Maxillary Fungus Ball Research Articles

The accuracy of deep learning models for diagnosing maxillary fungal ball rhinosinusitis.

To assess the accuracy of deep learning models for the diagnosis of maxillary fungal ball rhinosinusitis (MFB) and to compare the accuracy, sensitivity, specificity, precision, and F1-score with a rhinologist. Data from 1539 adult chronic rhinosinusitis (CRS) patients who underwent paranasal sinus computed tomography (CT) were collected. The overall dataset consisted of 254 MFB cases and 1285 non-MFB cases. The CT images were constructed and labeled to form the deep learning models. Seventy percent of the images were used for training the deep-learning models, and 30% were used for testing. Whole image analysis and instance segmentation analysis were performed using three different architectures: MobileNetv3, ResNet50, and ResNet101 for whole image analysis, and YOLOv5X-SEG, YOLOv8X-SEG, and YOLOv9-C-SEG for instance segmentation analysis. The ROC curve was assessed. Accuracy, sensitivity (recall), specificity, precision, and F1-score were compared between the models and a rhinologist. Kappa agreement was evaluated. Whole image analysis showed lower precision, recall, and F1-score compared to instance segmentation. The models exhibited an area under the ROC curve of 0.86 for whole image analysis and 0.88 for instance segmentation. In the testing dataset for whole images, the MobileNet V3 model showed 81.00% accuracy, 47.40% sensitivity, 87.90% specificity, 66.80% precision, and a 67.20% F1 score. Instance segmentation yielded the best evaluation with YOLOv8X-SEG showing 94.10% accuracy, 85.90% sensitivity, 95.80% specificity, 88.90% precision, and an 89.80% F1-score. The rhinologist achieved 93.5% accuracy, 84.6% sensitivity, 95.3% specificity, 78.6% precision, and an 81.5% F1-score. Utilizing paranasal sinus CT imaging with enhanced localization and constructive instance segmentation in deep learning models can be the practical promising deep learning system in assisting physicians for diagnosing maxillary fungal ball.

Characterization of fungus ball CT-hyperdensities within maxillary and sphenoid sinuses.

CT-scan hyperdensities (HD) are described in more than 60% of all paranasal sinus fungus ball (FB) cases. Two types can be distinguished according to their density: calcium and metal types. We aimed to establish the prevalence and density of the HD observed in sphenoid and maxillary sinus FB and their relation to dental factors. This retrospective study included 64 patients operated in a tertiary referral center for unilateral maxillary or sphenoid FB diagnosed by histology or mycology. Pre-operative CT scans were analyzed by three independent observers (two ENT and one radiologist). There were 45 maxillary FB and 19 sphenoid FB. 63 FB showed HD. Metal-type HD were observed in 28 maxillary FB but not in sphenoid sinuses. Among maxillary FB, the prevalence of endodontic treatment was significantly more significant on the FB side than on the healthy side (p = 0.02). The prevalence of endodontic treatment on the pathological side was more significant in the metal-type group than in the group without metal-type HD (p = 0.01). Isolated calcium-type HD were evidenced in 17 maxillary FB and 18 sphenoid FB (p = 0.019). This study highlights the existence of two different types of HD in FBs of the paranasal sinuses with an association between metal-type HD and endodontic treatments.

The Endonasal Endoscopic Approach to Different Sinonasal Fungal Balls.

