Maxillary sinusitis is inflammation of the maxillary sinus which are air filled spaces inside inside the cheek bones. It is one pair of sinuses that is located above or at the level of roots of molar teeth. The maxillary sinuses are connected to the nasal cavity through an opening and therefore any nasal infections can trigger maxillary sinusitis. It is commonly seen after viral infections such as the cold and may be associated with certain dental procedures and problems.
Maxillary sinusitis can be of acute form or chronic form. An untreated acute infection develops in to a chronic form.
The acute form presents itself as severe, constant pain in maxillary sinus region. The patient usually has a history of a cold 4 to 5 days before the onset of pain. The pain radiates towards the side of the face, teeth eyelid and ear.
Tender swelling is seen over the cheek region. Swelling inside the oral cavity may also be present. Headaches are often present and tend to suggest infection of the other sinuses as well. The pain worsens on lowering the head and increases on biting down on the affected side of the jaw.
Symptoms like difficulty breathing, fever and body ache are very common due to an active infection. Inner membrane of nose becomes reddish in color. Running nose with pus discharge is seen. If the lesion is caused due to dental problem, foul odor and bad taste in mouth is experienced by the patient
Chronic forms are associated with sore throat, cough, inability to sleep and nasal congestion. The patient’s voice becomes nasal. The feeling of being tired all the time and a low grade fever is commonly seen. Nasal discharge and headaches are more persistent in chronic forms. These symptoms are largely non-specific for maxillary sinusitis when compared to the acute form. Patients may therefore mistaken it for conditions such as hay fever (allergic rhinitis) and not seek appropriate treatment.
The most likely cause is a bacterial infection where the microbes often spread from the nasal cavity and sometimes the mouth. It often tends to follow an acute viral infection like the common cold or flu. In chronic sinusitis, there is often a history of allergic rhinitis which is a condition of the nose primarily. A deviated nasal septum and nasal polyps are the conditions predisposing to maxillary sinusitis. It is also caused due to cysts and tumors of maxillary sinus.
Dental causes of maxillary sinusitis include the spread of infection from roots of upper molar teeth to the floor of the sinus. The offending tooth is generally infected due to dental caries that have progressed to the root. Communication between the sinus and the oral cavity due to extraction of the upper molar teeth also poses a risk of developing maxillary sinusitis. Other dental causes include dental implant surgeries, periodontal abscess, chronic periodontitis and infected dental cysts.
Treatment is aimed at eradicating the underlying infections Dental causes are corrected by extractions and flap surgeries.
- Antibiotics are prescribed for the bacterial infection. Penicillin and its derivatives are commonly used drugs.
- Pain is managed by analgesic and anti-inflammatory medications such as paracetamol, ibuprofen and aspirin.
- Steam inhalation is advised every four hours but should not be the sole means of treating the condition.
- Nasal decongestion is treated by using ephedrine sulfate or xylometazoline solutions or sprays.
- In severe and non-responsive cases of maxillary sinusitis surgical approaches are indicated. The sinus is approached through nasal or oral cavity and washed out (irrigation).