Actual problems in dentistry Actual problems in dentistry Проблемы стоматологии 2077-7566 2412-9461 113713 10.18481/2077-7566-2026-22-1- ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ И ИМПЛАНТОЛОГИЯ SURGICAL DENTISTRY AND IMPLANTOLOGY ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ И ИМПЛАНТОЛОГИЯ PATHOMORPHOLOGICAL CHARACTERISTICS OF CHANGES IN THE MUCOSA OF THE MAXILLARY SINUS IN OROANTRAL COMMUNICATION ПАТОМОРФОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ИЗМЕНЕНИЙ СЛИЗИСТОЙ ОБОЛОЧКИ ВЕРХНЕЧЕЛЮСТНОГО СИНУСА ПРИ ОРОАНТРАЛЬНОМ СООБЩЕНИИ Гатило Ирина Анатольевна Gatilo Irina A. chijgay@yandex.ru

кандидат медицинских наук;

candidate of medical sciences;

 Сирак Сергей Владимирович Sirak Sergey V. sergejsirak@yandex.ru

доктор медицинских наук;

doctor of medical sciences;

 Быкова Наталья Ильинична Bykova Natal'ya I. bikov_mi@mail.ru

доктор медицинских наук;

doctor of medical sciences;

 Ставропольский государственный медицинский университет Stavropol State Medical University Ставропольский государственный медицинский университет Ставрополь Россия Ставропольский государственный медицинский университет Ставрополь Russian Federation Кубанский государственный медицинский университет Краснодар Россия Kuban State Medical University Krasnodar Russian Federation 22 1 10 10 28 01 2026 https://dental-press.ru/en/nauka/article/113713/view

Цель исследования. Патоморфологическое изучение изменений слизистой оболочки верхнечелюстного синуса при ороантральном сообщении, возникшем после удаления зубов, с оценкой связи между морфологическими признаками и клиническими проявлениями. Дополнительно, исследование направлено на анализ гистохимических характеристик воспаления, включая распределение мукополисахаридов, РНК и тучных клеток, для понимания механизмов хронизации процесса и обоснования терапевтических подходов. Материал и методы: Проведено ретроспективное исследование 196 пациентов с перфорацией дна верхнечелюстного синуса. Пациенты распределены на группы: 1-я (утолщение слизистой, n = 42; подгруппы А, n = 14, подгруппы Б, n = 28), 2-я (полипозные изменения, n = 85; подгруппы А, n = 25, подгруппы Б, n = 60), контрольная (n = 69). Методы: клиническое обследование, компьютерная томография, цифровая ортопантомография, гайморография с йодолиполом, хирургические вмешательства, патогистологическое исследование (окраска гематоксилином-эозином, по Маллори), гистохимический анализ (мукополисахариды, РНК, тучные клетки). Статистический анализ: t-критерий Стьюдента, χ²-критерий, корреляция Пирсона (p < 0,05, SPSS v.25.0). Результаты. В 1-й группе ограниченные изменения (подгруппа А) характеризовались умеренным утолщением эпителия, отеком стромы и минимальной инфильтрацией; распространенные (подгруппа Б) – метаплазией эпителия, выраженной инфильтрацией лейкоцитами и фиброзом. Во 2-й группе ограниченные полипы (подгруппа А) ассоциировались с криптами эпителия и отеком; распространенные (подгруппа Б) – метаплазией, кавернозными сосудами и продукцией коллагена. Гистохимически выявлено накопление нейтральных и кислых мукополисахаридов, повышение РНК и тучных клеток, коррелирующее с воспалением (r = 0,45–0,85, p < 0,01). Самоизлечение перфорации – в 7,1 % случаев; хирургическое вмешательство – в 92,9 %. Заключение. Изменения слизистой оболочки варьируют от локального утолщения до диффузного полипоза с прогрессией к фиброзу и метаплазии, поддерживаемым хроническим воспалением. Гистохимические маркеры (тучные клетки, мукополисахариды) указывают на «порочный круг» секреции и реинфекции. Раннее хирургическое лечение критично для предотвращения осложнений. Результаты согласуются с литературными данными и обосновывают мультидисциплинарный подход.

