Toward a multidisciplinary perspective: Are dental-origin pathologies overlooked in unilateral chronic...

To evaluate the prevalence of dental-origin pathologies and dentally related anatomical variants in patients with unilateral chronic rhinosinusitis with or without nasal polyposis undergoing surgical treatment and to explore their association with unilateral nasal polyposis.

This prospective study included 107 patients who underwent endoscopic sinus surgery for medically refractory unilateral chronic rhinosinusitis with or without nasal polyposis treated at our institution between January 2024 and March 2025. Patients with a history of previous sinus surgery or malignant disease were excluded. Detailed current and past dental histories were obtained from all patients. Preoperative paranasal sinus computed tomography and magnetic resonance imaging were evaluated for radiological signs possibly related to odontogenic pathology such as periapical lucency, mucosal thickening, or oroantral fistula as well as for anatomical variants such as dental root protrusion into the maxillary sinus. Intraoperatively, pathological specimens were obtained from all patients for histopathological examination. The data were statistically analyzed.

Of the 107 patients analyzed, 25 (23%) reported a history of dental disease or intervention involving the adjacent tooth. Periapical radiolucency was identified in 67 patients (63%) and oroantral fistulas in seven patients (6%). Seventy-eight patients (73%) demonstrated radiological evidence of mucosal thickening. Among the 78 patients with radiological findings suggestive of odontogenic involvement, the most common histopathological findings were unilateral inflammatory sinonasal polyps in 41 patients (53%) and chronic inflammatory changes consistent with sinusitis in 26 patients (33%). Antrochoanal polyps were identified in four patients (5%). These findings indicate frequent coexistence of odontogenic and inflammatory sinonasal findings in unilateral disease. Exploratory comparative analysis showed no statistically significant difference in the prevalence of odontogenic findings between patients with unilateral nasal polyposis and those with non-polyp pathologies (Fisher's exact test, p = 0.829).

Dental-origin pathologies and related anatomical variants appear to be encountered in patients with unilateral chronic rhinosinusitis. These findings suggest a possible association between odontogenic findings and unilateral sinus disease with or without nasal polyposis. A comprehensive dental evaluation and detailed radiological assessment should be considered as part of the preoperative workup. Furthermore, the observed coexistence of unilateral polyposis and odontogenic findings warrants further investigation to clarify the nature of this association.