Chronic Invasive Aspergillus Sinusitis Affecting the Maxillary Sinus: A Case Report
I. Nourwali
Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, KSA.
M. Elkablawy
Department of Pathology, College of Medicine, Taibah University, KSA and Department of Pathology, College of Medicine, Menoufia University, Egypt.
M. Hammad
Department of Preventive Dental Sciences, College of Dentistry, Taibah University, KSA.
A. Shamaa *
Department of Oral Basic and Clinical Science, College of Dentistry, Taibah University, KSA amd Department of Oral Biology, College of Dentistry, Minia University, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Chronic invasive Aspergillus sinusitis is an uncommon fungal infection that usually occurs in immunocompromized patients and rarely in healthy immunocompetent individuals. Chronic invasive Aspergillus sinusitis affecting the maxillary sinus may cause tremendous effects as maxillary bone destruction, displacement of teeth, bronchopulmonary infection and orbital involvement that may lead to proptosis and decreased vision. The maxillary sinus infection may result from direct inhalation of spores and not as a secondary infection from the oral cavity, endodontic treatment, or oro-antral fistulae.
Case Summary: A 30 years old male patient presented to clinic complaning of right sided facial swelling and nasal obstruction. Clinical examination, Ortho-Pantomogram (OPG) and Cone Beam Computerized Tomography (CBCT) revealed a right maxillary sinus mass; laboratory investigations exclude presence of any systemic disease. Antrostomy of the lateral sinus wall (Caldwell-Luc surgery) was performed under local anesthesia to remove the sinus lining and mass. The mass was sent for histopathological investigation. The defect of bone was covered with the integrum periostium (the mucosal flap) without any bone graft or meshes. No antifungal drugs were prescribed.
Post operative OPG and CBCT revealed complete removal of the lesion and clearance of the right side nasal air way. The histopathological examination found that the aspergillus Hyphae, fruits bodies and spores are present which confirmed the diagnosis. One year follow-up revealed that there is no recurrent infection; the drifted teeth realigned again and the maxillary sinus returns to its normal size.
Conclusion: Early diagnosis and therapeutic intervention is the key to successful treatment of chronic invasive aspergillosis of the maxillary sinus. Surgical debridement can be done under local anesthesia without antifungal drug prescription and good prognosis was achieved.
Keywords: Aspergillosis, maxillary sinus, healthy (immunocompetent) patient, case report.