Maxillary sinus aspergilloma of odontogenic origin: Report of 2 cases with cone-beam computed tomographic findings and review of the literature

Abstract

Aspergilloma of the maxillary sinus is considered rare in immunocompetent patients, but a considerable increase has recently been seen in the incidence of reported cases. Dental procedures involving the antral region are thought to predispose individuals to this form of aspergillosis. Because aspergilloma shares similar clinical features with other sinus pathologies, its diagnosis may be delayed. Thus, an early diagnosis confirmed by a histopathological examination plays a crucial role in the adequate management of aspergilloma. This article provides a concise review of the reported cases of aspergilloma associated with dental procedures and reports 2 new cases of aspergilloma in middle-aged female patients, with a presentation of their cone-beam computed tomographic findings.

A Case Report of Maxillary Aspergillosis with Unusual Clinical and Imaging Presentations

“…3 The maxillary sinuses are the most commonly affected of all the paranasal sinuses. 4,5 Introduction into the maxillary antrum can sometimes occur at the time of a dental procedure such as extraction, root canal therapy, or placement of a dental implant. 4,5 The first report of aspergillosis in the maxillary sinus was made by Zarniko in 1891.…”

“…4,5 Introduction into the maxillary antrum can sometimes occur at the time of a dental procedure such as extraction, root canal therapy, or placement of a dental implant. 4,5 The first report of aspergillosis in the maxillary sinus was made by Zarniko in 1891. 3 The mechanism by which sinus fungal infections cause destructive lesions are believed to be the induction of tissue necrosis.…”

“…4 Clinical manifestations are usually ambiguous and range from nasal congestion and discharge to pain and headaches. 5 The prognosis of maxillary aspergillosis is poor if not managed appropriately and promptly. 4 The mortality rate increases in immunocompromised patients.…”

“…The imaging features of maxillary aspergillosis are nonspecific, but usually unilateral. 5 Advanced imaging in the form of CT or magnetic resonance imaging is necessary. CBCT can also be used to assess the osseous structures of and around the maxillary sinus.…”

Invasive Aspergillosis in Transplant Recipients

“…Aspergillus spores may be deposited in the oral cavity upon inhalation or during dental procedures, for example, tooth extraction [3]. The fungus may then spread further into the sinuses as odontogenic infection [32,33]. The infection may also become established in the oral cavity itself.…”