Fungal Infections of the Maxillary Sinus: Case Reports

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Aspergillosis of the paranasal sinuses is uncommon ; however, its incidence in recent years has shown a marked increase. The non-invasive form is by far the most prevalent. Three cases of maxillary sinus aspergillosis were retrieved from the archives of the Department of Oral Pathology, Nihon University School of Dentistry at Matsudo, Japan, from 2002 to 2008, and they were clinically and histopathologically reviewed and studied. The specimens were stained with hematoxylin and eosin (HE) and special stains, such as Grocott methenamine silver-nitrate (Grocott) and periodic acid Schiff (PAS) to identify Aspergillus species. Three previous cases of fungal infection of the maxillary sinus reported from 1985 to 1993 were also reviewed. The details of the present cases (cases 4, 5, and 6) are presented. Case 4 : A 24-year-old man with maxillary sinusitis of unknown etiology had left sinus swelling with no acute symptoms. CT revealed complete opacification of the left maxillary sinus with numerous high density particles. On MRI, the mass lesion was shown to have high signal intensity on T2-weighted images and no signal intensity on T1-weighted images as a result of the granulation of the fungal disease. Case 5 : A 30-year-old man had a palatal root of his upper left first molar that extended into the maxillary sinus. CT revealed opacification of the left maxillary sinus. The inner part of the lesion also showed high density particles and mucosal hypertrophy of the sinus wall and nasal membrane. The radiographic findings of Cases 4 and 5 were compatible with aspergillosis associated with calcification. Case 6 : A 70-year-old man with serous discharge from the nasal cavity had a maxillary bony fracture due to a previous automobile accident that was treated with plate fixation. An intra-oral fistula on the buccal side of his upper right first molar was noticed from which pus was discharging. CT and panoramic radiography revealed opacity of the maxillary sinus. CT also revealed maxillary bony resorption on the right side surrounding the plate extending to the nasal cavity, which caused the plate to be exposed in the frontal wall of the nasal cavity. Our 3 previous reported cases were caused by dental procedures and were related to their respective upper first molar ; the 1st and 2nd cases had a root tip that remained in the sinus, while the 3rd case had a perforated sinus after tooth extraction. MRI and CT confirmed fungus infection of the maxillary sinus. Surgical treatment of the sinus revealed the presence of paranasal fungus balls. The typical characteristic branching hyphae of Aspergillus were seen on histopathological examination with the special stains. Although fungal infections of the paranasal sinuses caused by Aspergillus are found uncommonly in our hospital, the significance of its presentation clinically, histopathologically, and on special staining is important to consider, especially since such cases are rare.
日本大学松戸歯学部口腔科学研究所の論文

Fungal Infections of the Maxillary Sinus: Case Reports

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