The sinuses are cavities of the face that develop during the growth process and finalize their size with the formation of the skull. The sinuses are pneumatic cavities that contain air and are lined by a mucous lining.
They have multiple roles, the most important being:
– maintaining optimal pressure in the face
– cushioning blows in the middle third of the face
– purifying the air entering through the nasal passages
– produce mucus to protect the airways
There are four sinuses, found in pairs on either side of the skull, if we divide the facial mass into two symmetrical halves by drawing a vertical line.
Two are maxillary sinuses, two are sphenoid, two are ethmoid and two are frontal sinuses. The frontal sinuses are found on the forehead, the sphenoid and ethmoid sinuses are found deep in the skull, between the eyes and the nose, and the maxillary sinuses are located near the nose.
Sinusitis is a pathology that affects a large percentage of the population, especially in the cold season, and may have viral, bacterial, allergic or fungal etiology. It is the direct result of inflammation of the sinus cavities of the skull.
The maxillary sinuses may be found, in varying percentages, in the vicinity of the tips of the roots of the teeth, so in the case of dental infections or extractions, the sinuses may react by inflaming the mucous membranes lining them.
This type of sinusitis is known as odontogenic or tooth-related sinusitis, precisely because the causative factor is an infection or extraction that creates a communication gate between the sinus cavity and the oral cavity.
The oral cavity is a septic environment, with a considerable bacterial load, therefore microorganisms enter the sinus through the newly created portal, causing inflammation of the adjacent mucosa.
When the fluid in the sinus cavities can no longer be eliminated properly, there is a sensation of pressure, sinus pain, fever in the first days, stuffy nose, migraine, cough with expectoration and fatigue.
Sinusitis of odontogenic cause occurs if, after creating a communication between the maxillary sinus and the oral cavity, the sinus is not fixed and oral bacteria have free passage to the sinus.
Treatment is as follows:
Following extractions where the maxillary sinus is found to be open, immediate maxillary sinus plasty is recommended, followed by airtight suturing to limit the communication of the two cavities
If the patient presents to the dentist’s office and the diagnosis of maxillary sinusitis is established after imaging and clinical examination, then treatment consists of suppression of the causative factor and drug therapy.
The drug therapy consists of nasal decongestants (maximum 10 days) and antibiotics (penicillin is the most commonly used, given for 7 to 14 days).
If pus is found when the doctor wants to suture the communication between the mouth and the sinus, the treatment must be changed so that the suture can no longer be performed. The pus has to drain, decongestant and antibiotic therapy is instituted and the patient is referred to the ENT service, where the doctors concerned will take care of the drainage of the sinus cavity.
Only at a later stage will the closure of the junction between the oral cavity and the maxillary sinus be resorted to.
