Aspergillosis of the maxillary sinus as a complication of overfilling root canal material into the sinus: report of two cases

Anatomic relationship between the root apex of maxillary molars and maxillary sinus in the presence of antagonist teeth: A Kwak's method with divisions

OBJECTIVE

The purpose of the study was to evaluate the proximity between the root apices of maxillary molars and maxillary sinus floor using cone-beam computed tomography (CBCT) in the southern Turkish subpopulation.

DESIGN

For the study, 246 CBCT images were analyzed. The absence of antagonist teeth was excluded. Kwak's types III and V were detailed with three divisions. Division M; the penetration of the mesial root only, Division D; the penetration of the distal root only, and Division MD; the penetration of both buccal roots. The distance between the maxillary sinus and the root apices was measured. Student's t-test, one-way ANOVA, and chi-square were used for statistical analysis.

RESULTS

The penetration of maxillary molars was 24.40%. The highest prevalence belonging to Type I. Division MD was 44.35% for Type III and 40.42% for Type V. Division M was higher than Division D. The distances between the sinus and root apices were 1.35-2.41 mm in Type I. The distance decreased with age (p < 0.05).

CONCLUSION

Both buccal root penetration into the sinus was higher than the single root penetration. The distance of the second molar root apices to the sinus was closer than the first molar. One-quarter of the first and second molars were inside the sinus. A greater likelihood of penetration of the root apices into the sinus with increased age.

Prelacrimal Window Approach in the Management of Odontogenic Maxillary Sinusitis from Dental Foreign Body

The floor of the maxillary sinus is partly formed by the alveolar process of the maxilla, and this anatomical relationship forms an interface for collaboration between rhinologists, maxillofacial and dental surgeons, and dentists. Odontogenic maxillary sinusitis (ODMS) occurs secondary to infectious processes of the maxillary molar and premolar teeth or following complications from dental procedures. Extruded dental foreign bodies within the sinus can cause chronic mucosal irritation leading to mucociliary dysfunction and sinogenic symptoms. Anteriorly placed foreign bodies are difficult to access via the conventional endoscopic maxillary antrostomy. Endoscopic approaches to access the anterior maxillary sinus involve extended resection of the medial maxillary wall, potentially with the removal of the inferior turbinate and nasolacrimal duct mobilisation. The prelacrimal window approach (PLWA) is a favourable modification that provides excellent visualisation of the maxillary sinus with minimal tissue resection and displacement. We describe the case of an extruded distobuccal 27 tooth root into the anterior maxillary sinus, presenting with acute sinusitis. The patient was successfully managed via a PLWA. This case represents the importance of recognition of ODMS with early referral to otorhinolaryngologists.

Paranasal Sinus Fungus Ball, Anatomical Variations and Dental Pathologies: Is There Any Relation?

Objective:

The purpose of this study was to investigate the relationship between anatomical variations and the fungus ball (FB), and the association between odontogenic etiologies and the maxillary sinus FB.

Methods:

We analyzed the clinical records of 66 patients who underwent endoscopic sinus surgery for FB. The anatomical variations determined were nasal septal deviation (NSD) and direction, presence of Onodi and Haller cell, concha bullosa and lateral recess of the sphenoid sinus. Further, dental X-ray records were reviewed to detect any possible odontogenic etiologies in patients with maxillary sinus FBs.

Results:

There were 41 female and 25 male patients. Positive fungal culture was found in 60 patients (91%) and the causative fungus was Aspergillus species in all cases. The correlation between NSD and localization of the maxillary sinus FB was statistically significant (p=0.0409). Maxillary sinus FB was more common on the concave side of the NSD. Presence of dental pathologies was significantly associated with maxillary sinus FB compared to the healthy side (p=0.0011). For sphenoid sinus FB, NSD was detected in a similar number for both the affected and unaffected side and there were no significant correlations (p>0.05). However, the relationship between sphenoid sinus FB and presence of lateral recess was significant (p=0.0262).

Conclusion:

Our study revealed that the maxillary sinus FB was more common on the concave side of the deviated septum. Also, dental pathologies or a presence of dental treatment history were associated with maxillary sinus FB.

Aspergillosis of the maxillary sinus associated with dental implant

Aspergillosis is a fungal disease caused by fungus aspergillus ; this disease frequently involves the lungs and occasionally the maxillary sinus. Aspergillosis in the maxillary sinus usually has the characteristics of a non-invasive form. It has been suggested that spores of aspergillus can be inhaled to the maxillary sinus via the osteomeatal complex or via through an oroantral fistula after dental procedures such as an extraction. However, maxillary aspergillosis related to implant installation has rarely been reported. This report regards unusual cases of maxillary aspergillosis associated with dental implant therapies in healthy patients. The cases were successfully treated with the surgical removal of the infected or necrotic tissues.

