Evaluation and treatment of isolated maxillary sinus disease

Abstract

On the basis of the review, diagnosing isolated maxillary sinus disease can still be delayed due to late presentation. When suspected, it is advisable to investigate early with computed tomography scanning and proceeding to MRI if needed. Often these will show certain features with clues to the diagnosis. Final diagnosis is frequently only obtained on histological examination. The majority of these disorders can now be managed by endoscopic techniques alone with open surgery required in a small number of cases.

Maxillary sinus volume in patients with impacted canines

“…5 Apart from being in normal alignment, canines move into an even closer relationship with the maxillary sinuses when they are in an impacted position. 6 It is known that a wide array of factors, such as pathological findings, 7 could affect the maxillary sinus volume; most of these factors could be asymptomatic. Apart from pathological findings, as a result of the proximity of the premolars and canines to the maxillary sinuses, it is known that sinus pneumatization and/or sinus expansion can also occur after the extraction of these teeth.…”

Literature review. Noninvasive fungal rhinosinusitis

“…The sinusal content ap-pears on MRI as a hypointense or absent signal in T1 and T2 (pseudotumoral image), because of high protein density and dehydration of these caseous masses, with high concentrations of ferromagnetic elements 3,22 . The medical history, the clinical examination, the endoscopic examination and the imaging examination present valuable information only for the suspicion of FB; the definitive diagnosis relies on the macroscopic evaluation, biopsy and histopathologic examination of surgical pieces 6,9,24,25 . Anatomopathologically, FB is an accumulation of dense conglomerates of fungal hyphae that appear layeror sphere-shaped disposed in the sinus cavity.…”

“…Both techniques -endoscopic and open surgery -have similar results, but sinus endoscopic surgery is considered the "gold standard", a less invasive method and first-line surgical intervention, with a success rate of 97% and a negligible complication rate. The Caldwell-Luc procedure should be avoided because of the negative consequences for the sinuses physiology 9,25 . Both intraoperatively and postoperatively, it is essential to irrigate the sinuses with saline solutions, which increase MCC, facilitate the elimination of mucous secretions and the removal of any fungal residues.…”

“…There are many controversies regarding the medical and surgical management of sinus FB. In most of the cases, the disorder is managed by endoscopic techniques 3,9,11,25 ; open surgery (Caldwell-Luc), associated or not with endoscopic treatment, is required in a small number of cases, being determined by the impossibility of complete extraction of all the fungal concretions or foreign bodies by FESS 9,11,25 . Both techniques -endoscopic and open surgery -have similar results, but sinus endoscopic surgery is considered the "gold standard", a less invasive method and first-line surgical intervention, with a success rate of 97% and a negligible complication rate.…”

“…Differential diagnosis of FB is made with the invasive FRS, bacterial CRS, rhinoscleroma, sinus benign lesions (cyst, antrochoanal polyp, cholesterol granuloma, mucocele, hematoma, inflammatory pseudotumor), sinus benign tumors (sinonasal papilloma, fibrous bone lesion, salivary gland tumors, mesenchymal tumors -fibroma, lipoma, myxoma, etc. ), sinus malignant tumors (carcinoma, adenocarcinoma, lymphoma) 25 . The goal of treatment in patients with FB is surgical removal of the fungal hyphae mass with restoration of the affected sinus drainage and ventilation.…”