有/无鼻窦炎症状的牙源性鼻窦炎患者的临床特征比较

Comparison of clinical characteristics between odontogenic sinusitis patients with and without sinusitis symptoms

目的比较牙源性鼻窦炎(odontogenic sinusitis,ODS)患者中有鼻窦炎症状和无鼻窦炎症状群体的临床表现。方法回顾性收集2020年6月至2022年6月在首都医科大学附属北京同仁医院耳鼻咽喉头颈外科行内镜鼻窦手术的92例ODS患者的临床资料,77例有鼻窦炎症状(sinusitis symptoms,SS组),15例无鼻窦炎症状(non-SS组)。比较两组患者的病史、症状、病因、内镜检查和鼻窦电子计算机断层扫描(computed tomography,CT)等。结果non-SS组患者相比SS组患者的病程更短[(4.9±3.4)个月vs(10.4±11.0)个月,P=0.048],首诊口腔科比例更高(100%vs 24.7%,P=0.035)。两组患者报告牙痛、牙齿松动症状阳性率,差异无统计学意义(29.9%vs 53.3%,P=0.133;18.2%vs 35.3%,P=0.085)。牙周-牙髓联合病变(periodontal-endodontic combined lesions,PECL)、根尖周炎(apical periodontitis,AP)、牙周炎(periodontitis,PE)、医源性占SS组和non-SS组患者病因的比例分别为53.2%vs 20%(P=0.024)、28.6%vs 33.3%(P=0.76)、11.7%vs 26.7%(P=0.215)、6.5%vs 20%(P=0.119)。鼻窦CT显示,与non-SS组患者相比,SS组患者窦口鼻道复合体(ostiomeatal complex,OMC)、筛窦、额窦有更高比例的受累(83.1%vs 26.7%,P=0.000;80.5%vs 20%,P=0.000;41.6%vs 0%,P=0.002)。结论耳鼻喉科与口腔科的多学科合作,可以早期发现无鼻窦炎症状的ODS,及时诊治PECL等牙齿相关性疾病,减少内镜手术概率,提升患者生活质量。

Objective To compare the differences of clinical manifestation between odontogenic sinusitis(ODS)patients with and without sinusitis symptoms.Methods The clinical data of totally 92 ODS patients’clinical data were retrospectively collected,who underwent endoscopic sinus surgery in the Department of Otolaryngology,Head and Neck Surgery in Beijing TongRen Hospital,Capital Medical Uniersity,from June 2020 to June 2022.Among them,77 cases had sinusitis symptoms(SS group),and 15 cases had no sinusitis symptoms(non-SS group).The survey items included medical history,symptoms,etiology,endoscopic examination and sinus computed tomography(CT)were compared.Results Compared with the SS group,the non-SS group has a shorter course of disease[(4.9±3.4)months vs(10.4±11.0)months,P=0.048],and a higher proportion of first consultation in Department of Stomatology(100%vs 24.7%,P=0.035).There was no statistically significant difference in the positive rates of reported toothache and tooth loosening symptoms between the two groups of patients(29.9%vs 53.3%,P=0.133;18.2%vs 35.3%,P=0.085).The proportion of periodontal endodontic combined lesions(PECL),apical periodontitis(AP),periodontitis(PE),and iatrogenic factor,accounted for the etiology of the two groups of patients,were 53.2%vs 20%(P=0.024);28.6%vs 33.3%(P=0.76);11.7%vs 26.7%(P=0.215);and 6.5%vs 20%(P=0.119),respectively.CT of the sinuses showed that the SS group had a higher proportion of involvement in the ostiomeatal complex(OMC),ethmoid sinus,and frontal sinus than non-SS group did,with 83.1%vs 26.7%(P=0.000);80.5%vs 20%(P=0.000);and 41.6%vs 0%(P=0.002),based on the evaluation of CT opacification.Conclusions The multidisciplinary cooperation between Otolaryngology and Stomatology could early identify ODS patients without sinusitis symptoms,diagnose and treat timely dental related diseases,such as PECL,reduce the probability of endoscopic sinus surgery,and improve life quality of patients.