Combined Endoscopic and Intraoral Approach or Intraoral Alone in Surgical Management of Odontogenic Sinusitis

The physiological behavior of paranasal sinuses depends on the potency of the ostiomeatal complex and on normal mucociliary function. The interruption of this delicate equilibrium can lead to pathological conditions such as sinusitis. Anywhere between 10% and over 25% of cases of maxillary sinusitis have an odontogenic origin, such as: dental infection; alveolar dental trauma; or iatrogenic causes, such as extractions, endodontic therapies, maxillary osteotomies or placement of endosseous implants. The resolution of sinus pathology is related to the resolution of odontogenic pathology. Aim: to evaluate the therapeutic efficacy of a combined oral and endoscopic approach in the treatment of chronic odontogenic sinusitis vs. oral dental management through a case control study. Materials and Methods: all patients showing signs and symptoms of odontogenic sinusitis with obliteration (appreciable radiopacity in CT) of unilateral maxillary sinus between January 2018 and September 2019 at Padua University Hospital were enrolled in this retrospective study. The exclusion criteria were: maxillary sinusitis without odontogenic origin, or resolution with a systemic antibiotic therapy; and presence of anatomical abnormalities that promote the onset of rhinosinusitis. The patients were divided into two groups: one group was treated with a combined surgical approach under general anesthesia (Functional Endoscopic Sinus Surgery-FESS and simultaneous closure of oroantral communication with Bichat’s fat pad advancement); while the other group was treated only with an intraoral approach under local anesthesia and conscious sedation (closure of oroantral communication with Bichat’s fat pad advancement). The variable “success of the surgical procedure” in the two groups was compared by a Student test (with p < 0.05). Results: among the patients enrolled, 10 patients (aged between 42 and 70) made up the case group and the other 10 patients (aged between 51 and 74) constituted the control group. There was no statistically significant difference in success between the two groups (p < 0.025). Conclusions: according to this case study, an exclusive annotation invasive intraoral approach seemed to be comparable to the transoral endoscopic combined method. However, during diagnosis it is necessary and fundamental to distinguish between odontogenic and rhinogenic sinusitis in order for the resolution of odontogenic sinusitis to be achieved.

Surgical management of an odontogenic cutaneous sinus tract misdiagnosed for 4 years

A cutaneous sinus tract of dental origin may easily be misdiagnosed and incorrectly treated. This paper reported a case of a 20-years-old male patient referred for a productive cutaneous sinus tract misdiagnosed by medical doctors for more than 4 years. The clinical and radiographic examinations confirmed the odontogenic origin

Odontomas and imaging diagnosis: the concise systematic review

Introduction: Odontomas are tumors of odontogenic origin. They represent on average 70% of all odontogenic tumors found. Early diagnosis and treatment prevent the loss of tissue element, tooth impaction, bone malformations, and displacement of bone structures, differentiating their types through panoramic radiographic images. Objective: To carry out a concise systematic review of the characteristics of odontomas, differentiating their types through panoramic radiographic images. Methods: The research was carried out from May 2021 to June 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 84 articles were found. A total of 36 articles were evaluated in full and 17 were included and evaluated in the present study. A total of 3 Studies with a High Risk of Bias and 1 Study with Uncertain Risk. Radiographic examination is extremely important for the study and diagnosis of odontomas. Odontomas present a characteristic radiographic appearance. In complex odontomas, radiopacity is not specifically determined, showing itself as an irregular and disorganized mass surrounded by a narrow radiolucent zone. In the composite type, the radiographic image is pathognomonic. In the radiopaque image, dozens of denticles simulate small teeth surrounded by a thin radiolucent area. Composite odontoma, on the other hand, consists of the same calcified structures arranged in an orderly and related manner, similar to normal teeth contained in a fibrous capsule. The differential diagnosis of complex odontoma includes osteomas and condensing osteitis. Conclusion: Radiographic and/or tomographic examination is the best way to obtain an accurate diagnosis, precisely delimiting the lesion and nearby and involved structures.

Analysis of the frequency of maxillary sinus pathology among male and female adults

The maxillary sinuses diseases are an actual clinical problem today. The aim of our study was to determine the frequency of pathology of the maxillary sinuses of different origin and its age dynamics in adults. 500 series of anonymized tomograms of adults were analyzed: 22-35 years (1st group) and 36-60 years (2nd group in men) and 36-55 years (2nd group in women). Cone-beam computed tomography (CT) of the nose, paranasal sinuses, and upper jaw was performed on a Point 3D Combi 500 cone-beam tomograph. RealScan software was used to analyze the test results. The results of the study showed that among the adults who applied for examination of the maxillary sinus, only 20% had no pathology. Patients of the first age group are most often diagnosed with pathological changes of the maxillary sinus, which have a rhinogenic origin. In persons of the second age group, regardless of gender, the pathology of the maxillary sinus of odontogenic origin is most often diagnosed. With age, the number of pathologies of odontogenic origin increase both in men and in women, and the number of pathologies of other origin, including rhinogenic - decreases.

