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International Poster Journal of Dentistry and Oral Medicine
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Int Poster J Dent Oral Med 16 (2014), DGMKG     11. June 2014
Int Poster J Dent Oral Med 16 (2014), DGMKG  (11.06.2014)

Supplement, Poster 763, Language: English


Aspergillosis of the paranasal sinuses
Teiler, Anna Maria / Hoefer, Sebastian Herbert / Sader, Robert / Landes, Constantin
Background: Even today mycotic infection of the maxillary sinus is not a very rare disease. In most cases, Aspergillosis is the underlying pathogen and is associated with root canal filling - contains zinc oxide - that has been pressed into the maxillary sinus through the root tip. Most of the time aspergillosis remains non-invasive. However, the invasive form presents itself with a life-threatening condition due to potential destructive cranial progression. Often times diabetic or immunocompromised patients are affected.
Goals: The mycotic infection of paranasal sinuses requires thorough understanding of the underlying causes, possible surgical and anti-mycotic treatment options, and the willingness to work in an interdisciplinary setting with various clinics and sub-departments.
Methods: We exemplary choose 3 patients with a histopathological diagnosed mycosis of the maxillary sinus, we treated in our clinic.
Patient 1 (male, 68 years old) was transferred to us from the Department of Neurology after suffering from therapy-resistant headaches for two weeks and sudden paresis of the third cranial nerve.
A sinusitis maxillaris due to aspergillus fumigatus with affection of the left orbita and complete paralysis of the occulomotoric nerve could be diagnosed.
Patient 2 (male, 59 years old) presented himself with painless swelling of the cheek without dentogenic focus.
The underlying cause was right-sided rhinocerebral mucor-mycosis due to chronic sinusitis maxiallaris with subtotal destruction of the zygomatic bone.
Patient 3 (female, 80 years old) was transferred from the Department of Opthalmology due to left-sided periorbital swelling. The underlying cause was sinusitis due to aspergillosis infection.
Results: 2 out of 3 patients suffered from a predisposing condition: ulcerative colitis and renal insufficiency; as well as collagenous colitis.
2 out of 3 patients received prior root canal treatment.
In all cases surgical treatment (sanitization of the maxillary sinus and decortication) as well as systemic anti-mycotic therapy were applied.
2 out of 3 patients received additional local treatment via a drainage system.
Conclusion: Root canal treatment and persistent symptoms require early 3D-imaging of the perinasal sinuses (especially in the case of diabetic or immunocompromised patients).
The rapid confirmation of the diagnosis and the combined treatment (includiung surgical sanitation and systemic anti-mycotic therapy) are crucial for the outcome of the patient. Interdisciplinary treatment between Maxillofacial Surgeons and Infectious Disease Specialists leads to positive long-term results (follow-up duration of 18 months).

Keywords: aspergillosis, sinuses, infection

Conference/Exhibition:
64. Kongress der Deutschen Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG)
11.-14. Juni 2014
Mainz, Deutschland