Maxillary Sinus Papillary Edema as a Predictor of Odontogenic Sinusitis
Recommended Citation
Mackie H, Jassal J, Wilson C, Alkhoory W, Eide JG, McCoul ED, and Craig JR. Maxillary Sinus Papillary Edema as a Predictor of Odontogenic Sinusitis. Laryngoscope 2025.
Document Type
Article
Publication Date
12-19-2025
Publication Title
The Laryngoscope
Keywords
apical periodontitis; chronic rhinosinusitis; endoscopic sinus surgery; nasal polyps; odontogenic sinusitis; oroantral fistula
Abstract
OBJECTIVES: Odontogenic sinusitis (ODS) refers to purulent sinusitis caused by infectious maxillary dental pathologies, with > 90% occurring unilaterally. While various clinical features suggest ODS, diagnosing some ODS patients can be challenging. This study aimed to determine the value of maxillary sinus papillary edema (MSPE) in predicting ODS.
METHODS: A retrospective cohort study was conducted on patients who underwent at least maxillary antrostomy for unilateral sinus disease (USD). Adequately powered samples of three USD cohorts were generated: ODS, infectious maxillary CRS without nasal polyps (CRSsNP), and noninfectious CRSwNP. Multiple variables were collected, but the primary outcome was MSPE presence via double-blinded endoscopic image review by three rhinologists. Inter-rater agreement was calculated, and a predictive model for MSPE was generated.
RESULTS: Of 41 ODS, 22 infectious CRSsNP, and 13 noninfectious CRSwNP patients, mean age was 57.0 years and 55.3% were female. There was almost perfect agreement between rhinologists when assessing for MSPE on endoscopic images (κ = 0.927). MSPE was seen in 100% of ODS, 22.7% infectious CRSsNP, and 0% CRSwNP. MSPE was significantly more likely in ODS compared to non-odontogenic CRS (p < 0.0001), demonstrating 100% sensitivity and 89.1% specificity for ODS, with 85.7% positive and 100% negative predictive values.
CONCLUSIONS: MSPE is a distinct finding that is reliably identifiable and is significantly more likely in ODS compared to infectious CRSsNP and noninfectious CRSwNP. With 100% sensitivity and NPV, MSPE absence makes ODS very unlikely. With 86% PPV, MSPE is not pathognomonic for ODS, but should arouse suspicion for a possible odontogenic source.
PubMed ID
41416639
ePublication
ePub ahead of print
