Diagnosis
It is a unilateral sinusitis, purulent, recurrent.
Clinical examination will generally find pus in the medium and can often
identify the causal tooth.
An X-ray (panoramic radiograph, including the sinus) shows a complete opacity
sinus with or without liquid level and the image in part will reflect a
thickening of the sinus lining.
The dental origin is confirmed by radiograph.
Forms etiological
Differential
Diagnosis
Cellulitis
Sinusitis original (bilateral sinusitis, allergic ground, etc.)
Maxillary sinus cancer (epistaxis, osteolysis radiological justifying the
practice of a review)
Treatment
If the cause is dental, treatment is mostly extraction of the tooth.
If the cause is sinusitis, drainage of the sinus cavity and / or vestibular (intervention
Caldwell-Luc)
In all cases, an antibiotic will be involved.
Osteitis of maxillary
The infection of the jaw bone or, more rarely of the jaw occurs most often
among young adults due to an infection occurring at the apex of a mandibular
molar.
The blood-borne osteo-myelitis is exceptional and occurs mainly in a small
child.
Medical treatment is based
on an antibiotic (in the absence of allergy: clavulanic acid). An
anti-inflammatory treatment will never be prescribed in isolation. An ice pack is an excellent complement for
analgesic and anti-inflammatory effect.
Surgical treatment in simple cases (primarily cellulitis) will be the
extraction of the tooth. The extraction
will take place under local anesthesia.
In complicated cases, general anesthesia is necessary for the
evacuation, washing and draining the abscess dermal and / or vestibular and the
extraction of teeth or the cause.
Sinusitis maxillary dental origin
“Sinus” teeth are the first molar, the second premolar, and more rarely, the
second molar and the first upper premolar.
The apex is in intimate contact with the lining of the floor and so a
sinus infection may spread across the alveolar bone lining.
A mortified tooth is the
most common cause
Iatrogenic: pushing back the sinus by a root of a tooth extraction at a
difficult apical overrun during a dental treatment with projection through
channels in the sinuses, which produces a radio-opaque image of the bottom
sinus; a very substantive characteristic. In this case it described
aspergillosis sinusitis.
Oral Communication sinusitis
It is most often a complication of post-extraction allowing communication
between the oral cavity and the sinus cavity (moving air and fluid). A chronic sinusitis complicates this
procedure.
Osteitis
narrowly
Alveolitis post-extraction: a few days after extracting a molar very violent
pain occurs in the cell, which is mostly dry, and becomes sometimes filled by a
fleshy inflammatory bud.
The search for a small escrow bone or a root forgotten by a radiological exam
will be systematic. In this case, a
revision will be the necessary cellular complement of medical treatment.
Osteitis broadcasts of the mandible
The clinical picture involves pain, often irradiating. The symptoms are generally mandibular with
moderate, painful mandibular swelling). They are very often treated with
anesthesia on the lip and chin.
Treatment
Etiological treatment: the causal tooth extraction, revision of alveolar home,
or new osteosynthesis as needed in the case of traumatic osteitis.
Medical treatment: it is based on a long course of antibiotics, if possible,
adapted according to any susceptibility. The latter is not always possible and
antibiotic probability will be lessened.
An example of antibiotic treatment is pyostacine for three to six
months.
Surgical treatment: removal of receivers, stripping the outside of the
mandible.
On the
radiological, dental origin is more or less obvious (the tooth has to be
extracted). There is a modification of
the skeletal frame that appears deleted.
At a later stage, a receiver bone may be observed. A scan confirms the diagnosis and clearly
fixes the stage as early or late.
Evolution
Chronic osteitis is the rule in the absence of suitable treatment. The osteitis then moves along the course with
advanced inflammatory periods regularly separated by an interval free more or
less of symptoms.
The radiological image is increasingly evident with the appearance of one or
more receivers that can sometimes be extracted.
Forms clinics
Osteitis
traumatic: a mobile fracture or untreated infection after osteosynthesis.
Necrotizing
osteitis iatrogenic led to secondary treatment doing root canal work with
arsenous anhydride.
Dental cancer: see Chapter Cancer
Osteitis TB: exceptional
Tooth decay and disease Treatment
