Non-Odontogenic Toothache Caused by the Fungal Ball of Maxillary Sinus: Case Reports

Introduction: When a dental element is lost in the posterior region of the maxilla, there is natural reabsorption of the alveolar process and at the same time there will be pneumatization of the maxillary sinus. It will increase its volume towards the place where the roots existed and this will often make it difficult or impossible to restore implants in place. For this reason, the procedure for elevating the floor of the maxillary sinus or short implants should be performed when possible. In this context, allogeneic, xenogenous, and alloplastic bone grafts are an alternative for the treatment of bone defects in the jaws, since they avoid the need for a second surgical access. However, due to the need for processing to eliminate antigenic components, these grafts are only osteoconductive with a lower bone formation potential compared to autogenous bone grafts. Also, in this context, in the last 20 years, platelet concentrates have been proposed as regenerative materials in tissue regeneration procedures. Among the platelet concentrates proposed in the literature, PRP and FRP are found to act as autogenous platelet aggregates with osteoinductive properties. Objective: The present study aimed to conduct a wide literature review on maxillary sinus surgery using fibrin-rich plasma. Methods: Experimental and clinical studies (case reports, retrospective, prospective and randomized) with qualitative and/or quantitative analysis were included. Results: The total of 48 articles were found involving Maxillary sinus surgery, Fibrin-rich plasma, and Biomaterials, of which 22 were selected to compose the present study. Conclusion: Based on the literary findings, it was shown that the FRP is favorable for bone formation processes for dental implants, especially when combined with xenografts.

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Comparison of the Frequency of Detection of Some Radiological Signs in Chronic Maxillary Sinusіtis of Fungal and Non-Fungal Origin

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs05.06.202 ◽

2020 ◽

Vol 5 (6) ◽

pp. 202-207

Author(s):

Ya. V. Shkorbotun ◽

◽

Keyword(s):

Computed Tomography ◽

Maxillary Sinus ◽

Chronic Rhinosinusitis ◽

Chronic Sinusitis ◽

Maxillary Sinusitis ◽

Biologically Active ◽

Differential Diagnostics ◽

Diagnostic Significance ◽

Fungal Ball ◽

The One

The one of the most informative method of preoperative diagnosis of fungal paranasal sinuses is computed tomography. The radiological marker that allows to identify chronic sinusitis of fungal origin is an eclipse with hyperintensive inclusions. The sensitivity of this criterion for fungal ball is about 80%. In addition, a sign of recalcitrant chronic sinusitis is the presence of reactive changes in the bone wall of the sinus – "osteitis". The purpose of the work was to study the frequency of radiological signs of osteitis and areas of increased radiological density in the maxillary sinuses of the patients with chronic sinusitis of fungal and non-fungal etiology, to clarify the diagnostic significance of these symptoms in the differential diagnostics. Material and methods. The results of a retrospective study of computer tomography data of 60 people with chronic rhinosinusitis (intraoperative was verified fungal ball in the maxillary sinus space of 30 patients, other 30 patient had no signs of fungal etiology). Results and discussion. In patients with chronic rhinosinusitis of non-fungal nature, hyperintensive inclusions in the sinus were found in 13.3%, and signs of osteitis were detected in 36.7%, which was significantly less common than in patients with fungal processes, 83.3% and 80,0% respectively (p <0,05). The presence of both of the radiological symptoms was observed in 63.3% of patients from the group of chronic rhinosinusitis in the presence of a fungal body in the space of the sinus and in 6.7% of cases the chronic rhinosinusitis of non-fungal etiology. The severity of osteitis according to KOS, in patients with a fungal body in the sinus was 0.71 ± 0.15 points, and 0.55 ± 0.2 points in patients without a fungus. The pathogenesis of osteitis in the cases of sinusitis with fungal origin is a violation of bone trophism, which develops due to periostitis after the influence of biologically active substances secreted by the fungus. The increase of radiation density in areas of osteitis indicates the predominance of osteogenesis over osteolysis in the inflammatory focus of the bone wall of the maxillary sinus. Conclusion. The frequency of detecting radiological signs of osteitis in patients with chronic rhinosinusitis of the maxillary sinus with fungal bodies was 80%, that was comparable to the frequency of detecting hyperintense inclusions in the lumen of the sinus in these patients (83.3%), and was significantly more than in patients with chronic sinusitis nonfungal etiology. The presence of radiological signs of osteitis of the bone wall of the maxillary sinus in computed tomography should be regarded as an additional symptom in the differential diagnosis of maxillary sinusitis of fungal origin