The aim of the study. To conduct a pathological study of changes in the maxillary sinus mucosa in cases of oroantral communication following tooth extraction, assessing the relationship between morphological features and clinical manifestations. Additionally, the study aims to analyze the histochemical characteristics of inflammation, including the distribution of mucopolysaccharides, RNA, and mast cells, to understand the mechanisms underlying the chronicity of the process and support therapeutic approaches. Materials and Methods. A retrospective study of 196 patients with perforation of the maxillary sinus floor was conducted. Patients were divided into groups: 1st (mucosal thickening, n = 42; subgroups A, n = 14, B, n = 28), 2nd (polypoid changes, n = 85; A, n = 25, B, n = 60), control (n = 69). Methods: clinical examination, maxillary sinusography with iodolipol, surgical interventions, pathohistological examination (staining with hematoxylin and eosin, Mallory staining, toluidine blue, etc.), histochemical analysis (mucopolysaccharides, RNA, mast cells). Statistical analysis: Student's t-test, χ²-test, Pearson correlation (p < 0.05, SPSS v.25.0). Results. In group 1, limited changes (subgroup A) were characterized by moderate epithelial thickening, stromal edema and minimal infiltration; widespread (subgroup B) – by epithelial metaplasia, pronounced leukocyte infiltration and fibrosis. In group 2, limited polyps (subgroup A) were associated with epithelial crypts and edema; Disseminated (subgroup B) – metaplasia, cavernous vessels, and collagen production. Histochemical analysis revealed accumulation of neutral and acidic mucopolysaccharides, increased RNA and mast cells, correlating with inflammation (r = 0.45–0.85, p<0.01). Spontaneous healing of perforation occurred in 7,1 % of cases; surgical intervention occurred in 92,9 %. Conclusion. Mucosal changes range from localized thickening to diffuse polyposis with progression to fibrosis and metaplasia, supported by chronic inflammation. Histochemical markers (mast cells, mucopolysaccharides) indicate a "vicious cycle" of secretion and reinfection. Early surgical treatment is critical to prevent complications. The results are consistent with the literature and justify a multidisciplinary approach.

 перфорация верхнечелюстного синуса патогистологические изменения одонтогенный синусит гистохимический анализ полипозные изменения ороантральное соустье хроническое воспаление maxillary sinus perforation histopathological changes odontogenic sinusitis histochemical analysis polypous changes oroantral anastomosis chronic inflammation

