Department of Otorhinolaryngology-Head and Neck Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea; Department of Medicine, Graduate school, Kyung Hee University, Seoul, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea.
Rhinology. 2022 Oct 1;60(5):377-383. doi: 10.4193/Rhin22.175.
The pathogenesis of maxillary sinus fungal ball (MSFB) is explained by aerogenic and odontogenic factors. We evaluated the predisposing factors, including intranasal anatomical and dental factors for increased diagnostic accuracy.
In this study, 117 patients who underwent endoscopic sinus surgery for unilateral MSFB were included. Preoperative computed tomography (CT) scans were used to analyze the presence of anatomical variations (anterior and posterior nasal septal deviation (NSD), concha bullosa (CB), infraorbital cell (haller cell), paradoxical middle turbinate, everted uncinate process and MS size). Dental factors including history of dental procedures and findings on CT scans were reviewed.
Anterior and posterior NSD toward non-affected side were significantly associated with the presence of FB. The presence of CB and infraorbital cell was higher in the non-affected side rather than in the lesion side. Compared to non-affected MS, FB-presence MS was shallower and had a larger height to depth ratio. The presence of dental history was significantly higher on FB-presence MS than non-affected MS. In multivariable analysis, posterior NSD toward non-affected side, dental history increased the aOR of MSFB, while the presence of CB and infraorbital cell decreased the aOR of MSFB.
The occurrence of MSFB seems to be associated with ipsilateral odontogenic factors, followed by anatomic variations including posterior NSD toward non-affected side and absence of CB and infraorbital cell.
上颌窦真菌球（MSFB）的发病机制可以用空气传播和牙源因素来解释。我们评估了包括鼻腔内解剖和牙齿在内的易患因素，以提高诊断准确性。
本研究纳入了 117 例因单侧 MSFB 而行内镜鼻窦手术的患者。术前 CT 扫描用于分析解剖变异（前、后鼻中隔偏曲（NSD）、泡状鼻甲（CB）、眶下窦、反常鼻中隔、内翻性中鼻甲和 MS 大小）的存在情况。回顾了包括牙科手术史和 CT 扫描结果在内的牙齿因素。
朝向非病变侧的前、后 NSD 与 FB 的存在显著相关。CB 和眶下窦在非病变侧比在病变侧更常见。与非病变 MS 相比，FB 存在 MS 更浅，高度与深度之比更大。FB 存在 MS 的牙科史发生率明显高于非病变 MS。多变量分析显示，朝向非病变侧的后 NSD、牙科史增加了 MSFB 的优势比，而 CB 和眶下窦的存在则降低了 MSFB 的优势比。
MSFB 的发生似乎与同侧牙源因素有关，其次是包括朝向非病变侧的后 NSD 以及 CB 和眶下窦的缺失等解剖变异。
