Doo Jeon Gang, Min Hye Kyu, Min Jin-Young
Department of Otorhinolaryngology-Head and Neck Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
J Rhinol. 2024 Mar;31(1):22-28. doi: 10.18787/jr.2024.00001. Epub 2024 Mar 31.
Sinonasal fungal balls (FBs) most commonly occur in the maxillary sinus, followed by the sphenoid sinus (SS). Relatively little is known about the predisposing factors and pathogenesis of unilateral sphenoid sinus fungal balls (SSFBs) compared to maxillary sinus FBs. We investigated whether anatomical variations have clinical implications for the location of unilateral SSFBs.
This study included 33 patients who underwent endoscopic sinus surgery for unilateral SSFBs between 2010 and 2021. Preoperative computed tomography scans were used to analyze the presence of anatomical variations, including sphenoid lateral recess, complete accessory septum of the SS, types of SS pneumatization, anterior and posterior nasal septal deviation (NSD), cephalocaudal NSD, concha bullosa (CB), Haller cell (HC), paradoxical middle turbinate (MT), everted uncinated process (UP), and Onodi cell.
The presence of HC (33.3% vs. 12.1%, p=0.04), complete accessory septum of the SS (51.6% vs. 25.8%, p=0.04), and the sellar type of the SS (90.9% vs. 50%, p=0.003) differed significantly according to the presence or absence of FBs in the SS. However, other anatomical variations, including NSD, CB, paradoxical MT, everted UP, Onodi cell, and sphenoid lateral recess, were not significantly associated with the presence of unilateral SSFBs (all p>0.05). In the multivariable analysis, only sellar-type pneumatization of the SS showed a statistically significant relationship with SSFB, not the combined conchal and presellar type (adjusted odds ratio, 8.96; 95% confidence interval, 1.27-63.19; p=0.03).
We demonstrated that unilateral SSFBs were most strongly associated with the ipsilateral type of SS pneumatization, followed by the presence of HC and a complete accessory septum of the SS. Intranasal anatomical variations may play a significant role in the location of unilateral SSFBs.
鼻窦真菌球（FBs）最常发生于上颌窦，其次是蝶窦（SS）。与上颌窦真菌球相比，单侧蝶窦真菌球（SSFBs）的易感因素和发病机制相对鲜为人知。我们研究了解剖变异对单侧SSFBs位置是否具有临床意义。
本研究纳入了2010年至2021年间因单侧SSFBs接受鼻内镜鼻窦手术的33例患者。术前计算机断层扫描用于分析解剖变异的存在情况，包括蝶窦外侧隐窝、SS完全副隔、SS气化类型、鼻前后中隔偏曲（NSD）、头尾向NSD、泡状鼻甲（CB）、Haller气房（HC）、反常中鼻甲（MT）、翻转钩突（UP）和Onodi气房。
根据SS中是否存在FBs，HC的存在情况（33.3%对12.1%，p = 0.04）、SS完全副隔的存在情况（51.6%对25.8%，p = 0.04）以及SS的鞍型气化情况（90.9%对50%，p = 0.003）存在显著差异。然而，其他解剖变异，包括NSD、CB、反常MT、翻转UP、Onodi气房和蝶窦外侧隐窝，与单侧SSFBs的存在无显著相关性（所有p>0.05）。在多变量分析中，只有SS的鞍型气化与SSFB显示出统计学上的显著关系，而非泡状和鞍前联合类型（调整优势比，8.96；95%置信区间，1.27 - 63.19；p = 0.03）。
我们证明单侧SSFBs与同侧SS气化类型最密切相关，其次是HC的存在和SS完全副隔。鼻内解剖变异可能在单侧SSFBs的位置中起重要作用。
