Maxillary and Sphenoid Sinus Fungus Ball: A Single Belgian Centre's Experience
Background: Fungus ball describes the non invasive accumulation of dense fungal concrements in a sinus cavity. Bone, blood vessels, submucosa and sinus mucosa are free of fungal elements. It usually occurs in immunocompetent adults. It can involve the maxillary or the sphenoid sinus.
Methodology: We reviewed the files of 66 patients treated for sinus fungus ball (SFB) in the ENT department of the CHU Dinant - Godinne during the past 15 years. Our cohort of patients was divided in 2 groups. The first group comprised the patients with maxillary fungus ball (MSFB) (n = 50 patients) and the second with sphenoid fungus ball (SSFB) (n = 16 patients). Clinical presentation, imaging and surgical treatment were recorded.
Results: Patients with MSFB complained more frequently of postnasal drip whereas retroocular pain was more common in the group of SSFB. On CT scans, an heterogeneous partial or complete opacity of the affected sinus with sclerosis of the bony walls was present in both groups. Microcalcifications were much more common in the group of MSFB. The definitive diagnosis was made by the pathologist in all the cases. When positive (n = 13/55), Aspergillus fumigatus grew on culture. Fungus balls were treated by surgery (mainly endonasal approach) with a success rate of 91%. It consisted of a complete removal of the fungal hyphae with preservation of the healthy mucosa and restoration of the aeration and drainage of the sinus. Surgery mainly consisted of a middle antrostomy in the first group and a sphenoidotomy performed via the sphenoethmoidal recess in the second one.
Conclusions: The clinicians must be aware of this entity in case of a unilateral symptomatic rhinosinusitis persisting despite appropriate medical treatment. A biopsy of the mucosa adjacent to the fungus ball must be performed to rule out any invasion within the tissues.