Braun J J, Bourjat P, Gentine A, Koehl C, Veillon F, Conraux C
Service ORL, Hôpital de Hautepierre, Strasbourg.
Ann Otolaryngol Chir Cervicofac. 1997;114(4):105-15.
We analyse the most important clinical, CT, surgical, histopathological, biological, biochemical, mycological and bacteriological features of caseous sinusitis, i.e. chronic, poorly symptomatic sinusitis which are resistant to usual treatment. CT shows an opacity of the maxillary sinus with often a hyperdense foreign body (dental overfilling) but no valid predictive criteria for fungal etiology. The endoscopic or surgical procedures point out a caseous mass often called fungal mass or aspergilloma. The biochemical composition of this mass (water, proteins, lipids) is similar to that of tissues surrounding the sinus. The calcium value is variable and shows no correlation with CT imaging. The qualitative and quantitative analysis of the metals (zinc, lead, silver, copper, iron) is of relevance for exogenic origin (dental overfilling). The fungal etiology is inconstant (20 cases) after the mycological investigations. We discuss the nosologic and diagnostic features of caseous sinusitis, fungal or not, and which are often or too often called aspergillosis sinusitis.
我们分析了干酪性鼻窦炎的最重要临床、CT、手术、组织病理学、生物学、生物化学、真菌学和细菌学特征，即慢性、症状轻微且对常规治疗耐药的鼻窦炎。CT显示上颌窦混浊，常伴有高密度异物（牙体过度充填），但对于真菌病因没有有效的预测标准。内镜或手术操作显示出一个常被称为真菌团块或曲菌球的干酪样肿物。该肿物的生化组成（水、蛋白质、脂质）与鼻窦周围组织相似。钙值变化不定，与CT影像无相关性。金属（锌、铅、银、铜、铁）的定性和定量分析对于外源性病因（牙体过度充填）具有重要意义。真菌学检查后，真菌病因并不恒定（20例）。我们讨论了干酪性鼻窦炎（无论是否为真菌性）的疾病分类和诊断特征，其常被或过度被称为鼻窦曲菌病。