Aksoy U., Orhan K. Association between odontogenic conditions and maxillary sinus mucosal thickening: a retrospective CBCT study. Clinical Oral Investigations. 2019;23(1):123-131. https://doi.org/10.1007/s00784-018-2418-x Aksoy U., Orhan K. Association between odontogenic conditions and maxillary sinus mucosal thickening: a retrospective CBCT study. Clinical Oral Investigations. 2019;23(1):123-131. https://doi.org/10.1007/s00784-018-2418-x Günaçar D.N., Köse T.E., Ceren, F. Radiodiagnostic properties of maxillary antroliths: a retrospective cone beam computed tomography study. BMC Oral Health. 2025;25(1):259. https://doi.org/10.1186/s12903-025-05641-y Günaçar D.N., Köse T.E., Ceren, F. Radiodiagnostic properties of maxillary antroliths: a retrospective cone beam computed tomography study. BMC Oral Health. 2025;25(1):259. https://doi.org/10.1186/s12903-025-05641-y Lin Y.H., Yang Y.C., Wen S.C., Wang H.L. The influence of sinus membrane thickness upon membrane perforation during lateral window sinus augmentation. Clinical Oral Implants Research. 2016;27(5):612-617. https://doi.org/10.1111/clr.12646 Lin Y.H., Yang Y.C., Wen S.C., Wang H.L. The influence of sinus membrane thickness upon membrane perforation during lateral window sinus augmentation. Clinical Oral Implants Research. 2016;27(5):612-617. https://doi.org/10.1111/clr.12646 Nair A.K., Jose M., Sreela L.S, Prasad T.S., Mathew P. Prevalence and pattern of proximity of maxillary posterior teeth to maxillary sinus with mucosal thickening: A cone beam computed tomography based retrospective study. Annals of African Medicine. 2023;22(3):327-332. https://doi.org/10.4103/aam.aam_74_22 Nair A.K., Jose M., Sreela L.S, Prasad T.S., Mathew P. Prevalence and pattern of proximity of maxillary posterior teeth to maxillary sinus with mucosal thickening: A cone beam computed tomography based retrospective study. Annals of African Medicine. 2023;22(3):327-332. https://doi.org/10.4103/aam.aam_74_22 Fischborn A.R., Andreis J.D., Wambier L.M., Pedroso C.M., Claudino M., Franco G.C.N. Performance of panoramic radiography compared with computed tomography in the evaluation of pathological changes in the maxillary sinuses: a systematic review and meta-analysis. Dento maxillo facial radiology. 2023;52(5):20230067. https://doi.org/10.1259/dmfr.20230067 Fischborn A.R., Andreis J.D., Wambier L.M., Pedroso C.M., Claudino M., Franco G.C.N. Performance of panoramic radiography compared with computed tomography in the evaluation of pathological changes in the maxillary sinuses: a systematic review and meta-analysis. Dento maxillo facial radiology. 2023;52(5):20230067. https://doi.org/10.1259/dmfr.20230067 Wu J., Zheng M., Wang X., Wang S. Endo-Periodontal Lesions-An Overlooked Etiology of Odontogenic Sinusitis. Journal of Clinical Medicine. 2023;12(21):6888. https://doi.org/10.3390/jcm12216888 Wu J., Zheng M., Wang X., Wang S. Endo-Periodontal Lesions-An Overlooked Etiology of Odontogenic Sinusitis. Journal of Clinical Medicine. 2023;12(21):6888. https://doi.org/10.3390/jcm12216888 Craig J.R., Dai X., Bellemore S., Woodcroft K.J., Wilson C., Keller C. et al. Inflammatory endotype of odontogenic sinusitis. International Forum of Allergy & Rhinology. 2023;13(6):998-1006. https://doi.org/10.1002/alr.23099 Craig J.R., Dai X., Bellemore S., Woodcroft K.J., Wilson C., Keller C. et al. Inflammatory endotype of odontogenic sinusitis. International Forum of Allergy & Rhinology. 2023;13(6):998-1006. https://doi.org/10.1002/alr.23099 Silva E.J.N.L., Pinto K.P., Versiani M.A., Sassone L.M. Dental Pathophysiology of Odontogenic Sinusitis: Endodontic Infections. Otolaryngologic Сlinics of North America. 