Antrolith associated with aspergillosis of the maxillary sinus: report of a case

Challenges in plain film radiographic diagnosis for the dental team: a review of the maxillary sinus

The maxillary sinus is the largest of the paranasal sinuses, with its structure and contents commonly visualised on dental radiographs. Dental practitioners are required to evaluate the entire radiograph, and it is likely there is limited exposure to maxillary sinus pathoses and radiological interpretation in the undergraduate curriculum and routine continuing professional development courses. This review covers radiological features of common benign and malignant sinus disease. Identification of normal anatomical features, common variations and pathoses can facilitate holistic patient management and potentially early detection of neoplastic disease.

Maxillary Antroliths: A Digital Panoramic-based Study

Objectives Maxillary antroliths are calcified masses found within the maxillary sinus. The aim of this study was to investigate their presence in a sample of Lebanese population by means of digital panoramic radiographs. Material and methods In this study, 500 digital panoramic radiographs of Lebanese adult patients (281 females and 219 males) with a median age of 47.9±18.98 years were included and examined for maxillary antroliths. The statistical analysis of the data found was performed by IBM® SPSS® (IBM, Armonk, NY) version 20.0 for Windows. Results The sample investigated presented only three maxillary antroliths (0.6%). Among these, two were found in female patients and one in male; none of them was bilateral, one on the right side and two on the left side. No statistically significant relationships were observed with patients' gender and age. Conclusion Maxillary antroliths are rare entities detected accidentally on panoramic radiographs utilized frequently in dental clinics. In light of their possible association with chronic sinusitis, dentists should have a complete knowledge of their diagnosis.

Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management

For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.

Maxillary antroliths detected by cone-beam computed tomography in an adult dental population

PURPOSE

This study evaluated the prevalence and characteristics of maxillary antroliths using cone-beam computed tomography (CBCT) scans performed for maxillofacial diagnostic purposes.

MATERIALS AND METHODS

CBCT scans of 13,946 patients over the age of 20 were reviewed for maxillary antroliths, and prevalence according to sex, age, and the side of the jaw was calculated. The relationships of single or multiple antroliths with sex, side, and the degree of sinus inflammation were evaluated. The shape and dimension of antroliths were also assessed. The data were analyzed using descriptive statistics, the chi-square or Fisher exact tests, and Kendall's tau-b.

RESULTS

A total of 138 (0.99%) of the 13,946 patients showed an antrolith in at least 1 sinus. Only 18 patients presented a bilateral manifestation, which brought the total number of sinuses containing an antrolith to 156 (0.56%). Multiple antroliths were observed in 36 sinuses, and the total number of antroliths was 207: 110 punctate, 65 linear, and 32 amorphous. The antrolith dimensions varied from 1 mm2 to 91 mm2 (average, 10.2±15.5 mm2). No statistically significant differences were found according to sex, side, and age group (P>0.05). However, there was a statistically significant difference between the multiplicity of antrolith and the degree of sinus inflammation (P<0.05).

CONCLUSION

Cone-beam computed tomography is an effective modality for the detection of incidental antroliths. Maxillary antroliths were found to be very rare and were usually asymptomatic. Dentists should have a comprehensive understanding of their diagnosis and treatment in light of possible associated dental problems.

Maxillary sinus aspergilloma of odontogenic origin: Report of 2 cases with cone-beam computed tomographic findings and review of the literature

Aspergilloma of the maxillary sinus is considered rare in immunocompetent patients, but a considerable increase has recently been seen in the incidence of reported cases. Dental procedures involving the antral region are thought to predispose individuals to this form of aspergillosis. Because aspergilloma shares similar clinical features with other sinus pathologies, its diagnosis may be delayed. Thus, an early diagnosis confirmed by a histopathological examination plays a crucial role in the adequate management of aspergilloma. This article provides a concise review of the reported cases of aspergilloma associated with dental procedures and reports 2 new cases of aspergilloma in middle-aged female patients, with a presentation of their cone-beam computed tomographic findings.

Uncommon opportunistic fungal infections of oral cavity: A review

The majority of opportunistic oral mucosal fungal infections are due to Candida albicans and Aspergillus fumigatus species. Mucor and Cryptococcus also have a major role in causing oral infections, whereas Geotrichum, Fusarium, Rhodotorula, Saccharomyces and Penicillium marneffei are uncommon pathogens in the oral cavity. The broad spectrum of clinical presentation includes pseudo-membranes, abscesses, ulcers, pustules and extensive tissue necrosis involving bone. This review discusses various uncommon opportunistic fungal infections affecting the oral cavity including their morphology, clinical features and diagnostic methods.