Conservative Management of Unicystic Ameloblastoma: A Case Report

Ameloblastoma is a rare benign tumor of odontogenic origin with local invasive characteristics and a high recurrence rate. Depending upon the location, size and the subtype of Ameloblastoma, surgical treatments, such as marginal or segmental resection, have traditionally been implemented, but some conservative surgical methods are also being introduced, including decompression, enucleation, or curettage. We are presenting a case of 35 years male with Ameloblastoma of his right body of the mandible. Presentation of the case, Surgical workup, and management are discussed.

A Case of Ectopic Odontogenic Ghost Cell Tumor: Histogenetic Features of a New Entity

Background: Odontogenic tumors arising from extra-alveolar sites are extremerly rare. Dentinogenic ghost cell tumor (DGCT) is an uncommon odontogenic neoplasm characterized by CTNNB1 mutation, ghost cell appearance, and dentinoid-like calcification. We present a case of an ectopic DGCT arising from a calcifying odontogenic cyst in the floor of the mouth. Case presentation: A 72-year-old man presented with a painless sublingual swelling. Imaging revealed a multi-lobulated, solid-cyst mass on the floor of the mouth. Cytology showed folded epithelial clusters composed of basaloid cells, keratinized material, and dentinoid matrix. Histology also revealed a multi-cystic, cribriform to solid nest. Immunohistochemically, CK19, CK5/6, bcl-2, and p63 were diffuse positive. CTNTTB1 mutation was detected, leading to the final diagnosis of an ectopic DGCT. There was no recurrence during a 6-month follow-up. Conclusion: This is the first report to comprehensively describe the clinicopathological features of an ectopic DGCT of odontogenic origin, developing similarly to that of a true odontogenic DGCT. Accurate diagnosis of this rare entity is necessary to avoid overtreatment.

Trigeminal Neuralgia as Nonodontogenic Toothache: A Case Report

Toothaches typically originate from the odontogenic structures such as dentin, pulp and periodontium. Toothaches which have an odontogenic origin are managed effectively in the dental clinic; however, toothaches with a nonodontogenic origin are often difficult to identify. This article presents a case of trigeminal neuralgia that was misdiagnosed as pain of odontogenic origin and initially treated surgically and endodontically, despite no abnormality detected in the physical examination or X-ray. The aim of this article is to present a case of trigeminal neuralgia that may mimic odontogenic toothache. This case highlights the importance of having thorough knowledge and the appropriate clinical skills to differentiate both odontogenic and nonodontogenic toothaches, as well as the need for careful diagnosis before undertaking any treatment.

Adenomatoid Odontogenic Tumor- A Rare Case Report of “Two Third Tumor”

Adenomatoid odontogenic tumor (AOT) is a rare odontogenic origin tumor that manifests as a slow-growing cystic neoplasm in the anterior maxilla, often in conjunction with an impacted tooth. AOTs are divided into three kinds based on their histology: follicular, extrafollicular, and peripheral. Because the source of the AOT is unknown, it's impossible to say whether the lining of an associated cyst reflects the cause i.e. a real dentigerous cyst, a cystic alteration within an AOT, or a separate entity. The diagnosis and treatment should be determined following a thorough clinical, radiographic, and histological investigation. The presented case is a rare occurrence of its sort due to the favorable patient's age and the AOT's site in the lower jaw. The current study reports on a case with follicular AOT in the anterior mandibular region (a rare location), with unusual histomorphology (snow flake and calcified areas) associated with impacted 43 and retained 83.

Brain abscess of odontogenic origin in patients with malignant tumors: A report of two cases

Background: Oral infection and dental manipulations can lead to the development of brain abscesses, a rare but potentially life-threatening condition. Herein, we report patients undergoing cancer treatment who developed brain abscesses of odontogenic origin at our hospital. Case Description: Two patients developed brain abscesses during cancer treatment. Both underwent neurosurgical aspiration, and the causative microorganism was identified as Streptococcus intermedius of the Streptococcus anginosus group, which is a part of the normal bacterial flora in the oral cavity. There was clinical and radiographic evidence of dental infection in one of the patients diagnosed with a brain abscess of odontogenic origin. No infectious foci were found in the other patient during hospitalization for the abscess. However, the patient had undergone extraction of an infected tooth approximately 3 months before admission for the abscess, suggesting origination from an oral infection or dental manipulation. The patients’ cancers rapidly worsened because cancer treatment in both patients was interrupted for several months to treat the brain abscess. Conclusion: Oral infections can cause severe infections, such as brain abscesses, particularly during the treatment of malignant tumors. Improving the oral environment or treating oral infections before initiating treatment for malignant tumors is highly recommended. In addition, the possibility of odontogenic origin should always be considered as a potential etiology of brain abscesses.