SINUSITE MASCELLARE ODONTOGENA - Unife...Brook, I.-Sinusitis of odontogenic origin, Otolaryngol Head...
Transcript of SINUSITE MASCELLARE ODONTOGENA - Unife...Brook, I.-Sinusitis of odontogenic origin, Otolaryngol Head...
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2° PREMOLARE
1°/2° MOLARE
1. Lesioni dentarie acute
2. Lesioni dentarie croniche
SINUSITE MASCELLARE
ODONTOGENA
• periodontite/ osteite
• ascesso periapicale
• Granulomi apicali
• Cisti parodentarie
RECESSO ALVEOLARE (ZONA > DECLIVE DEL PAVIMENTO)
PERFORANTI VASCOLARI / NERVOSE
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RARA NELLA PRATICA OTORINOLARINGOIATRA
SEGNI E SINTOMI DELLA SINUSITE ACUTA (+):
1. Odontalgia pulsante
2. Sensazione di “denti troppo lunghi”
3. Tumefazione vestibolare
FORMA ACUTA DELLA
SINUSITE MASCELLARE
ODONTOGENA
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Frequenza
Approccio multidisciplinari
Mancanza di linee guida
• Brook, I.-Sinusitis of odontogenic origin, Otolaryngol Head Neck Surgery, 2006 Sep; 135(3):349-355 • Longhini, A.B: Ferguson, B.J- Clinical aspect of odontogenic maxillary sinusitis:a case series,
IntForum Allergy Rhinol, 2011 Sep-Oct; 1(5):409-415
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PRINCIPALI CAUSE
Granuloma periapicale
Cisti
Cisti
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PRINCIPALI
CAUSE
Fistola oro-
antrale
Presenza di corpi
estranei nel seno
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Numero medio
pazienti
annualmente
per sinusite
mascellare
odontogena:
19.42
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Rinorrea unilaterale fetida
Pus nel meato medio/opacamento radiografico del seno mascellare
L’origine odontogena è documentata da
1. CLINICA
2. T.C. (Rx ortopantomografia- Rx A/P)
FORMA CRONICA SINUSITE
MASCELLARE ODONTOGENA
• Anamnesi
• Bilancio della situazione dentale (carie, test di sensibilità alla percussione
orizzontale e verticale, pressione, iperemia gengivale, fistole gengivali, mobilità
dentaria)
• Ricerca di eventuali fistole oro-antrali
• Carie profonde
• Modificazioni dell’osso peri-alveolare
• Rapporti con il seno mascellare
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Una moderna apparecchiatura
Cone Beam
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Quanto spesso utilizza
una antrotomia media?
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Quanto spesso utilizza
una antrotomia esterna (CALDWELL
LUC)?
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Diagnosi differenziale con
Segni di osteite Sinusite di origine nasale
3. TERAPIA
• Estrazione dentaria
• Puntura diameatica
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Problemi diagnostici
Problemi terapeutici
1. CLINICA
2. RADIOGRAFIA
3. TERAPIA
FORMA ATTENUATA DELLA
SINUSITE MASCELLARE
ODONTOGENA
• Scarsi segni e sintomi
• Opacità costante a livello del pavimento del seno mascellare (a sole nascente)
• Odontoiatria
• Valutazione endoscopica del seno mascellare
• No terapia chirurgica sul seno mascellare
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