The role of oral microbiota in the development of perforative odontogenic maxillary sinusitis

Abstract

Objective. Analysis of the microbiota composition of the maxillary sinuses and evaluation of the antimicrobial susceptibility considering the duration of the sinus floor perforation.
Material and methods. A total of 35 patients with chronic odontogenic maxillary sinusitis participated in the study between 2020 and 2024. The patients’ ages varied from 20 to 60 years; 17 of them (48.6%) were men and 18 (51.4%) were women. The patients were divided into two groups. The first group comprised 23 patients (65.7%) whose disease was complicated by the presence of a formed oroantral fistula (lasting from two weeks to two years). The second group comprised 12 patients (34.3%) with foci of inflammation in the periapical tissues of the maxillary molars and premolars.
Results. A microbiological study of 35 patients with chronic odontogenic maxillary sinusitis showed that this group often has coccal flora, particularly gram-positive cocci belonging to the major groups of streptococci, staphylococci and enterococci, as well as Candida fungi. In both groups, the concentration of microbial colony-forming units did not exceed 10²–10⁵ CFU/ml. This suggests that surgical treatment was performed outside the phase of acute inflammation and that all patients received antibacterial and anti-inflammatory therapy, as well as oral cavity sanation, as outpatients before hospitalisation.
Conclusion. The study indicates that surgical treatment can only be performed after the acute inflammatory processes have resolved, and after preoperative antibiotic therapy if necessary. When selecting an antibacterial drug to treat odontogenic sinusitis, protected aminopenicillins, the latest generation of cephalosporins and fluoroquinolones should be preferred.