Fungus ball of the maxillary sinus - modern treatment by osteoplastic approach and functional endoscopic sinus surgery

Publication date: Available online 24 October 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Andreas Naros, Jens Peter Peters, Thorsten Biegner, Hannes Weise, Michael Krimmel, Siegmar Reinert

ABSTRACT

Purpose

Functional endoscopic sinus surgery (FESS) is considered the 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 our treatment results of fungus ball of the maxillary sinus using a combination of FESS and an endoscopically assisted osteoplastic approach via the anterior wall of the maxillary sinus, enabling the simultaneous treatment of the dental origin.

Materials and Methods

We retrospectively analyzed a cohort of 22 patients with histopathologically confirmed fungus ball of the maxillary sinus. We reviewed clinical records and medical imaging data 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 scans revealed complete opacity of the maxillary sinus in 11 patients and intralesional hyperdensities in 12 patients. An odontogenic association was verified in 18 patients. 21 patients underwent endoscopically assisted osteoplastic surgery via 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 accompanied 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. Facing the needs of proper treatment of fungus ball, we demonstrate a modern treatment concept, recommending a minimally invasive endoscopically assisted osteoplastic approach via the anterior maxillary wall as a sufficient and necessary surgical approach in treatment.

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