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Maxillary Sinusitis by G.Bertelli

Generality

Maxillary sinusitis is an inflammation of the paranasal sinuses located at the level of the cheekbones and the root of the nose.

This condition can result from infections, allergic reactions, anatomical defects of the paranasal sinuses and pathologies of the teeth of the upper arch.

Maxillary sinusitis typically causes pain in the cheek region, nasal congestion, purulent rhinorrhea, toothache and frontal headache. Sometimes, general malaise and fever are also associated.

The diagnosis of maxillary sinusitis is formulated on the basis of clinical evaluation, endoscopic examination of the middle meatus and computed tomography (CT) of the facial massif.

Decongestants, corticosteroid-based nasal sprays and moist heat applications can help relieve symptoms. Instead, the treatment of maxillary bacterial sinusitis is based on antibiotic therapy. Surgery is indicated in the event of failure of medical therapy and serves to correct the pathological causes and improve sinus drainage.

What's this

Sinusitis: preliminary notions

  • Sinusitis is an inflammatory process, acute or chronic, which affects one or more paranasal sinuses (frontal, maxillary, ethmoidal and sphenoidal).
  • The paranasal sinuses are cavities inserted in the thickness of the cranial bones, located behind the nose, between and above the eyes (at the level of the forehead and the root of the nose) and behind the cheekbones. These structures communicate with the nose through the hosts (small ducts that allow the passage of mucus produced by the mucous membrane that covers the sinuses into the nose).
  • Generally, the paranasal sinus most affected by sinusitis is the maxillary sinus.
  • The maxillary sinus is located between the nasal cavity and the oral cavity. For this reason, this area is susceptible to bacterial contamination both from the germs of the oral cavity and from the agents that infect the upper airways.

Maxillary sinusitis: what is it?

Maxillary sinusitis is an inflammation of the paranasal sinuses located at the front of the face, at the level of the cheekbones and the root of the nose. Maxillary sinusitis often develops following an acute viral infection of the upper airways (such as colds, flu and parainfluenza syndromes).

Causes

Depending on the origin of the inflammation, it is possible to distinguish odontogenic and rhinogenic maxillary sinusitis.

Rhinogenous maxillary sinusitis

Rhinogenous maxillary sinusitis is caused by the complete reduction or blockage of the ventilation, that is the entry of air into the nasal cavity during breathing. This alters the physiology of the sinus mucosa (in particular, it increases the production of mucus and there is a narrowing or obstruction of the maxillary sinus ostia) and hinders the normal drainage of the secretions towards the nasal cavity.

The stagnation of mucus in the paranasal sinuses can favor the development and replication of pathogenic microorganisms, which, from the nose to the throat, can reach the paranasal sinuses. In these cases, the infection overlaps with the infection .

Rhinogenous maxillary sinusitis can have viral origin (most frequent form), bacterial or fungal.

Generally, sinusitis occurs following acute rhinitis (ie a cold) or chronic (allergic or hypertrophic). For this reason, maxillary sinusitis, except in cases in which it is odontogenic (or deriving from a pathology of the teeth), should be defined as rhino-sinusitis .

Anatomic alterations of the nasal structures, allergies and traumas (in particular, the fracture of the bones that delimit the paranasal sinuses) can also cause rhinogenous maxillary sinusitis.

Odontogenic maxillary sinusitis

Odontogenic maxillary sinusitis is the consequence of dental infectious diseases . From time to time, in fact, it may happen that a periapical abscess of a maxillary tooth spreads to the overlying breast.

Infections of the upper arch of the teeth can be transmitted to the maxillary sinuses also following:

  • Poorly performed dental treatment (eg tooth extractions, gold-antral fistulas inadequately treated and endodontic therapies);
  • Incongruous positioning of dental implants.

Odontogenic causes are responsible for about 10-12% of maxillary sinusitis.

