CLINICAL FEATURES, ETIOLOGY, PATHOGENESIS AND MODERN TREATMENT APPROACHES OF ODONTOGENIC MAXILLARY SINUSITIS

Abstract

Odontogenic maxillary sinusitis is a significant inflammatory condition of the maxillary sinus that originates from dental infections and pathological processes affecting the upper teeth and surrounding structures. The anatomical proximity between the roots of maxillary premolars and molars and the maxillary sinus floor creates a pathway for the spread of odontogenic infections into the sinus cavity. This condition represents an important interdisciplinary problem involving dentistry, otorhinolaryngology, and maxillofacial surgery. Recent epidemiological studies indicate that odontogenic causes account for approximately 10–40% of all cases of maxillary sinusitis, while in patients with unilateral sinus disease the proportion may exceed 50%. The most common etiological factors include untreated dental caries, chronic apical periodontitis, complications following tooth extraction, endodontic treatment failures, and iatrogenic perforation of the sinus floor during dental procedures. The pathogenesis of odontogenic sinusitis is characterized by the penetration of pathogenic microorganisms from infected dental tissues into the maxillary sinus, leading to mucosal inflammation, impaired mucociliary clearance, and accumulation of purulent exudate. Microbiological investigations demonstrate that the infection is predominantly polymicrobial, including anaerobic bacteria commonly present in oral biofilms. Clinically, patients often present with unilateral nasal discharge, facial pain or pressure in the maxillary region, dental discomfort, and impaired nasal breathing. Diagnostic evaluation requires a comprehensive clinical examination supported by radiographic methods such as cone-beam computed tomography, which provides detailed visualization of the sinus and dental structures. Management strategies focus on eliminating the odontogenic source of infection and restoring sinus drainage and ventilation. Treatment may include endodontic therapy, extraction of infected teeth, antibiotic therapy, and surgical interventions such as endoscopic sinus surgery or closure of oroantral communications. Early diagnosis and interdisciplinary management significantly improve treatment outcomes and reduce the risk of chronic complications.