CLINICAL CASES   

Rivista Italiana di Chirurgia Maxillo-Facciale 2001 December;12(3):177-82

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

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.