牙源性鼻窦炎：一项前瞻性研究中的临床、影像学及生活质量特征分析

文献信息

中文摘要

背景： 鼻窦炎是一种日益普遍的疾病，会损害患者的生活质量并给医疗系统带来沉重负担。牙源性鼻窦炎是鼻窦炎的一种以单侧为主的形式，占单侧上颌窦炎的40%。本研究旨在描述牙源性鼻窦炎的临床表现、影像学累及范围及生活质量损害。方法：招募38例由牙科病变/治疗引起的单侧鼻窦炎患者。OS诊断标准依据EPOS-2020指南制定。采用22条目SNOT-22问卷评估症状严重程度及社会/情绪影响。此外，所有患者均接受CT成像，并采用Lund-Mackay评分对上颌窦、前组和后组筛窦、蝶窦及额窦的受累情况进行分期。结果：吸烟与患者报告的生活质量显著更差相关，当前吸烟者的SNOT-22评分高于非吸烟者（59.4 vs. 38.2；p = 0.026）。脓性分泌物与更严重的影像学严重程度、更长的症状持续时间以及显著更高的上颌窦外扩展发生率相关（92.3%；p < 0.001）。71.1%的患者存在上颌窦外受累，主要累及前组筛窦。尽管Lund-Mackay评分客观反映了影像学疾病扩展范围，但其与症状负担的相关性有限。结论：牙源性鼻窦炎常表现为明显的上颌窦外扩展及显著的生活质量损害。在该探索性队列中，吸烟和脓性分泌物与更严重疾病的标志物相关。这些关联应谨慎解读，并需在采用多变量分析的更大规模研究中加以证实。

英文摘要

Background: Rhinosinusitis is an increasingly prevalent condition that compromises patients' quality of life and imposes a substantial burden on healthcare systems. Odontogenic sinusitis, a predominantly unilateral form of rhinosinusitis, accounts for up to 40% of unilateral maxillary sinusitis cases. This study aimed to characterize the clinical presentation, radiological extension, and quality-of-life impairment associated with odontogenic sinusitis. Methods: Thirty-eight patients with unilateral sinusitis caused by dental pathology/treatment were recruited. OS diagnosis criteria were established according to EPOS-2020 guidelines. The 22-item SNOT-22 questionnaire was used to assess symptom severity and social/emotional impact. In addition, all patients underwent CT imaging and were staged with the Lund-Mackay scale for involvement of the maxillary, anterior and posterior ethmoid, sphenoid and frontal sinuses. Results: Smoking was associated with significantly worse patient-reported quality of life, with higher SNOT-22 scores in current smokers than in non-smokers (59.4 vs. 38.2; p = 0.026). Purulent discharge was associated with greater radiological severity, longer symptom duration, and a markedly higher prevalence of extra-maxillary extension (92.3%; p < 0.001). Extra-maxillary involvement was identified in 71.1% of patients, predominantly affecting the anterior ethmoid sinus. Although Lund-Mackay scores objectively reflected radiological disease extension, their correlation with symptom burden was limited. Conclusions: Odontogenic sinusitis frequently presents with substantial extra-maxillary extension and significant impairment of quality of life. Smoking and purulent discharge were associated with markers of greater disease severity in this exploratory cohort. These associations should be interpreted cautiously and confirmed in larger studies using multivariable analyses.