Kaczmarek I, Bilska J, Osmola K, Nowaczyk M T
Oddział Kliniczny Chirurgii Szczekowo-Twarzowej w Poznaniu.
Otolaryngol Pol. 2010 Jun;64(7):36-9. doi: 10.1016/S0030-6657(10)70007-X.
Mycotic infection of paranasal sinus could be the etiological factor of chronic sinusitis. The increase in number of fungal sinusitis cases have been reported recently among nonimmunocompromised patient after endodontic treatment of maxillary teeth. Nonspecific clinical signs and incorrect radiologic pictures interpretation as well as loss of therapeutic standards seems to be the cause of false negative diagnosis and difficulties in treatment of fungal sinusitis.
Clinical and radiological picture of maxillary sinus aspergillosis was described in this paper.
In the period of 2006-2009 in the Department of Maxillo-Facial Surgery 19 patient with fungal maxillary sinusitis was treated. The endodontic treatment of maxillary teeth of the related side was performed previously in 80% examined cases. In 2 cases there were immunocompromised patients with immunosuppressive treatment. In 16 cases patients were referred to our Department due to metallic foreign body of the maxillary sinus. Routine diagnostic radiological imaging was performed in each case: paranasal sinus view--Water's view and panoramic radiograph (orthopantomograph). In 4 cases imaging was extended with computer tomography (CT) visualization. The surgical treatment was performed in each case. The final diagnosis was puted on histopathological examination and fungal culture.
In 16 cases of analysed group histopathological examination and fungal culture revealed aspergilosis. In 2 cases fungal culture was negative, but histopathology slices confirm presence of hyphae of Aspergillus. In 1 case the root canal sealer was found in the maxillary sinus. In none case invasive form of aspergillosis was confirmed. In all cases Water's view of paranasal sinuses and ortopantomograph showed partially or totally clouded sinus with well-defined, single or multifocal radiopaque object similar to metallic foreign body. Characteristic finding in CT imaging was well-defined radiodence concretions that have been attributed to calcium deposits in inflammatory changed mucosa, that might suggest "foreign body" picture. In 1 to 3 years follow-up control there was a recurrence of symptoms in one case.
Foreign body of maxillary sinus have to be differentiated with aspergilosis. Metallic "foreign body" view in maxillary sinus seems to be characteristic sign of aspergillosis. The most often form of maxillary sinus aspergilosis is aspergilloma.
鼻窦真菌感染可能是慢性鼻窦炎的病因。近期有报道称，在上颌牙齿进行牙髓治疗后，非免疫功能低下患者中真菌性鼻窦炎病例有所增加。非特异性临床症状、放射影像解读错误以及治疗标准缺失似乎是真菌性鼻窦炎假阴性诊断和治疗困难的原因。
本文描述了上颌窦曲霉菌病的临床和放射影像学表现。
2006年至2009年期间，颌面外科治疗了19例真菌性上颌窦炎患者。80%的受检病例此前已对患侧上颌牙齿进行了牙髓治疗。2例为接受免疫抑制治疗的免疫功能低下患者。16例患者因上颌窦金属异物转诊至我科。每例均进行了常规诊断性放射影像学检查：鼻窦视图——华氏位片和全景X线片（曲面断层片）。4例患者的影像检查增加了计算机断层扫描（CT）可视化。每例均进行了手术治疗。最终诊断基于组织病理学检查和真菌培养。
分析组中16例组织病理学检查和真菌培养显示为曲霉菌病。2例真菌培养为阴性，但组织病理学切片证实存在曲霉菌菌丝。1例在上颌窦中发现了根管封闭剂。未确诊侵袭性曲霉菌病病例。所有病例的鼻窦华氏位片和曲面断层片均显示鼻窦部分或完全模糊，伴有边界清晰的单个或多灶性不透射线物体，类似于金属异物。CT影像的特征性表现是边界清晰的致密结石，归因于炎症改变黏膜中的钙沉积，可能提示“异物”影像。在1至3年的随访对照中，1例患者出现症状复发。
上颌窦异物必须与曲霉菌病相鉴别。上颌窦内的金属“异物”影像似乎是曲霉菌病的特征性表现。上颌窦曲霉菌病最常见的形式是曲菌球。