Chemical composition of essential oil and antifungal activity of Artemisia persica Boiss. from Iran

Artemisia is the largest and most diverse genus from the Asteraceae family that named locally "Dermaneh" in Iran. This study was conducted to determine, the chemical compounds of Artemisia persica Boiss essential oil and its antifungal effect, toward six toxigenic fungal strains in vitro. The yield of essential oil from the aerial parts of this plant species, using hydrodistillation method obtained 0.18% (v/w). The results of GC/MS analysis identified 31 components in the essential oil that laciniata furanone E (17.1%), artedouglasia oxide C (13.2%), Trans-pinocarveol (10.2%), pinocarvone (8.5%), and α-pinene (5.8%) were the major compounds. The results of the antifungal activity showed that the most sensitive fungal strains to A. persica Boiss. essential oil were Aspergillus ochraceus and Aspergillus parasiticus with lower minimal fungicidal concentration (MFC) of 1.25 μl/ml (v/v). Also the strong fungicidal effect was observed against Aspergillus flavus and Aspergillus nidulans at a MFC value of 2.5 μl/ml, while the fungicidal activity against Aspergillus fumigatus and Aspergillus niger observed in the 10 μl/ml oil concentration. According to the results A. persica Boiss essential oil has a acceptable antifungal activity against Aspergillus strains and can be used to prevent food crops from fungal contaminations.

Removal of fungal ball from the jaws by lefort i osteotomy: Difficulty in diagnosing patients with chronic sinusitis

Aspergillosis, aka fungal ball (FB), is classified as a type of non-invasive fungal rhinosinusitis, which usually occurs unilaterally in the maxillary sinus of an immunocompromised patient. Its diagnosis is complex and depends on the association between clinical, imaging, and histopathological exams. There are many treatments for fungal infections of the paranasal sinuses, so early diagnosis is extremely important to determine the appropriate treatment. This paper reports an unusual clinical case of aspergillosis present bilaterally inside the maxillary sinuses of a healthy patient, associated with mucous retention cysts, whose imaging exams and transnasal endoscopy were not sufficient to precisely identify the lesion. Its diagnosis and definitive treatment were obtained only after orthognathic surgery and integration between a multidisciplinary team. Key words:Aspergillosis, communicable diseases, fungal ball, infectious disease, orthognathic surgery.

Topographic relationship between maxillary sinus and roots of posterior teeth: a cone beam tomographic analysis

Purpose:

The objective of the research was to determine the relationship between root apices and maxillary sinus wall, and to analyze pulpoapical conditions of 2nd premolars, 1st molars, 2nd molars, 3rd molars using cone beam computerized tomography (CBCT).

Materials and methods:

This study was conducted on a retrospective manner of CBCT images of 1000 maxillary sinus with 500 subjects, who visited the Department of Dento-Maxillofacial Radiology. The association of each teeth with sinus floor and pulpoapical status were categorized. The association among gender, age, lateralization of sinus cavity were evaluated.

Results:

A total of 602 second premolars, 500 first molars, 623 second molars, 347 third molars were evaluated. There were no significant differences between pulpoapical condition of teeth and gender or left and right sides (p=0.065, p=0.072). There were significant associations between pulpoapical condition of all teeth and age (p=0.023), and the relationship of each root with maxillary sinus and age (p=0.037). There was significant association between vertical position and right/left sides in second and third molars (p=0.033).

Conclusion:

Age seems to have relationship with periapical condition of teeth, and the association of root with the sinus cavity.

Accuracy and stability of electronic apex locator length measurements in root canals with wide apical foramen: an ex vivo study

The aim of the current study was to determine the accuracy of electronic apex locator (EAL) measurements when using files of different sizes in roots with wide apical foramina while considering a new parameter of stability of EAL reading. Ten teeth with straight roots were subjected to a sequential widening of the apical foramen to 0.6, 0.7, and 0.8 mm. The roots were embedded after each enlargement stage in an alginate mold and subjected to EAL readings. Measurements were done using sequential K-file sizes and the self-adjusting file (SAF). Measurement stability was introduced as a new additional parameter. As the difference between the file size used and the apical diameter of the canal decreases, the results obtained were more accurate and stable. The stability and accuracy of the measurements coincided with each other in a statistically significant manner. Within the limitations of the present ex vivo study, it may be concluded that in straight canals with wide apical foramina of 0.6–0.8 mm, both SS K-files which fit snugly to the walls of apical foramen and the SAF file may offer both accurate and stable EAL measurements.