Risk factors

The most common risk factors for sinusitis include factors that hinder the normal drainage of the maxillary paranasal sinus, such as:

  • Anatomical defects (eg a deviation of the nasal septum and, in general, the alterations of the average turbinates can favor the appearance of maxillary sinusitis);
  • Nasal polyps (obstruct the regular flow of air through the first airways and the activity of hair cells);
  • Allergic rhinitis;
  • Mucociliary disorders (eg cilia dyskinesia).

Some people have a predisposition to maxillary sinusitis due to:

  • Exposure to environmental irritants (eg air pollution, tobacco smoke);
  • Immune deficiency status (diabetes, HIV infection etc.);
  • Presence of nasogastric or naso-tracheal tube;
  • Prolonged hospitalizations in intensive care;
  • Severe burns;
  • Cystic fibrosis.

Symptoms and Complications

The symptoms of maxillary sinusitis vary according to their evolution, in acute or chronic forms.

In the acute form, the manifestations tend to resolve within two to three weeks (complete resolution in less than 30 days). If they last longer, even for two months or more, it means that maxillary sinusitis is chronic.

Acute maxillary sinusitis

The most characteristic symptom of acute maxillary sinusitis is represented by the appearance of unilateral facial pain, which generally affects the cheeks, immediately below the eyes, and the jaw (ie the breast affected by the pathology).

The sensation can also extend to the eye sockets and the sense of heaviness is accentuated when the movements of the head are performed or when pressure is exerted on the affected breast ( tenderness to the touch ).

Other manifestations that may be associated with maxillary sinusitis include:

  • Toothache ;
  • Closed nose ;
  • Reduced taste and smell;
  • Headache ;
  • Cough with phlegm;
  • Temperature;
  • Bad breath (halitosis).

In acute maxillary sinusitis, a yellow-greenish secretion containing pus may also appear, which descends from the site of the inflammation into the nose or throat (retropharyngeal discharge).

Chronic maxillary sinusitis

The symptoms of chronic maxillary sinusitis are more nuanced and protracted over time, with accesses on certain occasions, such as after a cold or a cold. Usually, patients who are affected report intermittent jaw pain, along with a feeling of heaviness in the eye and lateral to the nose. Although it does not cause annoying symptoms, the inflammation expands and, in the most severe cases, can damage the structure of the bones.

Possible consequences of maxillary sinusitis

The main complication of maxillary sinusitis is the local spread of bacterial infection, which can predispose to:

  • Orbital or periorbital cellulite;
  • Cavernous sinus thrombosis;
  • Epidural or cerebral abscess.

Diagnosis

To diagnose maxillary sinusitis, it is necessary to rely on the symptoms reported by the patient and on the clinical and instrumental data .

The pathological anamnesis must seek the manifestations suggestive of the possible causes, determining the possible role of infectious agents or allergens (eg exposure to potential triggers, correlation with the season in which it occurs, etc.).

The physical examination focuses on the nose and the areas above the paranasal sinuses. The face is inspected for localized redness on the maxillary and frontal sinuses; these areas are also palpated in search of tenderness.

The observation of the teeth is systematic to search for a lesion of the dental apices. This should be accompanied by sinus and dental radiographic diagnostics.

The specialized otorhinolaryngological evaluation of maxillary sinusitis may also include an endoscopy examination ( nasal videoendoscopy ), performed with fiber optic instruments, through the nasal cavities. This survey provides information on the appearance of the nasal mucosa, detecting its color (eg red or pale), the swelling, the possible presence and characteristics of secretions, as well as the existence of polyps or other anatomical alterations. To identify the infectious agent involved in maxillary sinusitis, a culture test of nasal mucus with antibiogram can be performed .

To know precisely where the inflammation at the base of maxillary sinusitis is located, how much the pathology is really extended and to highlight the responsible paranasal structures, the doctor can also recommend the use of a computed tomography (CT) of the facial massif .

This examination can also be carried out after a course of medical therapy in order to correctly estimate the extent of the disease, without the "interference" due to the presence of nasal secretions.

