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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Rivista Italiana di Chirurgia Maxillo-Facciale 2001 December;12(3):177-82
Aspergillosis of the paranasal sinuses
Padula E., Cusino C., Brunello M.
From the Department of Maxillo-Facial Surgery and Dentistry Hospital S. Bortolo, Vicenza (Italy)
The aim of this article is to point out the risk of endodontic treatment of maxillary teeth for possible complication of cement spreading over the tooth apex inside the maxillary sinus. The possible consequence is aspergillosis of the paranasal sinuses that sometimes represents a lethal pathology. Aspergillosis is due to a mycotic infection that can be observed in patients affected with immunodeficiencies, otorhinolaryngological diseases inducing chronic local inflammation but also in healthy people. Our clinical observations regard a considerable number of patients affected with Aspergillosis of the paranasal sinuses as a consequence of endodontic care of antral teeth and cement inoculation in maxillary sinus treated in our Department of Maxillo-Facial Surgery in the last 10 years. The patients observed were mostly healthy adults without immunodeficiencies recently treated endodontically by their dentist and that developed symptoms like maxillary soreness, headache and rhinorrhoea. The reason for this infection is related to a favourable proliferation of the growth of the mycelium in the presence of materials commonly used for endodontic treatments. The consequence of the cases of aspergillosis observed in our Department is of different severity and in 1 case a patient died for diffusion of the infection from the frontal sinus to the brain. Our main surgical approach is the Caldwell-Luc operation despite the fact that other authors describe successfully the functional endoscopic sinus surgery (FESS). Medical therapy, complementary to the surgery, is always associated with protected B Amphotericin in dosage 4-5 mg/kg/die or with Itraconazolo in dosage 200-300 mg/die after meal for a period of at least 3 months each.