Maxillary sinusitis and respiratory health in medieval Tuscany

Chronic maxillary sinusitis is recognized as new bone formation indicating long-term inflammation of the soft tissues of the sinuses whose origin can be either odontogenic or environmental (e.g. due to poor air quality, indoor conditions and allergies). Bone modifi- cations within the sinuses related to chronic inflamma- tory process are rarely attested in human skeletal re- mains owing to their incidental discovery, mostly when post-mortem breakages occur allowing to observe the internal pneumatic cavities. As part of a preliminary study, a total of 113 individu- als coming from the Medieval rural cemetery of Pieve di Pava (10th-12th centuries AD) situated in Tuscany (central Italy) were examined to investigate the ori- gin of maxillary sinusitis. Both maxillary sinuses were available for examination in 110 individuals and only one sinus in 3 individuals. Eight males and 12 females were affected by maxillary sinusitis (17.7%, N = 113). Osseous alterations, represented by spicules, plaque- like formation and lobules, were bilaterally present in 25% of the male subsample (n = 8) and in 75% of the female subsample (n = 12) with statistically significant difference. Statistical difference was also assessed when compared the frequency of teeth and/or alveo- li affected by dentoalveolar diseases between sexes, with males greater influenced than females. In order to investigate the odontogenic role in the onset of chron- ic inflammation, co-occurrence of maxillary sinusitis and dentoalveolar diseases in the same sinus was ob- served in more than half of the individuals affected (11 out 20) with no statistical difference between sexes. It can be presumed that absence of statistically sex-re- lated difference is likely due sample size effect; in this respect, future enlargement of the osteological sam- ple might potentially help in clarifying the contribution of dentoalveolar diseases in the expression of maxillary sinusitis.