Pearls from Your Peers: Odontogenic Sinusitis
Zara M. Patel, MD, interviews John R. Craig, MD, about Odontogenic Sinusitis
Why is it important to recognize odontogenic sinusitis?
Diagnostic and therapeutic interventions for odontogenic sinusitis (ODS) are distinct from rhinosinusitis. If ODS is overlooked, and patients are treated as having rhinosinusitis, they will suffer until the dental source is treated.
What are the symptomatic, endoscopic, and radiologic findings suggestive of odontogenic sinusitis?
Think unilateral. ODS occurs unilaterally in ≥90% of cases, and usually causes classic sinusitis symptoms. One additional symptom more specific to ODS is foul smell.
Regarding endoscopy, pus is usually seen draining from the middle meatus on the side of ODS, with or without edema or polyps.
For imaging, look for unilateral maxillary sinus opacification on CT (ODS is the most common cause), then look for adjacent dental pathology.1
Do you think odontogenic sinusitis should be treated differently from other sinusitis types? How?
Absolutely. There are a few variables to consider. First, is the dental pathology treatable? If not, you can try antibiotics, then endoscopic sinus surgery (ESS) when they fail. For treatable dental pathology, antibiotics are not curative, so you consider primary dental treatment versus ESS. For this answer, a shared decision-making process should ensue, considering symptomatic burdens (if severe, primary ESS) and patients’ medical and dental insurance coverages.
What are your relationships like with dentists or dental specialists, and how do you work with them to help patients?
I have built collaborative relationships with endodontists, periodontists, and oral surgeons in my region. We simply text or email each other to expedite patients’ evaluations and treatments. This works very well.
- Craig JR, Poetker DM, Aksoy U, et al. Diagnosing odontogenic sinusitis: an international multidisciplinary consensus statement. Int Forum Allergy Rhinol. 2021.