Diagnosing odontogenic sinusitis and avoiding the trap of maxillary sinus mucosal thickening on computed tomography: A clinical report

Odontogenic sinusitis (ODS) refers to bacterial maxillary sinusitis caused by infectious maxillary dental pathology or dental procedures. ODS is the most common cause of unilateral sinusitis and a common cause of extrasinus infectious complications, including orbital and brain abscesses. While managing ODS has been highly successful, the greatest challenge can be recognizing and confirming the diagnosis. Diagnosing ODS requires confirming infectious maxillary dental pathology with appropriate examination and imaging and, very importantly, infectious sinusitis through nasal endoscopy. Sinus computed tomography is an important complimentary diagnostic method of confirming the location(s) of sinus disease but can be misleading if done without nasal endoscopy. Critical to note, clinicians must distinguish purulent ODS from maxillary sinus mucosal thickening (MSMT) seen on computed tomography, a reactive mucosal inflammation (mucositis) commonly seen with maxillary dental disease or dental treatment. MSMT is usually not infectious and, therefore, not usually ODS. The clinical scenario presented highlights the devastating progression from MSMT to ODS and ultimately a fatal brain abscess, all which had gone undetected for years. Recognizing and managing ODS requires increased ODS awareness and coordinated care between dental providers and otolaryngologists. Such interdisciplinary care will optimize outcomes for patients with ODS and may help prevent catastrophic complications.