Management of Maxillary Sinusitis of Endodontic Origin

counselling of Maxillary Sinusitis of Endodontic OriginA case report compendium Endodontic implications of the upper jawbone fistula include extension of periapical lesion into the fistula. Though the existent cause of sinusitis is difficult to determine accurately, majority of the cases occur through a alveolar consonant consonant cause. The purpose of this paper was to present tense the management of upper jaw sinusitis of endodontic origin. A 48 year old gener onlyy healthy virile affected role reported to the dental clinic for the implant placement in the scene of action of missing 26. During the procedure, the dental operating surgeon noticed a thick granulation tissue tissue in the stocky area with painful sensation. Further endodontic consultation revealed the tooth 25 was endodontically treated 9 years ago and CBCT showed periapical lesion pierce the upper jaw sinus. Extraction and enucleation was done and the biopsy sent to the histopathological lab revealed periapical granuloma. After 2 months, patient was asymptomatic and ENT interrogatory showed the floor of upper jawbone sinus with trim hyperplasia. Symptoms of maxillary sinusitis commode evoke pain of dental origin, and a overcareful differential diagnosis is important when dealing with pain in the maxillary posterior area.Keywords maxillary sinusitis, mucositis, odontogenic originIntroductionEndodontic implications of the maxillary sinus include extension of periapical lesion into the sinus. The literature mentions many cases of extension of periapical infection to the maxillary sinus 1-2-3-4. Stafne estimated that 1575% of the sinusitis cases occur through a dental cause although the actual cause is difficult to determine accurately 5. Sinusitis can be divided into acute, subacute and chronic types. Symptoms produced by acute or subacute maxillary sinusitis can be mistaken with those of bod magazineal origin 6. A comprehensive examination of the patients medical and dental tarradiddle will draw the attention of the clinician to endodontic implications of odontogenic origin.The purpose of this paper was to present the management of maxillary sinusitis of endodontic origin.Case reportA 48 year old generally healthy male reported to the dental clinic for the implant placement in the area of missing 26. During the procedure, the dental surgeon noticed a thick granulation tissue in the deep area and the patient started feeling painful sensation even with perennial anesthesia. The surgeon then put bone graft material and unopen the flap for further consultation. persevering was then shifted from implant clinic to the diagnosis clinic for examination of tooth 25 that had periapical lesion (figure 1). It was revealed during the examination that the tooth 25 had undergone root canal word 9 years ago. The pre-operative skiagraph had revealed a large periapical lesion with interrupted lamina dura nearly the tooth 25 with previous root canal option materi al and filling on the crown (Figure 2). The periodontal probing was within normal limits for all teeth in the upper left region and the teeth 24 and 25 was restored with amalgam. (figure 3 and 4). The tooth showed no response to cold and electric pulp testing and it was conjure on percussion but not on palpation. The tooth was diagnosed as previously treated with symptomatic periapical peridontitis.After the clinical examination, CBCT radiography was taken to check the maxillary sinus involvement. CBCT revealed a periapical lesion that perforated the maxillary sinus with thickening of the maxillary sinus floor (figure 5, 6 and 7). Patient then referred to ENT segment for consultation. They advised (i) extraction of the involved tooth to remove the bloodline of infection and the thickening of the floor will get resolved upon take note up, or (ii) to inoculate the lesion completely through endoscope under GA.Patient presented to the endodontic clinic for manipulation plan and dec ision making. The endodontist advised root canal re- intervention of 25 engageed by surgical root end resection and retrograde filling on with enucleation of the lesion with precaution to the maxillary sinus perforation. But after consultation with prosthodontist, it was heady to extract the tooth 25 as it was questionable in restorability (figure 8 and 9).So, the recommended treatment was extraction and the final diagnosis was maxillary sinusitis of endodontic origin. Patient referred to OMF department where extraction of tooth 25 and enucleation of the lesion was performed (figure 10, 11 and 12). The biopsy was sent to the histopathololgy lab. Post-surgical instructions were given to the patient and was prescribed cap. amoxicillin 500mg tid, tab. brufen 600mg, Rhinocort along with anti-histamines and decongestants. Biopsy report showed periapical granuloma which confirmed the diagnosis. On follow up after 2 months, patient was asymptomatic and PA radiograph revealed socket spac e (figure 13 and 14). ENT examination showed the floor of maxillary sinus with trim down hyperplasia.DiscussionRadiographic examination of the maxillary sinus includes periapical, occlusal, panoramic and seventh cranial nerve views7. Panoramic radiography provides a wide overview of the sinus floor and its anatomic relation with the tooth grow allows the determination of the size of periapical lesions. The symptom associated with maxillary sinusitis is hushed pain, mostly unilateral and during mastication, or a feeling of fullness more or less the upper posterior teeth. The patient may complain of pain exacerbated when untruth down or bending due to increased intracranial mash from blood flow and the affected sinus may be tender to palpation8. The teeth in relation to affected sinuses will be clean or extremely sensitive to palpation and/or percussion. Nasal carry out is considered to be important sign of sinus infection. The use of a local nasal decongestant may help in differentiating pain from sinusitis or from dental origin. On the other hand, the pain of dental origin ranges from thermal sensitivities to never-ending sharp pain which may be associated with localized swelling. Radiographic changes in sinusitis show thickened sinus mucosal membrane and air-fluid filled.The world-class quantify that showed the direct extension of dental infection into the sinus was in a study by Bauer in 1943. His study was done on cadavers and revealed the pulp of involved teeth with histological evidence of extension of infection into the maxillary sinus. The local hyperplasia of dental origin in the mucosa of the maxillary sinus could be removed by conservative root canal therapy. Selden and majestic in1970 also managed maxillary sinusitis after the treatment of a periodontal-endodontic lesion in first and second premolars. For the unflinching cases after a conservative management, the surgical tone-beginning was recommended10. In this case the restorabil ity of the tooth made the final decision.At least 70% of bacterial contamination of sinusitis is caused by Streptococcus pneumonia and Haemophilus37 influenzae11. Antibiotics are a prodigious part of management in acute suppurative sinusitis. Pinheiro et al recommended amoxycillin as a first-line of treatment aimed to cover both gram-positive and gram-negative organisms. local decongestants are advantageous for oxygenation and facilitate the sinus drainage of pus by decreasing the edema. Analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs are beneficial for the control of pain.ConclusionThe close anatomical inter-relationship of the maxillary sinus and the roots of upper posterior teeth can lead to endodontic complications. Periapical rubor can lead to maxillary sinusitis of dental origin with resultant firing and thickening of the mucosal lining of the sinus in areas adjacent to the corresponding teeth. In such cases, the conventional endodontic treatment or re-treatment is the treatment of choice with surgical intervention. But there are chance of refractory cases which requires extraction to remove the source of infection. An adequate diagnosis and appropriate treatment with antibiotics, decongestants and analgesics are indicated for the treatment of sinusitis.