牙源性上颌窦炎的临床研究进展

Clinical progress of odontogenic maxillary sinusitis

牙源性上颌窦炎(Odontogenic Maxillary Sinusitis,OMS)是指与牙齿和牙槽骨相关的因素导致上颌窦底破坏引起的上颌窦窦腔黏膜水肿、渗出而造成的上颌窦炎,是口腔临床上难治性疾病,占上颌窦炎症的10%~12%,OMS多发生于40~50岁,女性稍多(57.7%),随着种植牙的普及,牙源性上颌窦炎的比例大大提高。病因方面:上颌牙与上颌窦的位置关系是OMS的解剖基础,牙源性感染和医源性因素是OMS最常见的病因包括种植牙手术、牙槽外科和根管治疗。诊断方面:上颌牙齿疼痛是OMS就诊口腔科的最常见临床症状,单侧发病是OMS与非牙源性上颌窦炎临床表现上的鉴别诊断要点,详细的口腔科就诊病史是OMS诊断的重要依据,CBCT(cone-beam computed tomography,CBCT)是诊断OMS的金标准。治疗方面:临床上通常是全身使用抗生素、病变牙齿牙科手术和上颌窦手术综合治疗OMS,牙科手术包括根管治疗、根尖手术和拔牙,完善的根管治疗通常能够治愈根尖周炎引起的OMS,抗生素治疗是种植体相关OMS的一线治疗,如果药物治疗失败,考虑内镜上颌窦手术(endoscopic sinus surgery,ESS)治疗,上颌窦手术前必须去除牙源性感染和异物,以防止上颌窦炎复发。本文从病因、诊断和治疗等方面对牙源性上颌窦炎进行综述,希望为牙源性上颌窦炎的临床诊治提供帮助。

Odontogenic Maxillary Sinusitis(OMS)refers to the maxillary sinusitis caused by the destruction of the sinus floor of the teeth and alveolar bone.It is a clinically refractory disease of the oral disease,accounting for 10%-12%of the maxillary sinus inflammation,OMS occurs mostly in 40 to 50 years old,slightly more women(57.7%),with the popularization of dental implants,the proportion of odontogenic maxillary sinusitis greatly increased.Etiology:The position of maxillary teeth and maxillary sinus is the anatomical basis of OMS.Odontogenic infection and iatrogenic factors including implant surgery,alveolar surgery and root canal treatment are the most common causes of OMS.Diagnostic:Maxillary tooth pain is the most common clinical symptom of OMS.Unilateral onset is the main point of differential diagnosis of OMS and clinical manifestations of non-odontogenic maxillary sinusitis,Detailed dental history is an important basis for the diagnosis of OMS.CBCT is the gold standard for the diagnosis of OMS.Treatment:Clinically,OMS is usually treated with systemic antibiotics,dental surgery for diseased teeth,and maxillary sinus surgery.Dental surgery includes root canal therapy,apical surgery,and tooth extraction Perfect root canal treatment is usually able to cure OMS caused by apical inflammation,antibiotic treatment is the first-line treatment of implant-related OMS,if drug therapy fails,consider endoscopic sinus surgery(ESS)treatment,In order to prevent recurrence of maxillary sinusitis,odontogenic infection and foreign bodies must be removed before maxillary sinus surgery.The aim of this review is to help diagnosis and treatment by describing odontogenic maxillary sinusitis that discuss etiology,diagnosis and treatment.