摘要
背景：齒源性和鼻源性的慢性鼻及鼻竇炎，其病理致病機轉互不相同。慢性鼻及鼻竇炎臨床診斷易忽視齒源性病因，造成治療失敗。方法：回溯收集2005到2009年間，診斷爲齒源性慢性鼻及鼻竇炎病患共計18名，分析其病因、診斷、治療過程及結果。此外手術時以無菌方式採集鼻竇膿液進行細菌培養，並作抗生素的敏感性測試，其細菌學結果和同時期的159名鼻源性慢性鼻及鼻竇炎病患相比較。結果：在病因方面，以齒根周圍膿瘍最多，其次爲齒根掉入上頜竇。78%病患求診時，未意識到鼻及鼻竇炎導因於齒源性疾病。治療方式以配合牙科治療及功能性鼻竇手術的結果最佳。鼻竇膿液培養結果，厭氧菌、嗜氧及兼氣菌、混合性（嗜氧及厭氧菌）培養率分別爲73.3%、60%、40%，皆高於鼻源性病患的30.2%、55.3%、15.1%，且兩者的厭氧菌及混合性細菌培養率在統計上呈現顯著差異。結論：針對反覆或持續性的單側鼻及鼻竇炎，須將齒源性病因列入鑑別診斷。臨床上需耳鼻喉及牙科兩科醫師合作，診斷方能確立。治療上需涵蓋鼻及鼻竇炎和齒源病灶雙方面的治療，因常見厭氧菌及混合性細菌感染，須選擇具有嗜氧與厭氧抗菌範圍的抗生素。
並列摘要
BACKGROUND: The pathogenesis of chronic rhinosinusitis with odontogenic origin is quite different from that with rhinogenic origin. Disregard of the dental etiology in treating odontogenic rhinosinusitis may result in treatment failure. In this study, patients with odontogenic chronic rhinosinusitis treated at our hospital in recent 4 years were analyzed with respect to their clinical manifestations and outcomes.METHODS: From May 2005 to May 2009, 18 patients who were diagnosed to have odontogenic chronic rhinosinusitis were enrolled in this retrospective study. The dental etiology, diagnosis, treatment modality and outcome were reviewed. The bacteriology and antibiotic sensitivity test of the mucopus, aspirated from the diseased sinus by antiseptic techniques during the surgery, were analyzed and compared with those from 159 patients with rhinogenic chronic rhinosinusitis at the same period.RESULTS: Among 18 patients, the most common dental etiology was periapical abscess, followed by a displaced dental root in the maxillary sinus. At the time of clinical evaluation, 14 patients (78%) had no awareness that chronic rhinosinusitis was due to an odontogenic source. Dental treatment combined with functional endoscopic sinus surgery appeared to be the best treatment modality. Anaerobes, aerobes and facultatives, and mixed aerobic-anaerobic infection were found in 73.3%, 60%, and 40% of the sinus mucopus in patients with odontogenic rhinosinusitis, which were higher than 30.2%, 55.3%, and 15.1% in patients with rhinogenic rhinosinusitis. The difference in the culture rate of anaerobes and mixed aerobic-anaerobic infection was statistically significant.CONCLUSIONS: An odontogenic source should be considered in individuals with recurrent or persistent unilateral rhinosinusitis. Diagnosis requires a thorough dental and sinus evaluation, which need the cooperation of the otorhinolaryngologists and the dentists. Management of odontogenic chronic rhinosinusitis requires treatment of the sinusitis as well as the dental etiology. Empirical antibiotics should cover both aerobes and anaerobes because anaerobic and mixed infections were common.
延伸閱讀
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