Department of Otolaryngology, Head and Neck Surgery, Cathay General Hospital, 280 Sec. 4 Jen-Ai Road, Taipei, Taiwan.
J Formos Med Assoc. 2010 Oct;109(10):709-15. doi: 10.1016/S0929-6646(10)60115-5.
BACKGROUND/PURPOSE: Unilateral maxillary sinus opacity can be caused by many diseases, but an exact diagnosis is difficult to make. The aim of this study was to describe the pathological conditions and clinical features of patients with unilateral maxillary sinus opacity.
From 2004 to 2008, 830 consecutive patients underwent sinus surgery or endonasal endoscopic biopsy at an academic tertiary care center. The preoperative computed tomography (CT) images for these patients were reviewed, and 11 6 patients were identified with complete unilateral maxillary sinus opacification. We then analyzed presenting symptoms, physical examinations, specific CT findings, and pathology.
The most frequent diagnoses were as follows: chronic rhinosinusitis (52.6%), fungus ball (29.3%), antrochoanal polyp (2.6%), benign tumor (10.4%), and malignancy (5.1%). Fungus ball was the most common diagnosis (10/18, 55.6%) in the subgroup of patients with isolated maxillary sinus opacity without disease in the other sinuses. Nasal discharge and foul-smelling breath were more common in inflammatory disease than in neoplastic disease. Neoplastic disease was more likely to present as epistaxis; a polyp or mass revealed by nasal endoscopy; mass effect in the cheek, palate, or gingiva; and bony erosion on CT. Erosion of the maxillary posterolateral wall and extra-sinus extension suggested malignancy.
Although unilateral maxillary sinus opacity is usually inflammatory in origin, fungal sinusitis and neoplastic disorder are also likely. A careful history-taking, a thorough head and neck examination including nasal endoscopy, and CT evaluation are all imperative for reaching a correct diagnosis.
背景/目的：单侧上颌窦混浊可由多种疾病引起，但准确诊断较为困难。本研究旨在描述单侧上颌窦混浊患者的病理状况和临床特征。
2004 年至 2008 年，在一家学术性三级护理中心，连续 830 例患者接受了鼻窦手术或经鼻内镜活检。回顾这些患者的术前计算机断层扫描（CT）图像，发现 116 例患者存在完全单侧上颌窦混浊。然后我们分析了患者的主要症状、体格检查、特定 CT 表现和病理学。
最常见的诊断如下：慢性鼻-鼻窦炎（52.6%）、真菌球（29.3%）、上颌窦-后鼻孔息肉（2.6%）、良性肿瘤（10.4%）和恶性肿瘤（5.1%）。真菌球是孤立性上颌窦混浊且其他窦无病变患者亚组中最常见的诊断（10/18，55.6%）。在炎症性疾病中，鼻分泌物和恶臭呼吸比在肿瘤性疾病中更为常见。肿瘤性疾病更可能表现为鼻出血；鼻内镜检查发现息肉或肿块；面颊、 palate 或牙龈的肿块效应；以及 CT 上的骨侵蚀。上颌窦后外侧壁的侵蚀和窦外扩展提示恶性肿瘤。
尽管单侧上颌窦混浊通常是炎症性的，但也可能是真菌性鼻窦炎和肿瘤性疾病。仔细询问病史、包括鼻内镜检查在内的全面头颈部检查以及 CT 评估对于做出正确诊断至关重要。