Background Fungal ball sinusitis is a sinonasal fungus ball that usually affects immunocompetent adults with female predominance. The most affected sinus is the maxillary sinus. Aspergillus species is the most typically found fungus. Computed tomography (CT) scan is the gold standard tool in order to diagnose fungal ball sinusitis. The ultimate method for a fungal ball is functional endoscopic sinus surgery (FESS), which has a high success rate and a low morbidity rate. Objective This study aims to demonstrate the various clinical presentations of fungal ball sinusitis including isolated maxillary sinus, sphenoid sinus, simultaneous occurrence of maxillary and sphenoid fungal ball, and post endonasal endoscopic pituitary surgery fungal ball with various age groups. Also, this study aims to emphasize the importance of early diagnosis and treatment in such cases. Patients and Methods. A retrospective study that was carried in the otorhinolaryngology department of two hospitals: King Fahad Specialist Hospital and Qatif Central Hospital, Eastern Region, Saudi Arabia. The study was conducted on a total of 16 patients who were diagnosed with paranasal sinuses fungal ball in an 11-year period from January 2008 and November 2019. Results Out of 16 patients with paranasal sinuses fungal ball, 11 cases were female and 5 males, with age ranging between 16 and 46 years. Results showed eight isolated sphenoid (50%), six isolated maxillary fungal ball (38%), one simultaneous occurrence of the sphenoid and maxillary fungal ball (6%), and one post endonasal endoscopic pituitary surgery for pituitary adenoma (6%). CT scan was performed for all 16 cases which is the standard tool for the diagnosis of the fungal ball. Conclusion Fungal ball may present with variety of symptoms but most commonly with postnasal discharge (PND), headache, and facial pain. CT sinuses is the diagnostic radiological modality to confirm the diagnosis. The FESS functional endoscopic sinus surgery is the gold safe approach for patients with fungal ball to manage their symptoms, confirm the diagnosis, and removal of disease with no morbidities.

Third window approach assisted middle meatal antrostomy: prospective cohort study of the two ports technique in management of hard to reach maxillary sinus pathology.

This study aimed to assess the outcomes of a prelacrimal recess approach assisted middle meatal antrostomy in the management of hard to reach maxillary sinus pathologies. Twenty-five patients with maxillary sinus pathology underwent prelacrimal recess approach assisted middle meatal antrostomy (with a prelacrimal recess width of more than 3 mm). Patients were prospectively evaluated using both the Arabic version of the Sino-Nasal Outcome Test-22 and nasal endoscopy at least 6 months post-operatively. Our study included 25 maxillary sinuses (13 with antrochoanal polyps, 10 with maxillary fungal ball and 2 with a migrated part of a tooth). At a mean follow-up period of 10.9 months, all patients showed significant improvement in total mean Sino-Nasal Outcome Test-22 score. There was recurrence of one case with antrochoanal polyp and two cases with asymptomatic synechia. Injury to the nasolacrimal duct was not reported. A prelacrimal recess approach assisted middle meatal antrostomy is a reliable and safe technique to manage pathologies in hard to reach regions within the maxillary sinus.

Fungus ball of the maxillary sinus: Retrospective study of 48 patients and review of the literature.

Maxillary fungus ball (FB) is the most frequent paranasal localization. To review clinical presentation, surgery and results of treatment in our series of patients with maxillary FB. To review the literature concerning treatment of maxillary FB. 48 patients with a diagnosis of maxillary FB were treated with endoscopic sinus surgery (ESS) alone or in association with external approaches. Before surgery all patients received computed tomography (CT), nasal endoscopy and dental examination. All the patients were followed for 1 year after surgery. Studies concerning surgical treatment of maxillary FB from 2006 were reviewed. The mean age of patients was 53.6 ± 11.9 years. 20 patients (41.6%) did not present any symptom, 19 patients (39.7%) had nasal symptoms, 3 patients (6.2%) had facial pain, 6 patients (12.5%) had a combination of both. Endoscopic examination was positive in 31 patients (64.6%), 17 patients (35.4%) showed negative findings. Logit regression model demonstrated that clinical symptoms contribute to the prediction of a positive endoscopic examination. 25 patients (52.1%) presented odontogenic factors. Complete clinical and radiological resolution of FB was observed in 46 patients (95.8%). Comparing our sample to the studies reviewed we may concluded that odontogenic factors were frequently reported and should be treated at the same time of maxillary FB. ESS alone or in association with external approaches is an effective treatment for patients with maxillary FB.