2024;57(6):941-955. https://doi.org/10.1016/j.otc.2024.06.007 Silva E.J.N.L., Pinto K.P., Versiani M.A., Sassone L.M. Dental Pathophysiology of Odontogenic Sinusitis: Endodontic Infections. Otolaryngologic Slinics of North America. 2024;57(6):941-955. https://doi.org/10.1016/j.otc.2024.06.007 Yeung A.W.K., Hung K.F., Li D.T.S, Leung Y.Y. The Use of CBCT in Evaluating the Health and Pathology of the Maxillary Sinus. Diagnostics (Basel). 2022;12(11):2819. https://doi.org/10.3390/diagnostics12112819 Yeung A.W.K., Hung K.F., Li D.T.S, Leung Y.Y. The Use of CBCT in Evaluating the Health and Pathology of the Maxillary Sinus. Diagnostics (Basel). 2022;12(11):2819. https://doi.org/10.3390/diagnostics12112819 Tonetti M.S. Dental Pathophysiology of Odontogenic Sinusitis: Periodontitis. Otolaryngologic clinics of North America. 2024;57(6):957-975. https://doi.org/10.1016/j.otc.2024.07.020 Tonetti M.S. Dental Pathophysiology of Odontogenic Sinusitis: Periodontitis. Otolaryngologic clinics of North America. 2024;57(6):957-975. https://doi.org/10.1016/j.otc.2024.07.020 Лосев Ф.Ф., Иванов А.С., Лосев В.Ф., Абакаров С.И. Анализ результатов клинических случаев после дентальной имплантации с одномоментным поднятием дна гайморовой пазухи. Российский вестник дентальной имплантологии. 2019;(3-4):20-25. [Losev F.F., Ivanov A.S., Losev V.F., Abakarov S.I. Analysis of the results of clinical cases after dental implantation with one-single lifting of the sinus sinus bottom. Rossijskij vestnik dental'noj implantologii. 2019;(3-4):20-25. (In Russ.)]. https://elibrary.ru/item.asp?id=44038830 Losev F.F., Ivanov A.S., Losev V.F., Abakarov S.I. Analiz rezul'tatov klinicheskih sluchaev posle dental'noy implantacii s odnomomentnym podnyatiem dna gaymorovoy pazuhi. Rossiyskiy vestnik dental'noy implantologii. 2019;(3-4):20-25. [Losev F.F., Ivanov A.S., Losev V.F., Abakarov S.I. Analysis of the results of clinical cases after dental implantation with one-single lifting of the sinus sinus bottom. Rossijskij vestnik dental'noj implantologii. 2019;(3-4):20-25. (In Russ.)]. https://elibrary.ru/item.asp?id=44038830 Кошель И.В. Морфологическая характеристика слизистой оболочки верхнечелюстного синуса при перфорации его дна во время стоматологических вмешательств. Российская оториноларингология. 2016;(5):29-35. [Koshel' I.V. Morphological characteristics of mucous membrane of maxillary sinus in its bottom perforation during dental interference. Rossiiskaya otorinolaringologiya. 2016;(5):29-35. (In Russ.)]. https://doi.org/10.18692/1810-4800-2016-5-29-35 Koshel' I.V. Morfologicheskaya harakteristika slizistoy obolochki verhnechelyustnogo sinusa pri perforacii ego dna vo vremya stomatologicheskih vmeshatel'stv. Rossiyskaya otorinolaringologiya. 2016;(5):29-35. [Koshel' I.V. Morphological characteristics of mucous membrane of maxillary sinus in its bottom perforation during dental interference. Rossiiskaya otorinolaringologiya. 2016;(5):29-35. (In Russ.)]. https://doi.org/10.18692/1810-4800-2016-5-29-35 Dogan M.E., Uluısık N., Yuvarlakbaş S.D. Retrospective analysis of pathological changes in the maxillary sinus with CBCT. Scientific Reports. 2024;14(1):15529. https://doi.org/10.1038/s41598-024-66527-7 Dogan M.E., Uluısık N., Yuvarlakbaş S.D. Retrospective analysis of pathological changes in the maxillary sinus with CBCT. Scientific Reports. 2024;14(1):15529. https://doi.org/10.1038/s41598-024-66527-7 Bani-Ata M., Aleshawi A., Khatatbeh A., Al-Domaidat D., Alnussair B., Al-Shawaqfeh R. et al. Accessory Maxillary Ostia: Prevalence of an Anatomical Variant and Association with Chronic Sinusitis. International Journal of General Medicine. 