Chobillon Marcos Alejandro Jiménez, Jankowski Roger
Otolaryngology and Head & Neck Surgery Department, Central Hospital, Nancy, France.
Rhinology. 2004 Dec;42(4):230-5.
Aspergilloma of the maxillary sinus is a non-invasive mycotic infection of the immunocompetent host. Nowadays its treatment remains surgical removal, and endoscopic endonasal middle meatus antrostomy is retained as the most popular approach. In our experience, a complementary endoscopic canine fossa approach is often needed to achieve a complete resection of the fungus ball. This fact led us to ask ourselves if an isolated endoscopic canine fossa approach had any advantages over the endonasal middle meatus antrostomy. In this paper we retrospectively analyse the results of the surgical treatment of 31 patients presenting maxillary sinus aspergillomas. These patients were all operated between January 1997 and January 2003 in our Otolaryngology Department. They were divided in three groups. Group A included 10 patients operated through an endonasal middle meatotomy only, group B included 9 patients who were operated through a combined approach (endonasal middle meatus antrostomy and endoscopic canine fossa approach), and group C included 12 patients who were operated through an endoscopic canine fossa approach alone. No recurrences were noted in any group, but in group B three patients presented mild complications like persistent purulent discharge through the meatotomy and nasal crusting. The endoscopic canine fossa approach offers several advantages over other techniques. These include an optimal visualization of all maxillary sinus walls and recesses, the possibility of performing the procedure under local anaesthesia and on an outpatient basis, the preservation of the anatomy and physiology of the natural maxillary ostium and an easy removal of the eventual foreign bodies of dental origin in the sinusal cavity that could favourite the development of an aspergilloma.
上颌窦曲霉菌球是免疫功能正常宿主的一种非侵袭性真菌感染。如今其治疗仍以手术切除为主，鼻内镜下中鼻道上颌窦造口术仍是最常用的方法。根据我们的经验，通常需要辅助采用鼻内镜下犬齿窝入路才能完整切除真菌球。这一情况促使我们思考单纯的鼻内镜下犬齿窝入路相较于鼻内中鼻道上颌窦造口术是否具有优势。在本文中，我们回顾性分析了31例上颌窦曲霉菌球患者的手术治疗结果。这些患者均于1997年1月至2003年1月在我们的耳鼻喉科接受手术。他们被分为三组。A组包括10例仅通过鼻内中鼻道切开术进行手术的患者，B组包括9例通过联合入路（鼻内中鼻道上颌窦造口术和鼻内镜下犬齿窝入路）进行手术的患者，C组包括12例仅通过鼻内镜下犬齿窝入路进行手术的患者。所有组均未发现复发情况，但B组有3例患者出现了轻度并发症，如中鼻道持续脓性分泌物和鼻痂形成。鼻内镜下犬齿窝入路相较于其他技术具有若干优势。这些优势包括对上颌窦所有壁和隐窝的最佳可视化、在局部麻醉下和门诊基础上进行手术的可能性、对上颌窦自然开口解剖结构和生理功能的保留，以及易于清除窦腔内可能促进曲霉菌球形成的任何牙源性异物。
