INCIDENTAL FINDINGS OF ASYMPTOMATIC FUNGAL INFECTION IN PARANASAL SINUSES: A CASE REPORT AND LITERATURE REVIEW TO INCREASE AWARENESS AMONG DENTAL PROFESSIONALS

Abstract

BACKGROUNDExtensive fungal disease of the paranasal sinuses, an underrated entity that affects both immunocompromised and previously healthy patients, merits early diagnosis for effective diagnosis and treatment. Over the past few decades, the number of fungal infections in the sino-nasal tract has increased. The objective of this case report is to increase awareness of these conditions among dental professionals.CASE REPORTAn asymptomatic 21-year-old white man was referred for potential implant placement. His medical history was unremarkable. A cone beam computed tomography (CBCT) study portrayed a large polypoid soft tissue density mass occupying the right ethmoid and sphenoid sinuses. Significant expansion of the lateral and medial walls of the right ethmoid sinus and perforation of the sphenoid sinus floor were apparent. Furthermore, extension of the lesion into the nasal cavity and mucosal thickening of the right maxillary sinus were evident with suspected mild displacement of the inferior medial wall of the right orbit. These aggressive radiographic features in an asymptomatic patient downgraded the inflammatory process in the differential diagnoses. The patient was immediately referred to an otolaryngologist for further evaluation. Noncontrasted multidetector computed tomography showed opacification and expansion of multiple sinuses with centrally dense inspissated materials. The skull base and the extraocular muscles were intact. These features were compatible with allergic fungal sinusitis. Subsequently, the patient was treated with surgical debridement without any complications.DISCUSSION/CONCLUSIONSCBCT is commonly used for presurgical implant planning and paranasal sinuses are often imaged in the field of view. Moderate to severe allergic fungal sinusitis can lead to bony expansion and erosion with extension to the surrounding cranial and orbital region. These could progress into a potential life-threatening event. Timely diagnosis with early referral to an otolaryngologist could avoid serious complications such as blindness and rampant spread of infection that lead to irreversible outcomes. Extensive fungal disease of the paranasal sinuses, an underrated entity that affects both immunocompromised and previously healthy patients, merits early diagnosis for effective diagnosis and treatment. Over the past few decades, the number of fungal infections in the sino-nasal tract has increased. The objective of this case report is to increase awareness of these conditions among dental professionals. An asymptomatic 21-year-old white man was referred for potential implant placement. His medical history was unremarkable. A cone beam computed tomography (CBCT) study portrayed a large polypoid soft tissue density mass occupying the right ethmoid and sphenoid sinuses. Significant expansion of the lateral and medial walls of the right ethmoid sinus and perforation of the sphenoid sinus floor were apparent. Furthermore, extension of the lesion into the nasal cavity and mucosal thickening of the right maxillary sinus were evident with suspected mild displacement of the inferior medial wall of the right orbit. These aggressive radiographic features in an asymptomatic patient downgraded the inflammatory process in the differential diagnoses. The patient was immediately referred to an otolaryngologist for further evaluation. Noncontrasted multidetector computed tomography showed opacification and expansion of multiple sinuses with centrally dense inspissated materials. The skull base and the extraocular muscles were intact. These features were compatible with allergic fungal sinusitis. Subsequently, the patient was treated with surgical debridement without any complications. CBCT is commonly used for presurgical implant planning and paranasal sinuses are often imaged in the field of view. Moderate to severe allergic fungal sinusitis can lead to bony expansion and erosion with extension to the surrounding cranial and orbital region. These could progress into a potential life-threatening event. Timely diagnosis with early referral to an otolaryngologist could avoid serious complications such as blindness and rampant spread of infection that lead to irreversible outcomes.