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Maxillary sinus fungal ball due to aspergillus managed at a peripheral centre

Journal of Marine Medical Society ◽

10.4103/0975-3605.203703 ◽

2015 ◽

Vol 17 (2) ◽

pp. 141

Author(s):

Vishal Gaurav ◽

Natasha ◽

Prasant Panda ◽

Dilip Raghavan

Keyword(s):

Maxillary Sinus ◽

Fungal Ball

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Renal fungal ball—two case reports and review of literature

BJR|case reports ◽

10.1259/bjrcr.20150247 ◽

2016 ◽

Vol 2 (3) ◽

pp. 20150247 ◽

Cited By ~ 1

Author(s):

Devimeenal Jegannathan ◽

Kanagasabai Ramanathan

Keyword(s):

Case Reports ◽

Review Of Literature ◽

Fungal Ball

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Hemangioma and malignant hemangioendothelioma of the maxillary sinus: Case reports and clinical consideration

Journal of Oral and Maxillofacial Surgery ◽

10.1016/0278-2391(90)90350-b ◽

1990 ◽

Vol 48 (8) ◽

pp. 877-881 ◽

Cited By ~ 12

Author(s):

Tadashi Yasuoka ◽

Yasuaki Okumura ◽

Takashi Okuda ◽

Nobumitsu Oka

Keyword(s):

Maxillary Sinus ◽

Case Reports ◽

Clinical Consideration

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Disease Management in the Fungal Body of the Maxillary Sinus in People with Planned Dental Implantation

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.03.206 ◽

2021 ◽

Vol 6 (3) ◽

pp. 206-211

Author(s):

Ya. V. Shkorbotun ◽

◽

Keyword(s):

Maxillary Sinus ◽

Complete Removal ◽

Sinus Surgery ◽

Endoscopic Endonasal ◽

Main Method ◽

Maxillary Bone ◽

Fungal Ball ◽

Dental Implantation ◽

Group 2 ◽

Maxillary Sinuses

The fungal ball is the most common clinical form of fungal etiology sinusitis. The main method of treatment of patients with this pathology is surgery. Achieving complete removal of the fungal body is important, especially in patients who will have planned dental implantation. Among the accesses to the maxillary sinus in cases of the fungal body of the sinus, the most common one is through the middle meatus, but it does not provide visual control of the anterior parts of the sinus during the intervention. The use of modified infraturbinal access provides better opportunities for examination of the anterior parts of the maxillary sinus. The purpose of the study is to increase the effectiveness of surgical treatment of patients with fungal bodies of the maxillary sinus by optimizing access during endoscopic endonasal intervention. Materials and methods. The data of 113 patients with fungal ball of maxillary sinuses who underwent sinusotomy in preparation for dental implantation were analyzed. Cone beam computed tomography of paranasal sinuses of patients were performed twice – before functional endoscopic sinus surgery and before subantral augmentation of the maxillary bone. Group 1 included 78 patients to whom the fungal balls were removed from the sinus through the middle nasal meatus, group 2 – 35 patients to whom, in cases when it was impossible to visually confirm the completeness of removal of the fungal ball from the anterior area of the sinus, an additional infraturbinal approach was performed in our modification. Results and discussion. According to tomography before rhinosurgery it was established that "blackout" of more than 60% of the sinus space is observed in 50.5% of patients with fungal bodies, with the vast majority of patients (88.1%) fungal bodies in the maxillary sinus are located in its lower parts and spread forward from the nasolacrimal canal level. During sinus rehabilitation, the need for additional infraturbinal access arose in 5 (14.3%) patients of the second group. As a result of its performance in all 5 operated patients polyposis-altered tissues were found in "blind zones" and in 2 (5.7%) – there were also remains of a fungal body. Residual fungal bodies in the maxillary sinus were detected in 3 (3.9% CI 95% – 0.01; 11.6) patients of the first group, and were not observed in the second group. All cases of residual fungal masses in the sinus were not accompanied by specific complaints. A revision of sinusitis with fungal masses removing was performed on 3 patients due to the appearance of residual fungal bodies by preformed antrostomy with local anesthesia. Conclusion. Anthrostomy using additional endoscopic infraturbinal access when removing the fungal body from the lower anterior maxillary sinus is the optimal combined access that allows maximum visualization of the maxillary sinus and avoid recurrence of the disease

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