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BackTable / ENT / Podcast / Episode #126

Odontogenic Sinusitis

with Dr. John Craig

In this week’s episode of Backtable ENT, Dr. Ashley Agan and Dr. Gopi Shah talk with Dr. John Craig, chief of Rhinology and co-director of the Skull Base Center at Henry Ford Health in Detroit, about odontogenic sinusitis (ODS).

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Odontogenic Sinusitis with Dr. John Craig on the BackTable ENT Podcast)
Ep 126 Odontogenic Sinusitis with Dr. John Craig
00:00 / 01:04

BackTable, LLC (Producer). (2023, August 29). Ep. 126 – Odontogenic Sinusitis [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. John Craig discusses Odontogenic Sinusitis on the BackTable 126 Podcast

Dr. John Craig

Dr. John Craig is the chief of Rhinology and co-director of the Skull Base Center at Henry Ford Health in Detroit, Michigan.

Dr. Ashley Agan discusses Odontogenic Sinusitis on the BackTable 126 Podcast

Dr. Ashley Agan

Dr. Ashley Agan is an otolaryngologist in Dallas, TX.

Dr. Gopi Shah discusses Odontogenic Sinusitis on the BackTable 126 Podcast

Dr. Gopi Shah

Dr. Gopi Shah is a pediatric otolaryngologist and the co-host of BackTable ENT.

Synopsis

The episode begins by hearing about John’s path to rhinology and his work and research interests in ODS. First, John defines ODS and contrasts it with chronic rhinosinusitis (CRS). He notes that the cardinal symptoms of CRS are the same as ODS but for ODS, these symptoms are unilateral, such as unilateral nasal obstruction, unilateral nasal drainage and unilateral facial pressure. Also, a foul smell is a very common symptom of ODS.

The conversation then transitions to discussing the role of dental history in ruling in ODS. John explains his oral exam process and questions he asks related to a patient’s dental history such as upper dental pain, root canals, extractions, dental implants and dental bridges. Interestingly, current research has shown only 20-40% of patients have dental symptoms such as dental pain. The group discusses how insurance coverage plays a role in the treatment management patients with ODS may undergo, and John notes the importance of collaborating with dental providers for endodontic testing and imaging that includes dental roots.

John further delves into what he is looking for on an endoscopy exam including unilateral purulent drainage from the middle meatus, edema and polyps. CT sinus usually shows unilateral maxillary sinus opacification.

Then, John explains how he groups patients in two groups, treatable and untreatable dental pathologies, to help in deciding management of patients with ODS. Treating the sinus and the treatable dental pathology (i.e.-closure of oroantral fistula) will help the condition resolve in the majority of cases. Timing of treating the dental pathology and sinus surgery is complicated, but taking into account the patient’s symptom burden can help decide timing of these procedures. When there is no treatable dental pathology, management options include antibiotics (to temporize symptoms) and endoscopic sinus surgery (ESS) with 98% success. The episode concludes with the group discussing the role of ESS for ODS.

Resources

PubMed (Link to John’s list of Publications):
https://pubmed.ncbi.nlm.nih.gov/?term=Craig%20JR&cauthor_id=32656998

Transcript Preview

[Dr. John Craig]
Yes, I think first off, people just have to flip a switch in their head that this is more common than most people think, and once you start thinking about or looking for it, you find it more. I know that sounds obvious, but the problem is that all of these patients will have the cardinal sinusitis symptoms to some variable frequency. They're going to have nasal obstruction, they're going to have anterior drainage, posterior drainage, facial pressure, sometimes smell loss, and different permutations of all those symptoms. The symptomatic history by itself doesn't say, oh, it's definitely dental. If you happen to remember to ask about foul smell, which is not one of the cardinal symptoms in all national-international guidelines, then you might pick up on that. The other thing is unilateral. I've noticed, reading a lot of doctors' notes, they're all-or-none symptoms. Instead, you need to know whether that nasal obstruction is one-sided or both sides. Is the colored drainage one-sided or both sides? It's just been interesting to me noticing that not everyone asks that simple question. Try to focus in on what's unilateral or bilateral, and then that foul smell will be a little extra in terms of suspicion.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Odontogenic Sinusitis Treatment

Topics

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