis are reviewed followed by a discussion of the diagnostic performance of the presented imaging modalities. Last but not least, pitfalls for image interpretation are discussed.
