Download PDF
Int Arch Otorhinolaryngol 2012; 16(02): 286-290
DOI: 10.7162/S1809-97772012000200020
Case Report
Thieme Publicações Ltda Rio de Janeiro, Brazil

Fungus ball of the paranasal sinuses: Report of two cases and literature review

Bola fúngica dos seios paranasais: Relato de dois casos e revisão de literatura
Guilherme Rasia Bosi
1   Academic of Medicine of the University of Caxias do Sul.
,
Gustavo Lisbôa de Braga
1   Academic of Medicine of the University of Caxias do Sul.
,
Tobias Skrebsky de Almeida
1   Academic of Medicine of the University of Caxias do Sul.
,
Adriana de Carli
2   Master in Biotechnology for the University of Caxias do Sul. Otorhinolaryngologist doctor. Titular teacher of the Unit of Medical Education Otorhinolaryngologist-Ophthalmic of the University of Caxias do Sul.
› Author Affiliations
Further Information

Publication History

19 April 2010

18 July 2010

Publication Date:
05 December 2013 (online)

   Permissions and Reprints

Summary

Introduction: Fungal ball of the sinuses is a not invasive infection that if characterizes for its chronicity, being the majority related with previous endodontic treatment. Affect mainly the breasts to maxillary; even so all the breasts can be involved. The main etiological agent is the Aspergillus spp. The computed tomography, had to characteristic the radiological presentations, suggests the diagnosis that is carried through definitively through histopathological analyses. The treatment standard-gold is the sinus surgery with average meatal antrostomy.

Objective: Reporting two cases of fungal ball of the sinuses and to stand out important aspects of this pathology.

Story of the Cases: Case 1) Patient of the feminine sex, 78 years old, presented itself with complaints of face pain has 6 months and previous history of endodontic treatment. To the physical examination it was evidenced purulent secretion presence in left average meatus. Ray X presented complete veiling of the breasts to maxillary left, while the computed tomography showed injury calcified in this place. Sinusotomy was become fulfilled that evolved well. Case 2) Patient of the feminine sex, 70 years old, looked attendance for history of sinusitis of repetition. To the physical examination no particularity was not perceived. The computed tomography, as well as the magnetic resonance, detected thickening of the mucous wall of the breasts to maxillary left, beyond a calcified mass. It was become fulfilled same sequence of treatment and the patient also evolved well.

Final Considerations: The fungal infection must be considered in the patients who if present with chronic sinusitis, that they do not answer to the antibiotic use and that they possess history of endodontic manipulation.

Resumo

Introdução: Bola fúngica dos seios paranasais é uma infecção não invasiva que se caracteriza por sua cronicidade, sendo a maioria relacionada com tratamento endodôntico prévio. Acomete principalmente o seio maxilar, embora todos os seios possam ser envolvidos. O principal agente etiológico é o Aspergillus spp. A tomografia computadorizada, devido às apresentações radiológicas características, sugere o diagnóstico que é realizado definitivamente através de análises histopatológicas. O tratamento padrão-ouro é a cirurgia sinusal endoscópica com antrostomia meatal média.

Objetivo: Relatar dois casos de bola fúngica dos seios paranasais e ressaltar aspectos importantes desta patologia.

Relato dos Casos: Caso 1) Paciente do sexo feminino, 78 anos, apresentou-se com queixas de dor facial há 6 meses e história prévia de tratamento endodôntico. Ao exame físico constatou-se a presença de secreção purulenta em meato médio esquerdo. O Raio X apresentou velamento completo do seio maxilar esquerdo, enquanto a tomografia computadorizada mostrou lesão calcificada neste local. Realizou-se sinusotomia que evoluiu bem. Caso 2) Paciente do sexo feminino, 70 anos, procurou atendimento por história de sinusites de repetição. Ao exame físico não se percebeu nenhuma particularidade. A tomografia computadorizada, assim como a ressonância magnética, detectou espessamento da parede mucosa do seio maxilar esquerdo, além de uma massa calcificada. Realizou-se a mesma sequência de tratamento e a paciente também evoluiu bem.