2020;13:163-168. https://doi.org/10.2147/IJGM.S253569 Bani-Ata M., Aleshawi A., Khatatbeh A., Al-Domaidat D., Alnussair B., Al-Shawaqfeh R. et al. Accessory Maxillary Ostia: Prevalence of an Anatomical Variant and Association with Chronic Sinusitis. International Journal of General Medicine. 2020;13:163-168. https://doi.org/10.2147/IJGM.S253569 Zhao X., Gao W., Liu F. Clinical evaluation of modified transalveolar sinus floor elevation and osteotome sinus floor elevation in posterior maxillae: study protocol for a randomized controlled trial. Trials. 2018;19(1):489. https://doi.org/10.1186/s13063-018-2879-x Zhao X., Gao W., Liu F. Clinical evaluation of modified transalveolar sinus floor elevation and osteotome sinus floor elevation in posterior maxillae: study protocol for a randomized controlled trial. Trials. 2018;19(1):489. https://doi.org/10.1186/s13063-018-2879-x Wen S.C., Lin Y.H., Yang Y.C., Wang H.L. The influence of sinus membrane thickness upon membrane perforation during transcrestal sinus lift procedure. Clinical Oral Implants Research. 2015;26(10):1158-1164. https://doi.org/10.1111/clr.12429 Wen S.C., Lin Y.H., Yang Y.C., Wang H.L. The influence of sinus membrane thickness upon membrane perforation during transcrestal sinus lift procedure. Clinical Oral Implants Research. 2015;26(10):1158-1164. https://doi.org/10.1111/clr.12429 Chen H.H., Yi C.A., Chen Y.C., Tsai C.C., Lin P.Y., Huang H.H. Influence of maxillary antrolith on the clinical outcome of implants placed simultaneously with osteotome sinus floor elevation: A retrospective radiographic study. Clinical Implant Dentistry and Related Research. 2021;23(6):833-841. https://doi.org/10.1111/cid.13043 Chen H.H., Yi C.A., Chen Y.C., Tsai C.C., Lin P.Y., Huang H.H. Influence of maxillary antrolith on the clinical outcome of implants placed simultaneously with osteotome sinus floor elevation: A retrospective radiographic study. Clinical Implant Dentistry and Related Research. 2021;23(6):833-841. https://doi.org/10.1111/cid.13043 Jiam N.T., Goldberg A.N., Murr A.H., Pletcher S.D. Surgical treatment of chronic rhinosinusitis after sinus lift. American Journal of Rhinology & Allergy. 2017;31(4):271-275. https://doi.org/10.2500/ajra.2017.31.4451 Jiam N.T., Goldberg A.N., Murr A.H., Pletcher S.D. Surgical treatment of chronic rhinosinusitis after sinus lift. American Journal of Rhinology & Allergy. 2017;31(4):271-275. https://doi.org/10.2500/ajra.2017.31.4451 Betin-Noriega C., Urbano-Del Valle S.E., Saldarriaga-Naranjo C.I., Obando-Castillo J.L., Tobón-Arroyave S.I. Analysis of risk variables for association with maxillary sinus mucosal thickenings: a cone-beam computed tomography-based retrospective study. Surgical and Radiologic Anatomy. 2023;45(4):417-429. https://doi.org/10.1007/s00276-023-03090-2 Betin-Noriega C., Urbano-Del Valle S.E., Saldarriaga-Naranjo C.I., Obando-Castillo J.L., Tobón-Arroyave S.I. Analysis of risk variables for association with maxillary sinus mucosal thickenings: a cone-beam computed tomography-based retrospective study. Surgical and Radiologic Anatomy. 2023;45(4):417-429. https://doi.org/10.1007/s00276-023-03090-2 Turfe Z., Ahmad A., Peterson E.I., Craig J.R. Odontogenic sinusitis is a common cause of unilateral sinus disease with maxillary sinus opacification. International Forum of Allergy & Rhinology. 2019;9(12):1515-1520. https://doi.org/10.1002/alr.22434 Turfe Z., Ahmad A., Peterson E.I., Craig J.R. Odontogenic sinusitis is a common cause of unilateral sinus disease with maxillary sinus opacification. International Forum of Allergy & Rhinology. 