“Odontogenic sinusitis of endodontic etiology: Diagnosis and clinical management

Abstract

The expansion of periapical pathology in teeth whose apices are in close proximity to or extend into the maxillary sinuses (maxillary antra) can lead to inflammatory changes in the mucosal physiology, subsequently resulting in the development of odontogenic sinusitis (rhinosinusitis).

Odontogenic rhinosinusitis of endodontic origin is often misinterpreted as sinus-derived rhinosinusitis, leading to potential misdiagnosis and ineffective treatment.

Presentation Objectives:

The presentation aims to highlight:

• The clinical and radiographic findings of the disease
• The recommended therapeutic approach for proper management

This session will include patient cases who presented for endodontic evaluation and treatment of posterior maxillary teeth—both with and without previous root canal therapy, and either symptomatic or asymptomatic.

Patients underwent:

• Clinical examination
• Radiographic assessment with intraoral radiographs and/or Cone Beam Computed Tomography (CBCT)

Key Findings:

• Clinical findings varied, with tenderness on palpation and percussion pain as the most common symptom
• Radiographic findings frequently included:
  • Periapical osteoperiostitis
  • Partial or complete opacification of the corresponding maxillary sinus due to inflammatory pathology

Therapeutic Approach:

The treatment objective is the elimination of the microbial factor, either through:

• Endodontic treatment of the affected tooth
• Tooth extraction, when necessary
• Adjunctive pharmacological therapy, when indicated

This presentation will explore clinical decision-making for accurate diagnosis and appropriate intervention, ensuring optimal management of odontogenic rhinosinusitis of endodontic origin.