Clinical and Radiological Features of the Maxillary Sinus in Patients After Removal of Fungal Ball and Their Impact on the Frequency of Subantral Bone Augmentation Complications.

Abstract

Abstract. The mucoperiostitis and local osteitis are radiological symptoms of the fungal ball of the maxillary sinuses. The condition of the mucoperiosteum and the adjacent bone in the alveolar bay of the maxillary sinus predict the results of dental implantation and subantral augmentation. The endoscopic access to the sinus by the antrostomy in the middle meatus and infraturbinal have been used to avoid excessive tissue injury during the removal of the fungal ball.
 Aim: To assess the condition of the bone and mucoperiosteum of the maxillary sinus in patients with fungal ball after rhinosurgery by the antrostomy with additional osteoplastic infraturbinal access.
 Methods and materials: The data of 102 patients who underwent surgery for the fungal ball of the maxillary sinus were analyzed, and subsequently - subantral bone augmentation and dental implantation were performed. In patients of the first group (67 people) - endoscopic intervention was performed by antrostomy in the middle meatus, and in 2nd group (35 people) - additional osteoplastic infraturbinal access was used.
 Result: Computed tomography data were evaluated before endoscopic sinus surgery and before subantral augmentation. The frequency of signs and severity of osteitis according to Kannedy Osteitis Score, after the intervention did not change significantly, and was established as 0.90 ± 0.07 in patients of group №1 and 0.77 ± 0.08 – group №2. The total frequency of complications with subantral augmentation in the comparison groups was 17.91 ± 4.68% and 17.14 ± 6.37%, respectively. Symptoms of osteitis in patients with fungal ball of the maxillary sinus after endoscopic removal, in the first 4 - 6 months of observation tend to regress, but do not disappear.
 Conclusions: The incidence of osteitis in computed tomography in patients with maxillary sinuses fungal balls in 4.8 months after endoscopic removal tends to decrease and is 77.61 ± 5.09% when approach through the middle meatus and 74.29 ± 7, 39% in patients with combined infraturbinal approach. The use of additional infraturbinal approach in patients with a fungal ball does not adversely affect the results of subsequent subantral augmentation and dental implantation.