Negative Predictors of Tooth Extraction in the Management of Odontogenic Sinusitis in a Japanese Patient Population: A Retrospective Study.

Introduction  There are no clear guidelines for deciding between endoscopic sinus surgery and tooth extraction for the treatment of odontogenic sinusitis. Furthermore, tooth extraction does not necessarily improve sinusitis and eventually results in additional endoscopic sinus surgery. Objective  The present study aimed to retrospectively investigate negative predictive factors of tooth extraction for odontogenic sinusitis. Methods  In total, 22 patients with odontogenic sinusitis, who underwent tooth extraction between April 2017 and March 2021, were included. The patients were divided into the improved (n = 15) and non-improved (n = 7) groups. Subsequently, the two groups were compared. Results  A higher percentage of patients in the non-improved group had polyps in the middle nasal meatus ( p  = 0.0008), higher Lund-Mackay score (LMS) ( p  = 0.0008), and apical lesions penetrating the maxillary sinus ( p  = 0.113). Patients with middle nasal meatus polyps, with LMS ≥ 7, or with a combination of apical lesions penetrating the maxillary sinus and LMS ≥ 5, were less likely to see improvement in sinusitis with tooth extraction. Conclusion  Tooth extraction as the initial intervention for odontogenic sinusitis presents a higher risk of failure, particularly in cases in which polyps are present in the middle nasal meatus, with LMS ≥ 7, or with a combination of apical lesions penetrating the maxillary sinus and LMS ≥ 5.