Treatment and Remedies

The maxillary sinusitis must never be neglected, as it risks becoming chronic. As for the treatment, the interventions are directed to the triggering causes. In general, the treatment of maxillary sinusitis is pharmacological and, when necessary, surgical.

The goal is to improve sinus drainage and resolution of the infection.

drugs

To alleviate the symptomatology of maxillary sinusitis, the doctor can indicate the use of local anti - inflammatories and decongestants, administered with nasal drops or aerosols.

If maxillary sinusitis is caused by allergic factors, the use of antihistamines may also be useful.

In the presence of maxillary sinusitis of bacterial origin, the treatment is based on antibiotic therapy (such as amoxicillin / clavulanate or doxycycline administered for 5-7 days for the acute form and up to 4-6 weeks for the chronic form), while fungal infections make antifungals necessary. Sometimes, to alleviate symptoms, systemic corticosteroid drugs may also be prescribed.

Surgery

To resolve forms of maxillary sinusitis that do not respond to drug therapy, your doctor may recommend surgery to improve sinus drainage. This approach is useful above all in the presence of chronic maxillary sinusitis associated with alterations of the bone structure of the nose and in acute ones complicated by the extension of the disease.

The main objective of the procedure is the recovery of the normal function of the maxillary sinus, respecting the normal physiology of the nasal structures.

The intervention allows, in particular, to:

  • Remove the purulent material from the maxillary sinuses;
  • Restore drainage and improve ventilation;
  • Correct the anatomical changes that contribute to maxillary sinusitis.

Usually, the procedure used is called ESS ( Endoscopic Sinus Surgery, meaning endoscopic sinus surgery). In practice, we intervene with very small instruments that are introduced through the nasal cavities, under the control of a micro-camera. The latter allows the doctor to see on the monitor the areas where he is working and to act in a targeted manner on the area concerned.

Endoscopic maxillary sinusitis surgery is minimally invasive and has very short hospitalization times and minimal discomfort for the person. Generally, the operation allows the resolution of inflammation.

In the presence of odontogenic maxillary sinusitis, on the other hand, the simultaneous and adequate treatment of the dental source of infection (using an intra-oral approach) and inflammation of the paranasal sinuses is necessary, to ensure complete recovery from infection and prevent any recurrences and complications .

Some advice

It is also advisable to alleviate the disorders associated with maxillary sinusitis and to promote healing:

  • Avoid dry and crowded environments;
  • Try to blow one nostril at a time: in this way, excess pressure is prevented in the ears which can facilitate the passage of bacteria into the paranasal sinuses;
  • Drink plenty of water during the day: this habit maintains proper hydration and helps make the nasal secretions less dense;
  • Humidify the environment adequately, so as to promote nasal drainage. The optimal environmental conditions for the well-being of the upper airways are around 18-20 ° C and humidity around 45-55%;
  • Refrain from cigarette smoke (even passive), as it irritates the respiratory mucosa and blocks its defense mechanisms, especially the mucociliary transport;
  • Do not expose yourself to drafts or very cold temperatures;
  • Massage the painful areas;
  • Exercise;
  • Use of spa treatments (steam inhalations).

More generally, when the first symptoms of maxillary sinusitis occur, such as congestion or rhinorrhea, it is indicated to thin the nasal mucus for easier expulsion. For this purpose, it is possible to use fumigations with boiling water and bicarbonate or to irrigate the nasal cavities with a saline solution. This last practice allows the removal of the mucus, hindering the colonization by pathogenic agents, therefore it helps to prevent sinusitis, middle ear infections, rhinitis and pharyngitis. Nasal washing can also be performed with other methods, which include a micronized shower and saline-based sprays (isotonic or hypertonic), which can be purchased in pharmacies. Even applying wet and warm cloths on the affected breasts and taking hot drinks can help alleviate the symptoms of maxillary sinusitis.

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