Allergic Fungal Sinusitis Infratemporal Fossa Involvement: Saudi Experience

Abstract

Objectives: Allergic fungal rhinosinusitis (AFRS) is well known to expand and to extend to the surrounding structures like the orbit and the brain; however, it has not been reported to extend to the infratemporal fossa (ITF). Because of the difficulty of accessing the ITF, we report our experience over 5 years. Methods: One hundred one patients with AFRS were operated upon by the author between 2008 and 2013. Results: All of these patients had preoperative computed tomography scans (CTs), and all but 2 had postoperative CT of the paranasal sinus. Twelve had expansion or extension of the disease into the ITF: 8 males and 4 females, their ages ranged from 10 to 34 years with mean of 20.4 years. Four of them were children below 15 years of age. Three patients had bilateral disease and 9 had unilateral sinus involvement. Seven cases had expansion of the posterior wall of the maxillary sinus into the ITF, which was unilateral and mil; however, extension from the sphenoid sinus was more extensive in most of the cases; bilateral in 2 and unilateral in the others. Conclusions: ITF extension from the sphenoid sinus is more extensive than from the maxillary sinus. In a pediatric population, because of the incomplete fusion of the suture line, the disease expanded and eroded into the ITF. In adults, the opticocarotid recess is the weakest area and the disease can expand through it into the ITF. Posterior wall of maxillary sinus expansion into the ITF is mild in all cases, and all the ITF extensions were cured endoscopically.