AB086. Tooth be told, odontogenic sinusitis is an underdiagnosed cause of sinusitis

Background: Odontogenic sinusitis is an underdiagnosed cause of rhinosinusitis. The reported incidence of odontogenic sinusitis varies between 10–40% but the literature is limited. Sinonasal symptoms dominate over dental symptoms compounding differentiation from other causes of sinus disease. Furthermore there is a lack of association between dental and sinus disease in the radiology literature, resulting in poor recognition and thus under-reporting of associated dental disease on computerized tomography (CT) imaging by radiologists. Symptoms including unilateral foul discharge and facial pain are associated but not specific to sinusitis of dental origin.

Methods: Case series.

Results: We present 4 cases of odontogenic sinusitis where the diagnosis was missed initially on CT. Case 1: a 52-year-old lady with unstable asthma and sinusitis secondary to infected pre-molar. Case 2: a 48-year-old male with chronic headaches and active sinus disease due to oro-antral fistula. Case 3: a 55-year-old lady with preseptal cellulitis, found to have oro-antral fistula due to previous dental work. Case 4: an 82-year-old gentleman acutely unwell with complicated sinusitis. Post-operatively found to have necrotic premaxilla.

Conclusions: Odontogenic sinusitis is responsible for 10–40% of sinusitis. Iatrogenic causes account for 65.7% of these cases so a dental history should be included in history taking process, which is often neglected. However a wide range of odontogenic pathologies may be responsible, including periodontitis, perimplantitis and medication complications. Facial pain, malodour and mucopurulent secretions should encourage suspicion for a dental cause as should unilaterality of symptoms and radiological findings.

Keywords: Odontogenic; sinusitis; CT