Endoscopic view of maxillary fungal sinusitis.A 40-year-old woman presented to us with recurrent sinus infections associated with right facial and cheek discomfort. Computed tomography (CT) of the sinuses showed opacification of the right maxillary sinus and soft-tissue swelling in the right ostiomeatal complex (figure, A). Endoscopic evaluation of the right nasal cavity revealed that the uncinate process was edematous e·dem·a·tous adj. Marked by edema. and was obstructing the right middle meatus (figure, B). We performed endoscopic sinus surgery with a microdebrider. After we removed the edematous uncinate process from the right middle meatus, we performed a right middle meatal antrostomy, which revealed the presence of extensive fungal debris in the maxillary sinus (figure, C). We carefully debrided the sinus without stripping the mucosa (figure, D). Culture of the inspissated inspissated /in·spis·sat·ed/ (in-spis´at-id) being thickened, dried, or made less fluid by evaporation. inspissated being thickened, dried, or made less fluid by evaporation. material identified it as Aspergillus Aspergillus Any fungus of the genus Aspergillus of the Fungi Imperfecti (form-class Deuteromycetes). Species for which the sexual phase is known are placed in the order Eurotiales. A. niger causes black mold on some foods; A. niger, A. flavus, and A. . At the 1-year follow-up, the maxillary sinus remained clear. [FIGURE OMITTED] Fungal sinusitis has been the subject of increasing attention and discussion in recent years. (1) Likewise, the role of fungal organisms in the pathophysiology of chronic acute rhinosinusitis is being investigated. (2,3) The case presented herein illustrates the characteristic endoscopic findings in a patient with maxillary fungal debris. References (1.) Ponikau JU, Sherris DA, Kern EB, et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 1999;74(9):877-84. (2.) Mirante JP, Krouse JH, Munier MA, Christmas DA. The role of powered instrumentation in the surgical treatment of allergic fungal sinusitis. Ear Nose Throat J 1998;77(8):678-80, 682. (3.) Mirante JP, Christmas DA, Yanagisawa E. Endoscopic view of sphenoid sphenoid /sphe·noid/ (sfe´noid) 1. wedge-shaped. 2. sphenoid bone. sphenoi´dal sphe·noid n. The sphenoid bone. adj. 1. fungal sinusitis. Ear Nose Throat J 2005;84(3): 126-7. Dewey A. Christmas Jr., MD; Joseph P. Mirante, MD, FACS FACS Fellow of the American College of Surgeons. FACS abbr. Fellow of the American College of Surgeons FACS fluorescence-activated cell sorter. ; Eiji Yanagisawa, MD, FACS From the Department of Otolaryngology, University of South Florida College of Medicine As of Fall 2006, there were 477 students in the M.D. program; 78 students in the M.S. and 83 students in the Ph.D. program in the School of Basic Biomedical Sciences; and 55 students in the DPT program in the School of Physical Therapy. , Tampa, and the Halifax Medical Center Halifax Medical Center (HMC) is a 764-bed hospital located in Daytona Beach, Florida. HMC is the largest hospital serving Volusia and Flagler counties and provides the area's only trauma center, pediatric emergency department, neonatal intensive care unit and pediatric intensive , Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante), and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa). |
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