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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 2002 December;13(3):147-54
Endoscopic treatment of fungal sinusitis
Politi M. 1, Costa F. 1, Polini F. 1, Robiony M. 1, Emanuelli E. 2
1 Unit of Maxillo-Facial Surgery University of Udine, Udine, Italy
2 ENT Department University of Padua, Padua, Italy
Aim. Fungal sinusitis has been seen increasingly in immunocompetent individuals. Endoscopie treatment with surgical debridement is the treatment of choice after a correct diagnosis.
Methods. We report 3 cases of fungal sinusitis: 2 immunocompetent cases with unilateral maxillary involvement and 1 non immunocompetent case with unilateral maxillary and sphenoid sinus involvement. At presentation all of our patients had symptoms of chronic sinusitis refractory to medical management. Computerised tomography and, occasionally, magnetic resonance imaging are of great help in the assessment of the disease. The radiological presentation was always an heterogeneous opacity with microcalcifìca-tions. After adequate evaluation, functional endoscopie sinus surgery (FESS) was performed to obtain a wide opening of the affected sinus, permitting a careful extraction of all fungal material. After surgery, packs were placed in the middle meatus for 3 days and all patients received topic steroids over 4 weeks. Follow-up has ranged from 4 months to 1 year after surgery and patients were all closely followed postoperatively with serial endoscopic examinations.
Results. None of the patients required a second procedure. Two patients had positive fungal culture for Aspergillus. None of the patients had evidence of invasive disease and systemic antifungal therapy was not required.
Conclusion. FESS permits a safe extraction of mycetomas by a wide opening of the affected sinuses associated with a careful extraction of all fungal material without any removal of sinus mucosa.