Maxillary sinus volume: new physiopathological data in fungal ball genesis? A retrospective study

The goal of this study was to compare maxillary sinus (MS) volume in patients with, or without, maxillary fungal ball. Monocentric retrospective study performed on 115 patient CT scans. We defined two groups of patients according to the absence (control group) or the presence (fungal ball group) of unilateral fungal ball in the MS. Sinus 3D reconstruction was created from CT scan. Control group: 71 patients (36 women - 50.7%); mean age was 51 years. Fungal ball group: 44 patients (29 women - 65.9%); mean age was 54.5 years. The univariate association between MS volume and sinus covariates was tested by anova. Multivariate analysis was made including all variables statistically significant in univariate analysis. In the control group, mean MS volume was 14 766 mm3 . The volumes of the two MSs were not statistically different in the control group (P = 0.145). In the fungal ball group, mean MS volume was 15 982 mm3 . Fungal ball was found in the smallest MS in 41 of 44 cases. Univariate analysis showed a statistical difference between the pathological and the non-pathological MS volumes (P < 10-4 ). Multivariate analysis confirmed the correlation between MS volume and the presence of a fungal ball (P < 10-4 ). This study suggests that maxillary fungal ball is associated with a smaller size of the affected MS.

Extrasinonasal infiltrative process associated with a sinonasal fungus ball: does it mean invasive fungal sinusitis?

Invasive fungal sinusitis (IFS) has rarely been reported to develop from non-IFS. The purpose of this study was to disclose the nature of the extrasinonasal infiltrative process in the presence of a sinonasal fungus ball (FB). We retrospectively reviewed the medical records, computed tomography, magnetic resonance images of 13 patients with sinonasal FB and the extrasinonasal infiltrative process. Based on histology and clinical course, we divided the extrasinonasal infiltrative process into IFS and the nonfungal inflammatory/infectious process (NFIP). The images were analyzed with particular attention to the presence of cervicofacial tissue infarction (CFTI). Of the 13 patients, IFS was confirmed in only one, while the remaining 12 were diagnosed to have presumed NFIP. One patient with IFS died shortly after diagnosis. In contrast, all 12 patients with presumed NFIP, except one, survived during a mean follow-up of 17 months. FB was located in the maxillary sinus (n=4), sphenoid sinus (n=8), and both sinuses (n=1). Bone defect was found in five patients, of whom four had a defect in the sphenoid sinus. Various sites were involved in the extrasinonasal infiltrative process, including the orbit (n=10), intracranial cavity (n=9), and soft tissues of the face and neck (n=7). CFTI was recognized only in one patient with IFS. In most cases, the extrasinonasal infiltrative process in the presence of sinonasal FB did not seem to be caused by IFS but probably by NFIP. In our study, there were more cases of invasive changes with the sphenoid than with the maxillary FB.

"Gauze Technique" in the Treatment of the Fungus Ball of the Maxillary Sinus: A Technique as Simple as It Is Effective.

Fungus ball of maxillary sinus generally affects immunocompetent and nonatopic subjects. Although endoscopic removal is the current gold standard treatment, removal is at times difficult due to an accumulation of fungal elements in the anterior ad inferior recesses. Aim. To present our experience of maxillary fungus ball treated by the “gauze technique” that avoids these removal difficulties. Materials and Methods. A retrospective, cross-sectional, and descriptive study of 25 patients affected by maxillary fungus ball was carried out: 19 were treated by the “gauze technique” and 6 were treated without “gauze technique.” Results. A comparison was made between the two groups for surgery procedure time, length of hospitalization, time from surgery to nasal unpacking, complications, and postsurgical patient satisfaction. The only statistically significant difference observed was a shorter surgical procedure time (p < 0.05) for the “gauze technique.” Conclusions. The data obtained in this study demonstrated that the “gauze technique” is a safe, simple, and quick technique, able to reduce surgery procedure time whilst providing excellent functional outcomes and patient satisfaction.

