牙源性鼻窦炎的分类：一种指导多学科手术治疗的基于临床的表型分型系统

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中文摘要

背景： 牙源性鼻窦炎（ODS）是一种需要多学科方法才能成功治疗的疾病。参与其中的医疗提供者之间进行有效沟通可降低错误和治疗失败的风险。本研究提出一种新的ODS分类系统，以促进关键临床信息的沟通。
材料与方法： 在这项观察性研究中，作者纳入了在罗马Campus Bio-Medico基金会医院接受治疗的124例连续ODS患者。影响该疾病治疗的主要因素为：时机、病因、异物存在、上颌窦口鼻道复合体阻塞以及口腔上颌窦瘘（OAF）的存在；这些因素被组织成缩写TEBOF。每位患者均接受TEBOF分类。“T”分为“Tc”（诊断为慢性鼻窦炎的患者）、“Ta”（急性鼻窦炎）和“T0”（上颌窦异物但无鼻窦炎的患者）。“E”分为“Ec”（该情况为原发性牙科病理的副作用）、“Ep”（初始原因不是牙种植体）和“Ea”（初始原因为已植入牙种植体）。“B”在存在上颌窦异物时报告为“B1”，不存在时报告为“B0”。“O”在口鼻道复合体结果为闭合时报告为“O1”，通畅时报告为“O0”。“F”在存在交通时用作“F1”，不存在时用作“F0”。进行了初步评估，考虑接受不同治疗方法的患者组中分类的变化。该分类提供了一种简洁且易于理解的组合，便于对该疾病的适当治疗至关重要的各类医疗提供者之间进行沟通。
结果： 在纳入的124例患者中（64例女性，51.6%；平均年龄57.2±13岁），慢性鼻窦炎（Tc）是最常见的时机类别（96例患者，77.4%），而经典牙科病理是主要病因（Ec，88例患者，70.9%）。39例患者（31.5%）检出异物，80例患者（64.5%）存在口鼻道复合体阻塞，52例患者（41.9%）存在口腔上颌窦瘘。联合手术治疗（ESS+口腔手术）是最常采用的方法（70例患者，57%），其次是单纯牙科治疗（34例患者，27%）和单纯ESS（20例患者，16%）。总体成功率为97%，仅4例患者需要第二次手术。
结论： TEBOF分类为牙源性鼻窦炎的特征描述提供了一种简洁、可重复且临床直观的工具。通过将时机、病因和关键解剖特征整合为一个紧凑的字母数字代码，它促进了耳鼻喉科医生与牙科提供者之间的多学科沟通，并可能指导为每位患者选择最合适的手术策略。
证据等级： 4。

英文摘要

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 "Tc" for patients diagnosed with chronic sinusitis, "Ta" for of acute sinusitis, and "T0" for patients with maxillary sinus foreign body without sinusitis. The "E" was differentiated in "Ec" when the condition was a side effect of a primary dental pathology, "Ep" when the initial cause was not a dental implant, and "Ea" for when the initial cause was having a dental implant placed. "B" was reported as "B1" when there was a maxillary sinus foreign body and "B0" when there was not. "O" was reported as "O1" when the ostiomeatal complex resulted closed and "O0" when it was clear. "F" was used as "F1" when there was a communication, and "F0" 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 (Tc) was the most frequent timing category (96 patients, 77.4%), while classical dental pathology represented the predominant etiology (Ec, 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.