Rhinosinusitis Risk Factors In Dentistry – Clinical Aspects. Summary of the Doctoral Thesis

Abstract

The maxillary sinus is situated between the nasal and the oral cavities, therefore dentists, otolaryngologists and maxillofacial surgeons are involved in management of maxillary sinus surgery, diagnosis and treatment of the diseases. In this thesis maxillary sinus was analysed by clinical and radiological investigation methods of odontogenic rhinosinusitis (RS) and sinus lift aspects. In this thesis the presence of anatomic variations and pathology of the maxillary sinus using Cone Beam Computed Tomography (CBCT) of the maxilla were assessed. This retrospective study of pre-implant surgery evaluated a sample CBCT scans of 34 patients (68 sinuses). CBCT was used to assess maxillary sinus mucosa and outflow and prevalence of septa. The mucosal thickening was measured and the sinus outflow was classified as open or obstructed. Mucosal thickening was found in 48.5%, septa in 20.6% and total opacity in 2.9% of the sinuses. The prospective study analysed clinical symptoms and CBCT scans of 17 difficult-to-treat rhinosinusitis patients. CBCT was used to assess maxillary sinus mucosa and the condition of upper molar teeth. We found periapical lesions, foreign bodies and oroantral communication followed teeth extractions. Clinical guidelines, informed consent, flowchart for RS management and CBCT CHECK LIST prior to SL were created. Anatomic variations and lesions of the maxillary sinus were common findings in CBCT examinations of the maxilla required for dental preprosthetic planning. Routine CBCT scans, including maxillary sinus ostium, obtaining patient’s informed consent and CBCT CHECK LIST are recommended for risk assessment prior to sinus floor elevation and implant placement. Patients who do not reach an acceptable level of symptoms control of rhinosinusitis despite recommended medication and surgery, we recommend the collection of history of dental treatment in the posterior region of maxilla and CBCT scan of the maxilla. To evaluate the clinical significance of radiological findings, their clinical relevance and correlation with clinical symptoms, active interdisciplinary collaboration between the dentists, maxillofacial surgeons and otolaryngologists is required. This thesis is written in Latvian on 95 pages, illustrative analytical material in 8 tables, 30 figures and 6 attachments. In the list of references there are 272 titles.