著しい骨吸収を伴った歯性上顎洞炎の1例

We present a case of odontogenic maxillary sinusitis with marked perisinuous bone resorption. A 29-year-old man visited to our hospital because of pain in buccal region on left side after extraction of teeth at a dental practitioner. Orthopantomography and CT were performed and revealed inflammatory thickening of maxillary sinus mucosa and marked perisinuous bone resorption. In the blood examination, the values of WBCs and CRP were elevated abnormally. Moreover, bacterial examination was performed using the exudate from maxillary sinus through a fistula after extraction of teeth; α-Streptococcus, Prevotella buccae, Prevotella intermedia, Prevotella melaninogenica and Acinetobacter baumannii were detected. First, medication of antibiotics and irrigation of maxillary sinus was worked out under a clinical diagnosis of odontogenic maxillary sinusitis. These therapies didn't change perisinuous bone resorption for the better. Sequestrum and mucosa of maxillary sinus were biopsied to examine thoroughly; diagnosis of odontogenic maxillary sinusitis was confirmed histopathologically. Moreover, biochemical examination of blood showed normal serum level of specific markers for bone metabolism or Aspergilli. The similar therapies were continued from then and perisinuous bone resorption stopped suddenly for unknown reasons 3 months after these therapies.
Time course of perisinuous bone regeneration was found by CT. Finally, operation to close the antrooral fistula with palatal flap was performed. There has been no relapse of inflammation for more than 5 years.