Paranasal sinus fungus ball is an extramucosal mycosis, usually
occurring in immunocompetent people as a monolateral lesion. To review
the literature data and to report the Policlinico S. Matteo, University
of Pavia experience, 81 patients presenting paranasal fungus ball have
been treated (January 1994 to May 2005). Twenty-seven men and 54 women
(19-91 years old; mean 49.4 years) were considered. Seventy-three
patients had a single sinus affected, but eight presented multiple
localisations. Maxillary was the most involved sinus followed by
sphenoidal and ethmoidal. Moulds have been isolated in 28/81 cases.
Histology showed fungal colonisation but not invasion in all cases.
Tomography showed bone erosion in 33.3% of patients. All have been
treated only by functional endoscopic sinus surgery. Seventy-seven of 81
patients have been cured. Four of 81 patients needed another surgical
treatment. Follow up was between 6 and 132 months (average: 63 months).
Fungus ball is a sinusal pathology caused by mycetes like Aspergillus
spp. Histology confirms the fungal aethiology excluding tissue invasion.
Mycological culture consented to identify the pathogenic mould in 34.5%
of cases. Actually functional endoscopic sinus surgery is the gold
standard for treatment of this pathology, and antifungal therapy is
unnecessary.
Invasive sphenoid sinus aspergillosis is a rare infection and
usually affecting immunocompromised patients. We describe an invasive
sphenoid sinus aspergillosis patient with immunocompetent who present
progressive ocular dysfunctions. A 66-year-old woman with no history of
immune dysfunction was referred to our hospital with orbital
complications. Computed tomography (CT) scan and magnetic resonance
imaging (MRI) showed a mass lesion extending from the left orbital apex
to the sphenoid sinus. Inflammatory diseases were not suspected by
laboratory findings, but a transnasal endoscopic biopsy revealed
sphenoid sinus aspergillosis. After treatment of antifungal medication,
this patient showed improvement and no sign of recurrence during the
follow-up period. Diagnosis of invasive sphenoid sinus aspergillosis in
an immunocompetent, healthy individual, was challenging. However, if
patients have sinus wall deformities and orbital complications, early
surgery is necessary to improve their prognosis.Keywords:
endoscopic biopsy; immunocompetent patient; sphenoid sinus aspergillosis.
A case of sphenoid sinus aspergillosis presenting abducens nerve
palsy and visual field impairment is reported. A 73-year-old woman
visited our hospital with the complaint of head heaviness on the 27th of
March, 1989. Although results of neurological examinations were normal,
craniogram revealed the destruction of the clivus, and CT scan and MRI
showed a mass lesion, which was thought to be a mucocele in the sphenoid
sinus. On the 1st of September, she developed right abducens nerve
palsy and visual field impairment. MRI performed on the same day showed
an enlargement of the mass lesion in the sphenoid sinus. In order to
decompress the involved cranial nerves, her sphenoid sinus was explored
on the 22nd of September. The sphenoid sinus was filled with purulent
fluid and yellowish mass. Histopathological examination revealed
colonies of aspergillus fumigatus. Fluconazole, a new antifungal drug,
was given for 34 days postoperatively. The right abducens nerve palsy
and the visual field impairment gradually improved along with a
reduction of the mass lesion in her sphenoid sinus. Sphenoid sinus
aspergillosis is a rare disease. Its diagnosis is difficult. However,
MRI can show a specific low signal intensity in T2-weighted image. Also
in our case, MRI on the first admission showed a definite low signal
intensity in some parts of the lesion, which exhibited a high intensity
later on during the second administration, probably due to a qualitative
change. To our knowledge, only 33 such cases have been previously
reported. Intracranial involvement occasionally occurs in this disease.
In its early stage, cranial nerve palsies are caused by nerve
compression or invasion by this disease.(ABSTRACT TRUNCATED AT 250
WORDS)
Objective:
Isolated sphenoid sinus pathology is a relatively uncommon entity.
The present study is a retrospective review of 40 patients with
isolated sphenoid sinus pathology who were treated at the Department of
Otorhinolaryngology, Alexandria University between July 2002 and
December 2005. Special emphasis will be given to the role of various
endoscopic approaches in the surgical management of isolated sphenoid
sinus pathology. Factors that govern the selection of each approach will
be discussed.Methods:
Extracted data included patient demographics, clinical
presentation, imaging studies, treatment modalities and complications.
Sphenoid sinus was approached through one of the following three
approaches: (1) endoscopic transnasal approach, (2) endoscopic
transseptal approach and (3) endoscopic transpterygoid approach. Outcome
measures were based on assessment of patients' symptoms and
confirmation of a patent sphenoid sinus by office endoscopy.Results:
The pathology spectrum was rather wide and included 26 (65%)
inflammatory conditions (acute/chronic sphenoiditis, mucoceles, and
fungal sinusitis), 7 (17.5%) neoplasms and 7 (17.5%) miscellaneous
conditions (cerebrospinal fluid (CSF) rhinorrhea, sphenochoanal polyp,
and fibrous dysplasia). The most common initial symptom was headache
(50%) followed by ophthalmological symptoms (22.5%). Other presenting
symptoms included CSF leak in five patients, epistaxis in four patients
and nasal obstruction and/or rhinorrhea in two patients. Radiological
workup included computed tomography (CT) scan of the paranasal sinuses
in all patients. Magnetic resonance imaging (MRI) was performed in 21
patients (52.5%). The most common indication was a sphenoid mass based
on endoscopic and CT findings. Four patients with acute/chronic
sphenoiditis were successfully treated with medical therapy. One patient
with fibrous dysplasia did not require any definitive treatment.
Thirty-five patients underwent endoscopic surgery under general
anaesthesia. An adjuvant radiotherapy with or without chemotherapy was
utilized in two patients.Conclusions:
A high index of clinical suspicion, routine office nasal endoscopy
and radiological imaging are central to making an accurate and timely
diagnosis of isolated sphenoid sinus pathology. Surgical treatment of
sphenoid pathology can be safely and successfully performed through a
variety of endoscopic approaches. Selection of the most appropriate
endoscopic approach is governed by the nature and location of sphenoid
pathology as well as the anatomical configuration of the sphenoid sinus.
1946 syntynyt Tampereella
Ylioppilastutkinto 1964 Lempäälä
Lääketietaan kandidaatti 1966 Turun yliopisto
Lääketieteen lisensiaatti 1972 Turun Yliopisto
Dietetiikan opiskelu 1998 - 2001 Göteborgin Yliopisto
Eläkkeelle 2010