Maxillary and Sphenoid Sinus Fungus Ball: A Single Belgian Centre's Experience

Maxillary and Sphenoid Sinus Fungus Ball: A Single Belgian Centre's Experience Background: Fungus ball describes the non invasive accumulation of dense fungal concrements in a sinus cavity. Bone, blood vessels, submucosa and sinus mucosa are free of fungal elements. It usually occurs in immunocompetent adults. It can involve the maxillary or the sphenoid sinus. Methodology: We reviewed the files of 66 patients treated for sinus fungus ball (SFB) in the ENT department of the CHU Dinant - Godinne during the past 15 years. Our cohort of patients was divided in 2 groups. The first group comprised the patients with maxillary fungus ball (MSFB) (n = 50 patients) and the second with sphenoid fungus ball (SSFB) (n = 16 patients). Clinical presentation, imaging and surgical treatment were recorded. Results: Patients with MSFB complained more frequently of postnasal drip whereas retroocular pain was more common in the group of SSFB. On CT scans, an heterogeneous partial or complete opacity of the affected sinus with sclerosis of the bony walls was present in both groups. Microcalcifications were much more common in the group of MSFB. The definitive diagnosis was made by the pathologist in all the cases. When positive (n = 13/55), Aspergillus fumigatus grew on culture. Fungus balls were treated by surgery (mainly endonasal approach) with a success rate of 91%. It consisted of a complete removal of the fungal hyphae with preservation of the healthy mucosa and restoration of the aeration and drainage of the sinus. Surgery mainly consisted of a middle antrostomy in the first group and a sphenoidotomy performed via the sphenoethmoidal recess in the second one. Conclusions: The clinicians must be aware of this entity in case of a unilateral symptomatic rhinosinusitis persisting despite appropriate medical treatment. A biopsy of the mucosa adjacent to the fungus ball must be performed to rule out any invasion within the tissues.

Septal Deviation Is Associated with Maxillary Sinus Fungus Ball in Male Patients

Fungus is one of the causes of chronic rhinosinusitis. If the fungus occupies the sinus but does not invade the sinonasal mucosa, this is called sinus fungus ball. Any association between anatomical variations and fungus ball remains unclear. Sinus fungus ball is defined as non-invasive chronic fungal rhinosinusitis occurring in immunocompetent patients, and the maxillary sinus is the most commonly affected. The etiology of maxillary sinus fungus ball remains unclear. This study assessed the potential contribution of anatomical variations, such as deviated nasal septum, concha bullosa, and Haller cell to the development of fungus ball in the maxillary sinus. Concha bullosa and Haller cell are structural variations that narrow the nasal airflow passage and contribute to chronic rhinosinusitis. The involvement of these variations has been investigated in chronic sinusitis but not in sinus fungus ball. Preoperative computed tomography findings of 103 patients with maxillary sinus fungus ball were evaluated retrospectively. Septal deviation and Haller cell were not correlated with the side of maxillary sinus fungus ball. Concha bullosa was more common on the unaffected side (p = 0.099). When we analyzed males and females separately, maxillary sinus fungus ball was more common on the concave side of the deviated septum in only male patients (p = 0.006). The high incidence of maxillary fungus ball in the concave side may reflect the consequences of the traumatic effects caused by wall shear stress of the high-velocity airflow and the increased chance of inhaling fungus spores.

