Microbiology of Maxillary Sinus Infections: Systematic Review on the Relationship of Infectious Sinus Pathology with Oral Pathology

The main objective of this systematic review was to evaluate the microbiology of maxillary sinus infections and to determine whether an odontogenic origin of the infection can be established. The PIE question posed was the following: In patients with sinus and dental symptomatology who come for ENT or dental assessment and who undergo a microbiological study of the maxillary sinus and are found to have infectious sinus pathology, is the infectious sinus pathology related to an odontogenic origin? The literature review was carried out in PubMed, Web of Science, and the Cochrane Library. A total of 2769 articles were identified in the three databases used. Inclusion and exclusion criteria were applied, and after eliminating duplicates, 55 full-text publications were identified as suitable for inclusion. After reading this series of publications, four articles were excluded due to lack of data in the article. Finally, 51 studies were included in the qualitative analysis. In this study, the microorganisms were classified into three groups: group 1 (microorganisms of the oral microbiome related in the literature to oral pathology, namely caries and periodontal disease), group 2 (microorganisms found in the oral microbiome but not related to oral disease), and group 3 (microorganisms not identified in the microbiome). This review included 51 articles and a total of 6415 patients who underwent surgery in 7051 sinuses. Most sinus infections were caused by group 2 (63.51%) or group 1 (24.21%) bacteria. Within group 1, the most frequent bacteriological agents in sinus infections were Peptostreptococcus spp. (35.22%) and St. Viridans spp. (39.89%). In group 2, the most frequent bacteriological agents in sinus infections were H. influenzae (29%) and Streptococcus spp. (23.63%). In group 3, the most frequent cause of sinusitis of dental origin was dental caries, followed by foreign bodies (implants) and sinus elevation. Different studies have shown that certain species of bacteria isolated from maxillary sinus cultures are more frequently associated with rhinosinusitis of odontogenic origin. The results of this systemic review show that, among the bacterial species most frequently found, anaerobic species predominate over aerobic species, especially Peptostreptococcus and Staphylococcus aureus, which are part of the oral microbiome, suggesting an odontogenic origin of maxillary sinus infection. Therefore, bacterial cultures of maxillary sinus aspirate can be of great use to clinicians in the differential diagnosis of odontogenic sinusitis.