Analysis of sinonasal anatomical variations associated with maxillary sinus fungal balls

Shin, Jae–Min; Baek, Byung Joon; Byun, Jang Yul; Jun, Young Joon; Lee, Jae Yong

doi:10.1016/j.anl.2015.12.013

Cited by 22 publications

(49 citation statements)

References 14 publications

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“…Most studies do not report this variant with such a high frequency. Despite this, studies with prevalence up to 97% are found, where it is argued that the lack of probabilistic sampling and the ratio of cases vs controls generally greater than 1: 1 in this type of studies exclude that it is found so frequently this anatomical variant [16,17]. It is very important to know that this anatomical variant has a high prevalence in our population, since including in the tomographic report this variant allows the Otorhinolaryngologist to propose a better therapeutic approach in this disease (12).…”

Section: Discussionmentioning

confidence: 96%

Multiparametric Correlation Between Anatomical Variants of the Paranasal Sinuses and Chronic Rhinosinusitis: Case-control Study

William¹,

Fernando²

2019

IJMI

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Introduction: Chronic rhinosinusitis (RSC) is a disabling disease that can affect up to 70% of people. It is very important to know which are the anatomical variants that the patient presents for surgical planning and often for the treatment of the variants that can present as a risk factor. The evidence shows heterogeneity in the prevalence of these anatomical variants and it is not described quantitatively which are the variants that present the greatest relationship as a risk factor. Establishing the multiparametric correlation between at least one of the most frequent anatomical variants of the paranasal sinuses and the development of rhinosinusitis is the most important objective of this investigation. Materials and methods: Case-control study with multiparametric correlation analysis of the anatomical variants of paranasal sinuses as a risk factor in the development of sinusitis. Analysis with measures of central tendency, Xi2, Fisher's exact test, binary logistic regression. Results: The most frequent anatomical variant was the deviation of the nasal septum on the left side (78%). The second most common variant found was the Agger Nasi cells (68%), followed by the protrusion of the Vidian nerve in the sphenoid sinus (52%). The only anatomical variant that could be determined within the regression model was the obstruction of the osteomeatal complex; which is presented as a risk factor with an OR of 16 (95% CI: 6.9-41.3). Conclusions: Obstruction of the osteomeatal complex is a very important risk factor for the development of chronic rhinosinusitis.

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Section: Discussionmentioning

confidence: 96%

Multiparametric Correlation Between Anatomical Variants of the Paranasal Sinuses and Chronic Rhinosinusitis: Case-control Study

William¹,

Fernando²

2019

IJMI

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“…The FB sinus pathophysiology remains unknown. The disorder develops in two conditions: penetration of hyphae and fungal spores into a paranasal sinus and creating the environment that contribute to the growth of fungi 9,12,13 . Three possible theories of FB development have been suggested: airborne, odontogenic and mixed.…”

Section: Fungus Ballmentioning

confidence: 99%

“…According to the airborne theory, large quantities of fungal spores in the air penetrate the sinuses through the natural ostia, multiply and become pathogenic when the sinus becomes an anaerobic environment. A possible cause may be the ostiomeatal obstruction, accentuated by anatomical factors (septum deviation, turbinate hypertrophy) contributing to the stasis occurred inside the sinuses, with the development of a hypoxic and anaerobic environment, with the lowering of the pH -a favourable and ideal condition for the proliferation of fungi and increasing the possibility of allergic reactions 9,12,13 . The odontogenic path is a iatrogenic one, where fungal colonization of the maxillary sinus occurs through a iatrogenic oro-antral communication, secondary to dental extraction, by periodontal lesions, channel perforation or, most frequently, after endodontic treatment with overfilling of the dental channel.…”

Section: Fungus Ballmentioning

confidence: 99%

“…The metals from the endodontic material, particularly zinc oxide, titanium, lead, calcium salts, barium and sulfur, accidentally introduced into the maxillary sinus during the endodontic treatment of the maxillary teeth, have a key role in the growth of fungi, the gradual filling of the sinuses and in the FRS pathogenesis. However, the odontogenic theory does not explain the FB occurrence in the ethmoid, sphenoid, frontal sinuses or in the maxillary sinuses of patients who have no history of dental pathology 9,12,13 .…”

