Cone beam computed tomography for odontogenic sinusitis

Objectives: The introduction of cone-beam computed tomography (CBCT) for the maxillo-facial region provides opportunities for dental practitioners to obtain three-dimensional images in axial, coronal, and sagittal planes. Orthopantomography and periapical radiography present many limitations because of two-dimensional image projections and the possibility of superpositions. Until now, computed tomography (CT) has been the gold standard examination for the detection of conditions that alter maxillary sinus volume and configuration. This investigation presented periapical lesions and their relationship with the sinus tract by CBCT. Methods: Twenty-one patients (ages, 27-56 yrs; mean, 42.5 yrs; eight males and 13 females) presenting clinical symptoms that could be related to periapical problems in maxillary molars or premolars were analyzed by CBCT exam with the 3D Accuitomo (J. Morita Mfg. Corp., Kyoto, Japan). Four parameters were considered for the detection of odontogenic maxillary sinusitis (OMS): presence of dental pathology, presence of periapical bone defect with disruption of the Schneidarian membrane, mucosal thickening of the sinus, and the presence of foreign bodies inside the sinus. Results: OMS was diagnosed in 17 cases. Every case presented mucosal thickening and periapical bone defect with disruption of the Schneidarian membrane. One case presented a foreign body inside the sinus. Conclusion: When, from dental and medical examinations together with patient anamnesis, an OMS is suspected, a CBCT exam should be performed to evaluate the relationship of a periapical abscess to a sinus floor defect and the diseased tissues, and to determine the exact location of a foreign body within the maxillary sinus. The present study demonstrated that CBCT successfully diagnosed OMS. CBCT characteristics with respect to the very low radiation dose compared with that of CT and the high quality of the image make this radiological tool the new gold standard in OMS diagnosis.