[Diagnostic and therapeutic aspects of odontogenic sinusitis]

Odontogenic sinusitis is classified as a localized, secondary form of the paranasal sinus inflammation, in which odontogenic focus, foreign body and/or any surgical intervention violating the Schneiderian membrane may be found in the background. Rhinosinusitis is defined by at least two from the symptoms of nasal blockage, anterior or posterior nasal discharge, facial discomfort/pain, loss of smell and typical alterations with nasal endoscopy. Acute rhinosinusitis seems to be infectious, while the chronic phenotype shows immunopathological signs of primary, diffuse bilateral disease. Acute and chronic rhinosinusitis as well as odontogenic sinusitis appear to have markedly different symptoms, pathomechanistic properties and therapeutic possibilities, thus the appropriate diagnosis is of utmost importance. The symptoms of the odontogenic sinusitis is similar compared to acute bacterial rhinosinusitis, though putrid nasal discharge and/or foetor from the nose might be pathognomic, while anosmia is usually not present. Mucosal changes and alterations in sinus-CT scans without typical clinical symptoms and nasal endoscopic findings do not define the diagnosis of odontogenic sinusitis. The goal of the therapy comprises treatment of the acute symptoms and inflammation, improvement of sinus drainage, eradication of the odontogenic focus, removal of foreign bodies if present, and finally closure of the oroantral fistules, if needed. Conservative medical therapy should be initiated first, and in the case of failure, endoscopic sinus surgical intervention is considered as the next step. In individual and more complicated cases, consultation with dental-, maxillo-facial surgeon and specialist in otorhinolaryngology is recommended, together with repeated nasal endoscopy and sinus-CT-scan. Diagnostic and therapeutic algorithms are suggested in order to promote up-to-date treatment of odontogenic sinusitis patients. Orv Hetil. 2025; 166(9): 323–330.