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Abstract
Background and Objectives
Unilateral sinus lesions can be caused by many diseases and exact preoperative diagnosis is often difficult to make. The aims of this study were to evaluate the recent trends for prevalence of unilateral sinus lesions and find useful factors in differential diagnosis.
Materials and Method
Preoperative clinical diagnosis including computed tomography (CT) images, endoscopic findings and postoperative diagnosis based on pathology were assessed retrospectively in 384 consecutive patients who underwent unilateral sinus surgery from 2004 to 2013.
Results
Chronic bacterial rhinosinusitis (40%) was the most common cause of unilateral sinus lesions, followed by fungal sinusitis (21%), benign and malignant tumors (14%), and odontogenic sinusitis (11%). The incidence of odontogenic sinusitis has recently increased and mismatches of pre- and post-operative diagnosis were commonly found among patients with chronic bacterial rhinosinusitis, fungal sinusitis, or odontogenic sinusitis. Microcalcification in fungal sinusitis and dental lesions in odontogenic sinusitis were confirmed as critical factors by logistic regression analysis.
Conclusion
The incidence of odontogenic sinusitis has been increasing steadily over the last 10 years. The findings of microcalcification and dental lesions on CT could provide crucial information to make a precise preoperative diagnosis among chronic bacterial rhinosinusitis, fungal sinusitis and odontogenic sinusitis.
Figures and Tables
Fig. 1
Natures of nasal discharge are classified into mucoid (A), milky (B) and yellow-colored discharge (C).
Fig. 2
Degree of sinus haziness is classified into full haziness (A), partial haziness including mucosal swelling (B) and air-fluid level (C) in this study.
Fig. 3
Various dental lesions such as periapical abscess (A), oroantral fistula (B) and dental implant (C) are observed on CT scans.
Fig. 4
Trends of unilateral sinus lesion. It shows the changes of the final diagnosis. The percentage of CBRS is decreasing, whereas that of odontogenic sinusitis is increasing to 26% in 2013. CBRS: chronic bacterial rhinosinusitis, Fungal: fungal sinusitis, Odontogenic: odontogenic sinusitis, Tumor: benign and malignant tumor, ACP: antrochoanal polyp.
Table 2
Comparison of endoscopic findings in chronic bacterial rhinosinusitis, fungal rhinosinusitis and odontogenic rhinosinusitis
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