Section: Fungus Ballmentioning

confidence: 99%

“…The mixed theory combines the features of the first two, being based on the ubiquitous nature of fungal spores, which can be inhaled and are present as saprophytes in the sinuses; but, under certain favourable conditions (ventilation disorders, foreign body), the fungal colony grows and causes sinusitis 13 . Recent studies suggest that immune disorders and factors affecting the nasal mucus may be more important in the FB pathophysiology than nasal anatomical variations obstructing the ostiomeatal complex.…”

Section: Fungus Ballmentioning

confidence: 99%

See 2 more Smart Citations

Literature review. Noninvasive fungal rhinosinusitis

Cojocari

Sandul

2017

Romanian Journal of Rhinology

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Fungus ball (FB) of the paranasal sinuses has a distinctive clinicopathological presentation. The disease occurs more frequently in elderly patients and has a female preponderance. Classically, it involves only one paranasal sinus in more than 90% of the cases, most commonly the maxillary sinus. Imaging characteristics (calcifications and / or erosion of the inner wall of the sinus visible on CT) and histopathological ones (luminal aggregation of fungal hyphae) confirm the diagnosis. Allergic fungal rhinosinusitis (AFRS) usually occurs in younger, immunocompetent patients, with a history of atopy, including allergic rhinitis and / or asthma, or a long clinical picture of chronic rhinosinusitis (CRS), refractory to antibiotic treatment. Nasal polyps (NP) are present in almost all patients, while extra-sinusal complications are described only in some of them. Usually, there is involvement of several sinuses, as well as bilateral damage. The definitive diagnosis is confirmed only by examining surgical specimens - the characteristic appearance of eosinophilic mucin is the most reliable indicator of AFRS.

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Contemporary Classification of Chronic Rhinosinusitis Beyond Polyps vs No Polyps

Grayson

Hopkins

Mori

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Chronic rhinosinusitis (CRS) is a broadly defined process that has previously been used to describe many different sinonasal pathologic conditions from odontogenic sinusitis and allergic fungal sinusitis to the more contemporary definition of broad inflammatory airway conditions. Previous classification systems have dichotomized these conditions into CRS with nasal polyps and CRS without nasal polyps. However, clinicians are learning more about the inflammatory subtypes of CRS, which can lead to improved delivery and effectiveness of treatment.OBSERVATIONS In clinical practice, treatment decisions are often based on observable findings, clinical history, presumed disease, and molecular pathophysiologic characteristics. A proposed classification system is simple and practical. It proposes that the functional anatomical compartments involved create the first level of separation into local and diffuse CRS, which are usually unilateral or bilateral in distribution. Diffuse does not imply "pansinusitis" but simply that the disease is not confined to a known functional anatomical unit. This classification takes into account whether local anatomical factors are associated with pathogenesis. Then the inflammatory endotype dominance is separated into a type 2 skewed inflammation, as this has both causal and treatment implications. The non-type 2 CRS encompasses everything else that is not yet known about inflammation and may change over time. The phenotypes or clinical examples are CRS entities that have been described and how they align with this system. CONCLUSIONS AND RELEVANCEAlthough research continues to further define the subtypes of CRS into phenotypes and endotypes, the proposed classification system of primary CRS by anatomical distribution and endotype dominance allows for a pathway forward.

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Analysis of sinonasal anatomical variations associated with maxillary sinus fungal balls

Cited by 22 publications

References 14 publications

Multiparametric Correlation Between Anatomical Variants of the Paranasal Sinuses and Chronic Rhinosinusitis: Case-control Study

Multiparametric Correlation Between Anatomical Variants of the Paranasal Sinuses and Chronic Rhinosinusitis: Case-control Study

Literature review. Noninvasive fungal rhinosinusitis

Contemporary Classification of Chronic Rhinosinusitis Beyond Polyps vs No Polyps

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