Management of maxillary aspergillosis in a patient with diabetic mellitus followed by prosthetic rehabilitation

BACKGROUND

Mycotic infection of the paranasal sinuses and Maxilla are on the rise globally. Since 1968 the number of reported cases has increased three fold of all the fungal infections. Aspergillosis is one of the most rapidly progressing and lethal form of fungal infection. Among all fungal infections, Aspergillosis is the commonest fungal infection in human beings especially in orofacial region. Its early medical and surgical treatment can improve survival. We report a case of invasive Aspergillosis of maxilla in a patient with diabetes mellitus who was managed by systemic as well local antifungal therapy, along with surgical debridement and followed by prosthetic rehabilitation.

Sinolith in the ethmoid sinus: report of two cases and review of the literature

We present two cases of sinolith in the ethmoid sinus. The first was a 52-year-old woman who complained of nasal dyspnea, postnasal drip and dry cough. Computed tomography (CT) showed a smooth-margined oval stone embedded in the middle meatus and occupying the bulla ethmoidalis, which was destroyed. The second was a 71-year-old man who had had repeated polypectomies. An oval calcified mass was revealed on CT in the anterior ethmoid sinus adjacent to the left lamina papyracea. All pertinent literature were reviewed and only one further case of ethmoid sinolith was encountered. The etiology, radiological features, differential diagnosis and treatment are discussed.

[General review of rhinolithiases]

OBJECTIVE

The aim of this study was to analyze the clinical presentation and characteristics of rhinolithiasis, a rare and forgotten entity.

METHODS

Between 1990 and 2007, 20 cases of rhinolithiasis presented for consultation. The clinical course noted chronic nasal discharge associated with nasal obstruction. The protocol was the same for all patients: history of disease, meticulous endonasal endoscopy and plain radiography (+/-CT scan).

RESULTS

Rhinolithiasis was found in adults (55%), females, patients living in rural areas (66%) with unfavorable socioeconomic conditions. The diagnosis delay varied between six months and eight years. The examination showed the rhinolith in the form of a grey concretion, primarily unilateral and on the right-hand side in 60% of the patients. Only one bilateral case presented following destruction of the posterior nasal septum. The rhinolith measured between 5 and 50mm in diameter with only three associated foreign bodies (15%). The rhinolith was extracted through the natural pathways under local anesthesia in 60% of the cases. Complications were rare (epistaxis 10%) and favorable progression without recurrence was generally observed after a mean 16 months of follow-up (range, six months to 11 years).

CONCLUSION

Chronic nasal discharge without a history of rhinologic disease requires an endonasal examination under good conditions after retraction. Rhinolithiasis is easily recognized, in particular on imaging studies. Treatment is simple and curative in the majority of cases.

Surgical treatment of Aspergillus mycetomas of the maxillary sinus: Review of the literature

The present study reviews the literature concerning the surgical treatment of Aspergillus mycetoma (AM) in the last 20 years to identify a gold standard surgical technique. Aspergillus mycetoma of the maxillary sinus, or mycetoma (fungus ball), is a noninvasive or extramucosal mycotic infection. Surgical removal of the sinus fungal masses to ensure drainage and aeration is performed using the traditional Caldwell-Luc (CL) procedure or endoscopic sinus surgery (ESS). Results of this review suggest that the gold standard surgical technique for AM is ESS with middle meatal antrostomy. General or local antifungal drugs are not indicated. Combined approach with an intraoral surgical access from the anterolateral wall of the maxillary sinus has to be reserved for selected cases in which ESS doesn't permit complete extraction of all fungal concretions or foreign bodies. The CL procedure should be avoided, because it has detrimental consequences for sinus physiology.

Aspergillosis: a nidus of maxillary antrolith

We present a case of polypoid sinusitis with maxillary sinus antrolith, which is composed of Aspergillus species. Unlike most muddy or necrotic fungal balls, this first reported fungal antrolith is solid and extremely hard. Aspergillus served as a central fungal nidus associated with long-standing sinusitis, and poor sinus drainage could be a possible pathophysiology for the formation of a sinus stone. Aspergillosis infection should be considered in the differential diagnosis of a radiopaque paranasal sinus lesion. The endoscopic sinus surgery can be a reliable and minimally invasive method not only for the removal of the stone, but also for the restoration of ventilation and drainage of the diseased sinus.

Antroliths: survey of the literature and report of a case

In the present report, a case with a radiopaque mass within the right maxillary sinus antrum is presented, and the clinical/radiographic features of the lesion are provided. The patient's dental history has revealed extrusion of calcium hydroxide into the periapical area during a previous endodontic treatment. This finding has underscored the need to discuss the potential role of endodontic materials in the development of calcified tissues within the adjacent body cavities.