Endoscopic antrostomy in the treatment of odontogenic maxillary sinusitis: Two cases report

Abstract

Introduction. Maxillary sinusistis of odontogenic origin is a wellknown condition that occurs due to close relationship of the maxillary posterior teeth to the maxillary sinus. We presented two patients with symptoms and signs of chronic inflammation of the maxillary sinus of odontogenic origin. Case report. In both patients, after clinical examination, microbiological testing, skin prick tests to inhalant allergens, and endoscopy of the nasal cavity, we performed the cone beam computed tomography (CBCT) of paranasal sinuses, which showed thickening of the mucosal lining of the maxillary sinus. The mucosal oedema resulted in obstruction of the osteomeatal complex in both patients. The presence of a foreign body in the right alveolar recess in the first case and in the left osteomeatal complex in the second case were noticed. The both foreign bodies had densities similar to bone. The alveolar recesses in both cases were below the level of the nasal cavity floor. The patients were treated by endoscopic approach, a combination of lower and middle meatal antrostomy. The thickened mucous membrane was removed in the region of the osteomeatal complex, and then the foreign bodies were removed in both cases. Histopathological analysis proved that both foreign bodies were tooth roots. Conclusion. This case report show how be able to successfully surgically remove foreign bodies from the maxillary sinuses using endoscopic approach, a combination of both, lower and middle meatal antrostomy.

Uvod. Maksilarni sinuzitis dentogenog porekla je dobro poznato stanje koje nastaje zbog blizine korenova gornjih zuba i maksilarnog sinusa. Prikazali smo dva bolesnika sa simptomima i znacima hroničnog zapaljenja maksilarnog sinusa dentogenog porekla. Prikaz bolesnika. Kod oba bolesnika, nakon kliničkog pregleda, mikrobioloških ispitivanja, kožnih proba sa inhalacionim alergenima, kao i endoskopije nosne šupljine, urađena je kompjuterizovana tomografija konusnog zraka - [cone beam computed tomography (CBCT)], koja je pokazala zadebljanje sluznice maksilarnog sinusa. Otok sluznice doveo je do opstrukcije ostiomeatalnog kompleksa. Uočeno je prisustvo stranog tela u desnom alveolarnom recesusu u prvom, i u predelu ostiomeatalnog kompleksa, u drugom slučaju. Oba strana tela davala su senku sličnu koštanoj supstanci. Dno alveolarnog recesusa sinusa je u oba slučaja bilo ispod ravni poda nosne šupljine. Bolesnici su operisani endoskopskim pristupom, kombinacijom srednje i donje antrostomije. Odstranjena je zadebljala sluznica u predelu ostiomeatalnog kompleksa, a nakon toga su uklonjena strana tela. Histopatološka analiza je u oba slučaja pokazala da su strana tela bili korenovi zuba. Zaključak. Ovim prikazom se ukazuje na mogućnost uspešnog hirurškog uklanjanja stranih tela iz maksilarnog sinusa endoskopskim pristupom, kombinacijom srednje i donje antrostomije.