Classification of Odontogenic Sinusitis: A Clinical‐Based Phenotyping System to Guide Multidisciplinary Surgical Management
Lorenzo Sabatino, Simone Di Giovanni, Michelangelo Pierri, Carmen Bigliardo, Marco Mattaroccia, Matteo Valentini, Antonio Moffa, Manuele Casale, Michele Antonio LopezABSTRACT
Background
Odontogenic sinusitis (ODS) is a condition that requires a multidisciplinary approach for successful treatment. Effective communication among the healthcare providers involved reduces the risk of errors and treatment failure. This study proposes a new ODS classification system to facilitate the communication of pivotal clinical information.
Materials and Methods
In this observational study the authors considered 124 consecutive patients with ODS treated in the Campus Bio‐Medico of Rome Foundation Hospital. The main elements influencing the treatment of this condition resulted as: timing, etiology, presence of foreign body, maxillary obstruction of the ostiomeatal complex, and presence of oroantral fistula (OAF); these elements were organized in the acronym TEBOF. Each patient received a TEBOF classification. The “T” was categorized in “T c ” for patients diagnosed with chronic sinusitis, “T a ” for of acute sinusitis, and “T 0 ” for patients with maxillary sinus foreign body without sinusitis. The “E” was differentiated in “E c ” when the condition was a side effect of a primary dental pathology, “E p ” when the initial cause was not a dental implant, and “E a ” for when the initial cause was having a dental implant placed. “B” was reported as “B 1 ” when there was a maxillary sinus foreign body and “B 0 ” when there was not. “O” was reported as “O 1 ” when the ostiomeatal complex resulted closed and “O 0 ” when it was clear. “F” was used as “F 1 ” when there was a communication, and “F 0 ” when there was not. A preliminary assessment was performed considering the change in the classification in the groups of patients that underwent different therapeutic approaches. This classification provides a concise and easy‐to‐understand combination facilitating communication between the various healthcare providers who are essential for the appropriate treatment of this condition.
Results
Among the 124 patients included (64 women, 51.6%; mean age 57.2 ± 13 years), chronic sinusitis (T c ) was the most frequent timing category (96 patients, 77.4%), while classical dental pathology represented the predominant etiology (E c , 88 patients, 70.9%). Foreign body was detected in 39 patients (31.5%), ostiomeatal complex obstruction in 80 patients (64.5%), and oroantral fistula in 52 patients (41.9%). Combined surgical treatment (ESS + oral surgery) was the most frequently adopted approach (70 patients, 57%), followed by dental treatment alone (34 patients, 27%) and ESS alone (20 patients, 16%). The overall success rate was 97%, only four patients required second surgical procedure.
Conclusions
The TEBOF classification provides a concise, reproducible, and clinically intuitive tool for the characterization of odontogenic sinusitis. By integrating timing, etiology, and key anatomical features into a compact alphanumeric code, it facilitates multidisciplinary communication between otolaryngologists and dental providers, and may guide the selection of the most appropriate surgical strategy for each patient.
Level of Evidence
4.