Author(s)
Edward Mo, DDS 1
Yongjin Yoon, DDS 1
Peter Giannaris, BS 3
Zachary Pek, MD 2
Mark Chaskes, MD
Aron Pollack, MD 3
Judd Fastenberg, MD 3
Andrew Salama, DDS, MD 1
Laurent Ganry, MD 1
Brett A. Miles, DDS, MD 3
David Hirsch, DDS, MD 1
Hunter Martin, DDS, MD 1
Charles C. L. Tong MD 3 ?
Affiliation(s)
Northwell Health;
Abstract:
Objectives:
ODS is a distinct form of rhinosinusitis that requires multidisciplinary treatment from oral surgeons and Otolaryngologists. The purpose of this study is to describe the microorganisms identified in cultures and propose optimal antibiotic coverage.
Study Design:
This is a retrospective cohort study of patients with ODS who presented to a large multi-center health system.
Methods:
Patient demographics, microbiology of the sinus aspirate, antibiotic prescribed are reported.
Results:
A total of 71 patients underwent surgery with OMFS and ENT from 2022 to 2024 were included. Preliminary analysis found that patients most often had ODS in the setting of infected implant, retained root tip, osteomyelitis, bisphosphonate-related osteonecrosis, or post extraction with persistent oroantral fistula (OAC). 14% of patients had surgery with OMFS only, 17% of patients with ENT only, and 69% had concurrent surgery. Patients were treated with debridement of the maxilla, ESS, and a buccal fat pad graft for wound closure. Intraop cultures identified polymicrobial infections in 89% of the patients. Gram-positive, gram-negative and anaerobic organisms were all represented in the cohort. Amoxicillin, azithromycin, and clindamycin were most commonly prescribed by dental providers prior to referral. Augmentin was the most common antibiotic of choice for discharge (96%).
Conclusions:
Based on the identified organisms, our Infectious Disease department has recommended Amoxicillin with Clavulanic acid to be the most appropriate outpatient antibiotic treatment, with Cefpodoxime plus Metronidazole reserved for patients with penicillin allergy.