Endoscopic Removal of Fungus Balls in Maxillary Sinuses

Objective: We aimed to compare between a newly developed instrument, powered saline irrigation system, and the traditional technique in the complete removal of fungus balls in maxillary sinuses during functional endoscopic sinus surgery. Method: Between July 2009 and July 2011, unilateral maxillary sinus fungus balls were removed with the traditional method in 17 patients and with the assistance of powered saline irrigation in 12 patients. The duration, complication and recurrence by these 2 procedures were compared. Results: The fungus balls could be efficiently cleared in all (100%) maxillary sinuses. However, the mean duration for the traditional method group was 397 ± 42 seconds, significantly longer than 155 ± 29 seconds for the powered saline irrigation group ( P &lt; .001). In the traditional method group, 4 patients (24%) developed focal maxillary mucosal detachment during the procedure and 1 patient (6%) developed chronic bacterial maxillary sinusitis later, requiring a secondary endoscopic sinus surgery. Neither operative complication nor disease recurrence occurred during the follow-up period in the powered saline group. Conclusion: Our series confirms the efficacy of functional endoscopic sinus surgery in the treatment of maxillary fungus balls. The assistance of powered saline irrigation provides more timesaving procedures and less postoperative complications.

Maxillary Fungus Ball Caused by Retained Foreign Bodies for 25 Years

We present a case of a maxillary fungus ball caused by retained foreign bodies for 25 years. The patient sustained a stab wound in the left face 25 years ago. The patient had no symptoms and complications of a foreign body, until the patient went to the hospital. The fungus ball and foreign bodies were removed via an endoscopic and Caldwell-Luc approach. We suggest the need for careful inspection and radiologic studies to localize occult foreign bodies in the sinonasal cavity or facial soft tissues after facial trauma.

What is the Relationship between the Localization of Maxillary Fungal Balls and Intranasal Anatomic Variations?

ObjectivesAlthough the mechanisms underlying the initiation and maintenance of inflammation in unilateral maxillary fungal balls (FBs) are poorly understood, the relationship between intranasal anatomy and maxillary FB is thought to play an important role. The aim of this study was to investigate the relationship between anatomic variations and FB.MethodsWe enrolled 140 patients who were composed of 56 patients with FB, 56 patients with unilateral chronic rhinosinusitis (CRS), and 28 patients with no sinus disease. Computed tomography scans were retrospectively analyzed to identify and compare the associated nasal anatomic abnormalities. To measure the volume of the nasal cavity and middle meatus, computed tomography scans were reconstructed into three-dimensional images.ResultsThe relatively larger volume of the middle meatus was associated with the localization of the FB in contrast with the CRS. However, the nasal-cavity volume, nasal valve area, and nasal septal deviation were not significantly associated with localization of FB. The mean volumetric and areal measurements such as nasal cavity, middle meatus, and nasal valve in FB-ipsilateral sides were not significantly different from those in contralateral sides as well as other groups.ConclusionThe middle meatus bears the major part of the inspiratory nasal airflow, and its volume may influence the occurrence of FB.

Endodontic Treatment: A Significant Risk Factor for the Development of Maxillary Fungal Ball

ObjectivesThe risk factors for maxillary fungal ball are largely unknown. The aim of this study was to determine whether endodontic treatment of maxillary teeth is a risk factor for fungal ball development in the maxillary sinus, and to identify other possible risk factors.MethodsOne hundred and twelve case patients diagnosed with maxillary fungal ball (FB group) and age and gender matched control patients diagnosed with chronic paranasal rhinosinusitis (PNS group) were included to determine associations between previous endodontic treatment and maxillary fungal ball. In addition, we reviewed the dental extraction status of maxillary teeth and the underlying disease in both groups to analyze the other risk factors for maxillary fungal ball.ResultsThere were 36.3% of patients in the FB group and 16.1% in the PNS group showed evidence of endodontic treatment on the maxillary teeth (P<0.001). Even after correction for possible confounding factor - the frequency of dental extractions - the rate of endodontic treatment remained higher in the FB group. The mean number of endodontically treated maxillary teeth in the FB group and PNS group were 0.63 and 0.27, respectively (P=0.001). In addition, 20.5% of the patients in the FB group and 13.4% in the PNS group has diabetes mellitus (P=0.154).ConclusionEndodontic treatment on maxillary teeth was a significant risk factor for the development of fungal balls in the maxillary sinus.

Is canine fossa access necessary for successful maxillary fungus ball treatment?