Considerações finais: A infecção fúngica deve ser considerada nos pacientes que se apresentam com sinusite crônica, que não respondem ao uso de antibióticos e que possuem história de manipulação endodôntica.

Keywords

mycetoma - sinusitis - maxillary sinusitis - sinuses - aspergillus. droaereo and presence of hypo intense of left maxillary sinus

Palavras-chave

micetoma - sinusite - sinusite maxilar - seios paranasais - aspergillus
 

  • Bibliographical References

  • 1 Infectious rhinosinusitis in adults: classification, etiology and management. International Rhinosinusitis Advisory Board. Ear Nose Throat J 1997; 76 (12 Suppl): 1-22
    Google Scholar
  • 2 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Diretrizes Brasileiras de Rinossinusites (suplemento). Br J Otorhinolaryngol 2008; 74 (2)
    Google Scholar
  • 3 Nicolai P, Lombardi D, Tomenzoli D, Villaret AB, Piccioni M, Mensi M , et al. Fungus ball of the paranasal sinuses: experience in 160 patients treated with endoscopic surgery. Laryngoscope 2009; 119 (11) 2275-9
    CrossrefGoogle Scholar
  • 4 Taxy JB. Paranasal fungal sinusitis: contributions of histopathology to diagnosis: a report of 60 cases and literature review. Am J Surg Pathol 2006; 30 (6) 713-20
    CrossrefGoogle Scholar
  • 5 Ferguson BJ. Definitions of fungal rhinosinusitis. Otolaryngol Clin North Am 2000; 33 (2) 227-35
    CrossrefGoogle Scholar
  • 6 Grosjean P, Weber R. Fungus balls of the paranasal sinuses: a review. Eur Arch Otorhinolaryngol 2007; 264 (5) 461-70
    CrossrefGoogle Scholar
  • 7 Robey AB, OBrien EK, Richardson BE, Baker JJ, Poage DP, Leopold DA. The changing face of paranasal sinus fungus balls. Ann Otol Rhinol Laryngol 2009; 118 (7) 500-5
    Google Scholar
  • 8 Ferguson BJ. Fungus balls of the paranasal sinuses. Otolaryngol Clin North Am 2000; 33 (2) 389-98
    CrossrefGoogle Scholar
  • 9 Mensi M, Piccioni M, Marsili F, Nicolai P, Sapelli PL, Latronico N. Risk of maxillary fungus ball in patients with endodontic treatment on maxillary teeth: a case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103 (3) 433-6
    Google Scholar
  • 10 Stevens MH. Primary fungal infections of the paranasal sinuses. Am J Otolaryngol 1981; 2 (4) 348-57
    CrossrefGoogle Scholar
  • 11 Stammberger H, Jakse R, Beaufort F. Aspergillosis of the paranasal sinuses x-ray diagnosis, histopathology, and clinical aspects. Ann Otol Rhinol Laryngol 1984; 93 (3 Pt 1): 251-6
    Google Scholar
  • 12 Klossek JM, Serrano E, Peloquin L, Percodani J, Fontanel JP, Pessey JJ. Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses. Laryngoscope 1997; 107 (1) 112-7
    CrossrefGoogle Scholar
  • 13 deShazo RD, OBrien M, Chapin K, Soto-Aguilar M, Swain R, Lyons M , et al. Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol 1997; 99 (4) 475-85
    CrossrefGoogle Scholar
  • 14 Costa F, Polini F, Zerman N, Robiony M, Toro C, Politi M. Surgical treatment of Aspergillus mycetomas of the maxillary sinus: review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103 (6) e23-9
    Google Scholar
  • 15 Chobillon MA, Jankowski R. What are the advantages of the endoscopic canine fossa approach in treating maxillary sinus aspergillomas?. Rhinology 2004; 42 (4) 230-5
    Google Scholar