Classification of Odontogenic Sinusitis: A Clinical-Based Phenotyping System to Guide Multidisciplinary Surgical...

Odontogenic sinusitis (ODS) is a condition that requires a multidisciplinary approach for successful treatment. Effective communication among the healthcare providers involved reduces the risk of errors and treatment failure. This study proposes a new ODS classification system to facilitate the communication of pivotal clinical information.

In this observational study the authors considered 124 consecutive patients with ODS treated in the Campus Bio-Medico of Rome Foundation Hospital. The main elements influencing the treatment of this condition resulted as: timing, etiology, presence of foreign body, maxillary obstruction of the ostiomeatal complex, and presence of oroantral fistula (OAF); these elements were organized in the acronym TEBOF. Each patient received a TEBOF classification. The "T" was categorized in "T_c" for patients diagnosed with chronic sinusitis, "T_a" for of acute sinusitis, and "T₀" for patients with maxillary sinus foreign body without sinusitis. The "E" was differentiated in "E_c" when the condition was a side effect of a primary dental pathology, "E_p" when the initial cause was not a dental implant, and "E_a" for when the initial cause was having a dental implant placed. "B" was reported as "B₁" when there was a maxillary sinus foreign body and "B₀" when there was not. "O" was reported as "O₁" when the ostiomeatal complex resulted closed and "O₀" when it was clear. "F" was used as "F₁" when there was a communication, and "F₀" when there was not. A preliminary assessment was performed considering the change in the classification in the groups of patients that underwent different therapeutic approaches. This classification provides a concise and easy-to-understand combination facilitating communication between the various healthcare providers who are essential for the appropriate treatment of this condition.

Among the 124 patients included (64 women, 51.6%; mean age 57.2 ± 13 years), chronic sinusitis (T_c) was the most frequent timing category (96 patients, 77.4%), while classical dental pathology represented the predominant etiology (E_c, 88 patients, 70.9%). Foreign body was detected in 39 patients (31.5%), ostiomeatal complex obstruction in 80 patients (64.5%), and oroantral fistula in 52 patients (41.9%). Combined surgical treatment (ESS + oral surgery) was the most frequently adopted approach (70 patients, 57%), followed by dental treatment alone (34 patients, 27%) and ESS alone (20 patients, 16%). The overall success rate was 97%, only four patients required second surgical procedure.

The TEBOF classification provides a concise, reproducible, and clinically intuitive tool for the characterization of odontogenic sinusitis. By integrating timing, etiology, and key anatomical features into a compact alphanumeric code, it facilitates multidisciplinary communication between otolaryngologists and dental providers, and may guide the selection of the most appropriate surgical strategy for each patient.

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