Sinus fungus ball (FB) is a non-invasive mycosis that affects immunocompetent hosts, most frequently localized in the maxillary sinus. The current golden standard treatment is surgical removal. To evaluate the effectiveness of an endonasal endoscopically assisted approach to remove a maxillary FB combined or not with a transoral approach (sinusoscopy via canine fossa). A retrospective evaluation of paranasal FB treated by functional endoscopic sinus surgery (FESS) + transoral approach, compared to those treated by a sole FESS procedure. In total, 65 out of 90 patients presented with a maxillary localization and were treated by FESS. Thirthy-three patients received a combined FESS + transoral approach and 32 received solely a FESS procedure. Antimycotic medical therapy was not used in any case. With a mean follow-up of 93 months, the treatment was successful in 62 patients (95,4%) without significant differences between the two groups. Our data confirm the efficacy of FESS in the treatment of maxillary FB. A similarity in long-term results in both groups demonstrated that transoral sinusoscopy can be avoided. With the assistance of lateral-view and flexible endoscopes, angled surgical equipment and maxillary saline solution irrigations, complete removal of the diseased material and sinus clearance can be achieved by a sole middle meatotomy, reducing both morbidity and operating time.

Risk of maxillary fungus ball in patients with endodontic treatment on maxillary teeth: a case-control study

Maxillary sinus fungus ball (FB) is a noninvasive fungal disease commonly associated with symptoms of recurrent maxillary rhinosinusitis and/or extrusion of root canal filling material into the sinus. Chronic periapical inflammatory processes of dental origin are believed to be the risk factors in the pathogenesis of FB. The aim of this study was to determine whether endodontic treatment performed on maxillary molar, premolar, and canine teeth was a risk factor in the development of FB. We designed a case-control study in which the cases were patients with FB admitted to the Department of Otorhinolaryngology at the University of Brescia between January 1990 and April 2005. For each case, 3 age-matched controls were randomly selected from the admission registry of the University Dental Clinic. Orthopantomography was used to detect endodontically treated maxillary molar, premolar, and canine teeth in both patients and controls. Of 102 patients with FB who were admitted during the study period, 91 (89.2%) had had endodontic treatment compared with 113 (36.9%) of 306 controls (chi square = 83.6601, P = 0.000; OR 14.13; 95% CI 7.25-27.54). The mean number (standard deviation; interquartile range [IQR]) of endodontic procedures was 1.39 (0.86; 1-2) in patients and 0.53 (0.81; 0-1) in controls (Mann-Whitney U test = -9.138, P = 0.0000). The interval between the endodontic treatment and the diagnosis of FB was available for 37 (36.3%) patients, and the median was 4 years (IQR 2-10). Endodontic treatment on maxillary teeth is a strong risk factor for FB of the maxillary sinus.

The Role of Ostiomeatal Complex Obstruction in Maxillary Fungus Ball

The aim of this study was to clarify the role of ostiomeatal complex obstruction in maxillary fungus ball. Comparative study in a hospital setting of the mean Lund-Mackay scores for the anterior ethmoid and frontal sinuses of 54 versus 48 patients with maxillary fungus ball versus chronic unilateral rhinosinusitis, respectively. In cases with partial opacification in the maxillary sinus, the anterior ethmoid and frontal sinuses were diseased in the chronic unilateral rhinosinusitis group but not in the maxillary fungus ball group. In cases with total opacification in the maxillary sinuses, all anterior ethmoid and frontal sinuses in both groups were diseased, but the disease condition of the frontal sinuses was significantly less severe in the maxillary fungus ball group (P < 0.001). In this era of evidence-based medicine, we provide statistical data supporting the principle that maxillary fungus ball is not associated with osteomeatal complex obstruction and that another as-yet-unexplained mechanism must be responsible. B-3b.

Minimally invasive surgery for maxillary fungal balls

Minimally invasive surgery for maxillary fungal balls