Maxillary sinus pathology of odontogenic origin

Maksilarni sinusitis definira se kao simptomatska upala maksilarnih paranazalnih sinusa. Odontogena upala sinusa proizlazi iz bolesti zuba tako da se u mikrobiologiji i patofiziologiji razlikuje od drugih sinusitisa. Incidencija je odontogenog sinusitisa niska s obzirom na učestalost dentalnih infekcija. Intimni anatomski odnos gornjih zuba i maksilarnog sinusa potiče razvoj periapikalne ili parodontne dentalne infekcije u maksilarni sinusitis. On se također može razviti zbog upalnih cisti, mehaničkih ozljeda sluzice tijekom liječenja korijenskog kanala, prepunjenja korijenskog kanala endodontskim materijalom, nepravilno postavljenih dentalnih implantata, perforacije sinusa pri ekstrakciji ili potiskivanju korijena ili cijelog zuba u sinus. Simptomi na temelju kojih je moguće dijagnosticirati OMS jesu unilateralna purulentna rinoreja, maksilarna bol, postnazalna sekrecija, unilateralna nazalna kongestija te glavobolja. Razlike u simptomima OMS-a i drugih vrsta upala sinusa nisu značajne, ali je bila veća učestalost jednostranih simptoma. Uz anamnezu i klinički pregled, ortopantomogram, CT i CBCT primjenjuju se u radiološkoj dijagnostici. Terapija se izvodi na više načina, a podrazumijeva uklanjanje infekcije, primjenu antibiotika te kiruršku metodu, Caldwell-Lucovu operaciju ili FESS tehniku. Komplikacije koje mogu nastati zbog OMS-a jesu orbitalni apsces ili endokranijalne komplikacije, a mogu biti opasne i za život. Od odontogenih lezija, odontogene ciste nikad neće invadirati u maksilarni sinus, nego će ga svojim rastom i povećanjem pomicati. Ciste mogu biti upalne, odontogena keratocista i folikularna cista. Odontogeni tumori u maksili rijetko se javljaju, a slučajevi sa zahvaćenošću maksilarnog sinusa vrlo su rijetki. Benigni tumori koji se mogu pojaviti jesu ameloblastom, Pindborgov tumor, Gorlinova cista, odontom, odontoameloblastom, odontogeni miksom te cementoblastom. Od zloćudnih tumora u literaturi se navode ameloblastični karcinom i ameloblastični fibrosarkom, ali i maligne promjene odontogenih cista.Maxillary sinusitis is defined as a symptomatic inflammation of maxillary sinuses. Odontogenic sinusitis develops as a result of tooth disease, therefore distinguishing its microbiology and pathophysiology from other forms of sinusitis. The incidence of odontogenic sinusitis is low compared to the incidence of dental infections. The close anatomic relation of the upper teeth and the maxillary sinus allows easy progression of periapical or periodontal infections into maxillary sinusitis. It can also be caused by inflammed cysts, mechanical injury to the membrane during root canal treatment, ovefilling the root canal with endodontic material, improper placement of implants, sinus perforation during tooth extraction, or pushing the root or a whole tooth into the sinus. The symptoms that indicate odontogenic maxillary sinusitis are unilateral purulent rhinorrhea, maxillary pain, postnasal secretion, unilateral nasal congestion, and headache. The difference between symptoms of odontogenic maxillary sinusitis and other types of sinusitis is not significant, however there is a higher incidence of unilateral symptoms in odontogenic maxillary sinusitis. In addition to medical history and clinical examination, orthopantomogram, computed tomography and cone beam computed tomography are used as part of diagnostic radiology. Therapy for odontogenic maxillary sinusitis is multifaceted and it includes the elimination of the infection, antibiotics, surgical methods, Caldwell-Luc antrostomy, and functional endoscopic sinus surgery. Complications that may ensue due to odontogenic maxillary sinusitis are orbital abscesses or endocranial complications, which can be dangerous and life-threatening. A cyst coming from odontogenic lesions will never invade a maxillary sinus; however it may push on the sinus through its formation and enlargement. Cysts can be classified as inflammatory, odontogenic keratocysts, and follicular cysts. Odontogenic tumors in maxilla are generally rare, and cases involving maxillary sinuses are very rare. Among the benign tumors that may occur are ameloblastomas, Pindborg tumor, Gorlin cyst, odontoma, odontoameloblastoma, odontogenic myxoma, and cementoblastoma. In terms of malignant tumors, the literature mentions ameloblastic carcinoma and ameloblastic fibrosarcoma, as well as malignant changes in odontogenic cysts