Fungus Ball of the Maxillary Sinus-Modern Treatment by Osteoplastic Approach and Functional Endoscopic Sinus Surgery

Andreas Naros; Jens Peter Peters; Thorsten Biegner; Hannes Weise; Michael Krimmel; Siegmar Reinert

doi:10.1016/j.joms.2018.10.010

Fungus Ball of the Maxillary Sinus-Modern Treatment by Osteoplastic Approach and Functional Endoscopic Sinus Surgery

J Oral Maxillofac Surg. 2019 Mar;77(3):546-554. doi: 10.1016/j.joms.2018.10.010. Epub 2018 Oct 24.

Authors

Andreas Naros¹, Jens Peter Peters², Thorsten Biegner³, Hannes Weise², Michael Krimmel⁴, Siegmar Reinert⁵

Affiliations

¹ Resident, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany. Electronic address: andreas.naros@med.uni-tuebingen.de.
² Medical Specialist, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany.
³ Resident, Institute of Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany.
⁴ Vice Chairman, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany.
⁵ Department Head, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany.

PMID: 30448431
DOI: 10.1016/j.joms.2018.10.010

Abstract

Purpose: Functional endoscopic sinus surgery (FESS) is considered standard surgical therapy for fungus ball of the maxillary sinus. However, recent findings have indicated an odontogenic etiology, which requires simultaneous treatment of the dental origin. This study presents the authors' treatment results of fungus ball of the maxillary sinus using a combination of FESS and an endoscopically assisted osteoplastic approach through the anterior wall of the maxillary sinus, enabling simultaneous treatment of the dental origin.

Materials and methods: A cohort of 22 patients with histopathologically confirmed fungus ball of the maxillary sinus was retrospectively analyzed. Clinical records and medical imaging data were reviewed to evaluate the etiology, clinical and radiologic findings, and postoperative outcome.

Results: Only 15 patients presented nonspecific clinical symptoms compatible with chronic unilateral maxillary sinusitis. Computed tomography visualized complete opacity of the maxillary sinus in 11 patients and intralesional hyperdensity in 12 patients. An odontogenic association was verified in 18 patients. Twenty-one patients underwent endoscopically assisted osteoplastic surgery through the anterior maxillary sinus wall. In 12 cases, the assumed persistent odontogenic source was treated simultaneously. Depending on the patency of the ostiomeatal complex, the accompanying chronic sinusitis was treated by FESS.

Conclusions: The present data support the assumption of an odontogenic etiology of fungus ball of the maxillary sinus. Hence, surgical management requires simultaneous treatment of the fungal mass, the odontogenic origin of the disease, and the accompanying chronic sinusitis. To properly treat fungus ball, the authors present a modern treatment concept, using a minimally invasive endoscopically assisted osteoplastic approach through the anterior maxillary wall, for sufficient and necessary surgical treatment.

MeSH terms

Endoscopy
Humans
Maxillary Sinus*
Maxillary Sinusitis*
Retrospective Studies