This study aimed to propose appropriate management for odontogenic chronic rhinosinusitis.

Thirty-one adult patients with odontogenic chronic rhinosinusitis undergoing maxillary extraction were retrospectively analysed. Patients with (n = 21) and without (n = 10) oroantral fistula on computed tomography were classified. Functional endoscopic sinus surgery was performed when sinusitis did not improve after extraction. The critical indicators for surgical requirement in the management of odontogenic chronic rhinosinusitis were analysed.

Sinusitis significantly improved after extraction in both groups. Patients without oroantral fistula had significantly more severe remnant sinusitis than those with oroantral fistula after extraction on computed tomography (p = 0.0037). The requirement for functional endoscopic sinus surgery was statistically significant for patients without orofacial fistula over those with orofacial fistula (p < 0.0001). The surgical improvement ratio was 93 per cent.

The absence of oroantral fistula and severe sinusitis can be critical indicators for the requirement of functional endoscopic sinus surgery after extraction in the management of odontogenic chronic rhinosinusitis.

A non-surgical approach for managing rhinosinusitis associated with chronic oroantral fistula resulting from tooth extraction was evaluated.

Twenty-six consecutive patients (15 males and 11 females) aged 28–72 years (mean, 49.81 years) were administered local decongestion therapy for 2 weeks and antibiotics for 10 days. Patients showing a reduction in Sino-Nasal Outcome Test 22 scores after two weeks continued to receive local decongestion therapy weekly for up to six weeks, while those not showing any improvement underwent surgical management.

At 2 weeks, 17 patients (65.38 per cent) showed an improvement in rhinosinusitis (33.39 per cent mean reduction in Sino-Nasal Outcome Test 22 scores). The primary determinant of response was fistula size. At 6 weeks, sinusitis resolved completely in all 17 patients, and the fistula closed in 16 of these. Final Sino-Nasal Outcome Test 22 and Lund–Mackay scores showed no significant difference between the surgically treated and non-surgically treated groups.

Local decongestion therapy along with antibiotics may promote resolution in this subset of rhinosinusitis patients.

Transoral endoscopic ENT surgical procedures are a mainstay of treatment for a variety of conditions and are often preferable to open surgery where possible. Cases of micrognathia, prominent incisor teeth or trismus may create difficulties in gaining sufficient access to undertake such procedures. Extraction of the anterior maxillary teeth can help overcome these problems in appropriate cases, with subsequent prosthetic tooth replacement supported by dental implants. To date, this approach has not been reported in the literature.

This paper reports on two cases which illustrate this approach; the first case involved pharyngeal pouch management where previous open surgery had failed, and the second case involved glottic carcinoma management where oral access was compromising resection.

This technique is recommended to facilitate effective transoral surgical procedures as a low-morbidity alternative to either open surgery or non-surgical therapies.