2019;9(12):1515-1520. https://doi.org/10.1002/alr.22434 Zhang H.M., Feng X.H., Lu C., Hu W.J. Effect of severe periodontitis of maxillary molars on the maxillary sinus and the treatment principles of periodontitis related maxillary sinusitis. Zhonghua kouqiang yixue zazhi = Chinese journal of stomatology. 2024;59(11):1162-1167. Article in Chinese. https://doi.org/10.3760/cma.j.cn112144-20240421-00161 Zhang H.M., Feng X.H., Lu C., Hu W.J. Effect of severe periodontitis of maxillary molars on the maxillary sinus and the treatment principles of periodontitis related maxillary sinusitis. Zhonghua kouqiang yixue zazhi = Chinese journal of stomatology. 2024;59(11):1162-1167. Article in Chinese. https://doi.org/10.3760/cma.j.cn112144-20240421-00161 Craig J.R. Odontogenic sinusitis: A state-of-the-art review. World Journal of Otorhinolaringology - Head and Neck Surgery. 2022;8(1):8-15. https://doi.org/10.1002/wjo2.9 Craig J.R. Odontogenic sinusitis: A state-of-the-art review. World Journal of Otorhinolaringology - Head and Neck Surgery. 2022;8(1):8-15. https://doi.org/10.1002/wjo2.9 Craig J.R., Tataryn R.W., Cha B.Y., Bhargava P., Pokorny A., Gray S.T. et al. Diagnosing odontogenic sinusitis of endodontic origin: A multidisciplinary literature review. American Journal of Otolaryngology. 2021;42(3):102925. https://doi.org/10.1016/j.amjoto.2021.102925 Craig J.R., Tataryn R.W., Cha B.Y., Bhargava P., Pokorny A., Gray S.T. et al. Diagnosing odontogenic sinusitis of endodontic origin: A multidisciplinary literature review. American Journal of Otolaryngology. 2021;42(3):102925. https://doi.org/10.1016/j.amjoto.2021.102925 Riekki V.P., Nevalainen M.T., Haapea M., Sipola A., Kallio-Pulkkinen S., Bode M.K. Associations between odontogenic and sinus pathologies - a low-dose CBCT study. Acta Odontologica Scandinavica. 2025;84:310-317. https://doi.org/10.2340/aos.v84.43779 Riekki V.P., Nevalainen M.T., Haapea M., Sipola A., Kallio-Pulkkinen S., Bode M.K. Associations between odontogenic and sinus pathologies - a low-dose CBCT study. Acta Odontologica Scandinavica. 2025;84:310-317. https://doi.org/10.2340/aos.v84.43779 Zhang L., Zhou C., Jiang J., Chen X., Wang Y., Xu A. et al. Clinical outcomes and risk factors analysis of dental implants inserted with lateral maxillary sinus floor augmentation: A 3- to 8-year retrospective study. Journal of Clinical Periodontology. 2024;51(5):652-664. https://doi.org/10.1111/jcpe.13947 Zhang L., Zhou C., Jiang J., Chen X., Wang Y., Xu A. et al. Clinical outcomes and risk factors analysis of dental implants inserted with lateral maxillary sinus floor augmentation: A 3- to 8-year retrospective study. Journal of Clinical Periodontology. 2024;51(5):652-664. https://doi.org/10.1111/jcpe.13947 Лосев Ф.Ф., Троицкий С.С., Брайловская Т.В. Осложнения при операции синус-лифтинга с одномоментной дентальной имплантацией. Российский вестник дентальной имплантологии. 2024;(1):53-61. [Losev F.F., Troitsky S.S., Brailovskaya T.V. Complications of sinus lifting surgery with simultaneous dental implantation. Rossijskij vestnik dental'noj implantologii. 2024;(1):53-61. (In Russ.)]. Losev F.F., Troickiy S.S., Braylovskaya T.V. Oslozhneniya pri operacii sinus-liftinga s odnomomentnoy dental'noy implantaciey. Rossiyskiy vestnik dental'noy implantologii. 2024;(1):53-61. [Losev F.F., Troitsky S.S., Brailovskaya T.V. Complications of sinus lifting surgery with simultaneous dental implantation. Rossijskij vestnik dental'noj implantologii. 2024;(1):53-61. (In Russ.)].