Influence of the Maxillary Sinus on the Accuracy of the Root ZX Apex Locator: An Ex Vivo Study

This study evaluated the accuracy of the Root ZX (J. Morita, Tokyo, Japan) electronic apex locator in determining the working length when palatal maxillary molar roots are in a relationship with the sinus. Seventeen human maxillary molars with vital pulp were scheduled for an extraction and implant placement as part of a periodontal treatment plan. The access cavity was prepared, and a #10 K file (Dentsply Maillefer, Ballaigues, Switzerland) was inserted into the palatal root using the Root ZX apex locator in order to determine the electronic working length (EWL); then, the teeth were extracted. To determine the real working length (RWL), a #10 K file was introduced into the root canal until its tip touched a glass plate. EWL and RWL were compared. Images reconstructed with CBCT (cone beam computerized tomography) revealed that eight palatal roots were related to the maxillary sinus, whereas nine were not. The results showed a significant difference between the EWL and the RWL of the palatal roots related to the sinus (p < 0.001). No significant difference was observed in measurements of roots not in contact with the sinus (p > 0.05). Within the study limitations, the reliability of Root ZX was influenced by the relationship of the roots with the maxillary sinus.

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.

Extrusion of Root Canal Sealer in Periapical Tissues - Report of Two Cases with Different Treatment Management and Literature Review

Background: Extrusion of root canal sealers may cause damage to the surrounding anatomic structures. Clinical symptoms like pain, swelling and paresthesia or anesthesia may be present. The purpose of this presentation is to describe two cases of root canal sealer penetration into periapical tissues. A different treatment management was followed in each case.

Case reports: A 55 year-old man underwent root canal retreatment of the right mandibular first molar tooth due to a periapical lesion. Postoperative periapical radiographs revealed the presence of root canal sealer (AH26) beyond the apex in the distal root in proximity to the mandibular canal. The patient reported pain for the next 7 days. Radiographic examination after 1 year showed complete healing of the periapical area and a small absorption of the root canal sealer. A 42 year-old woman was referred complained of swelling and pain in the area of the right maxillary first incisor. Radiographic examination showed extrusion of root canal sealer in the periapical area associated with a periapical lesion. Surgical intervention was decided upon, which included removal of the sealer, apicoectomy of the tooth and retrograde filling with MTA. After 1 year, complete healing of the area was observed.

Conclusion: In conclusion, cases of root canal sealer extrusion, surgical treatment should be decided on only in association with clinical symptoms or with radiographic evidence of increasing periapical lesion.

Aspergillosis associated with surgically assisted rapid maxillary expansion

Surgically assisted rapid palatal expansion (SARPE) is one of the most common orthognathic surgery operations for the treatment of maxillary transverse deficiencies. Although this operation is considered technically simple and has low complication rate, predisposing factors can complicate the postoperative period. In this case report, fistula formation and aspergillosis after SARPE operation were presented.

Maxillary Sinus Impaction of a Core Carrier Causing Sustained Apical Periodontitis, Sinusitis, and Nasal Stenosis: A 3-year Follow-up

INTRODUCTION

The aim was to present a case report of a full-length extrusion of an obturator's core carrier into the maxillary sinus, causing clinical symptoms from the nose region with differential diagnostics aspects, which, in turn, led to several surgical treatments of the nostrils before diagnosis and correct endodontic retreatment of a maxillary right first molar. A 36-year-old man presented in 2012 with complaints from the right nostril region. Medical treatment with antibiotics and surgical procedures because of nasal stenosis resulted only in partial improvement. Five years earlier, a root canal treatment was performed on the maxillary right first molar. Intraoral radiographs revealed 10-mm overfilling of root filling material into the maxillary sinus from the palatal root of tooth #3.

METHODS

Before surgical removal of the excess root filling material, orthograde revision was performed. Cone-beam computed tomographic imaging was used to localize the position of the root filling material, which protruded through the maxillary sinus and reached the inferior nasal wall.

RESULTS

Surgical removal from the palatal aspect revealed that the root filling material was a core carrier of an obturator. Scanning electron microscopy and transmission electron microscopy showed evidence of microbial biofilm on the core carrier as well as remnants of sinus mucosa. At the long-term follow-ups, the tooth had healed apically, and symptoms of nasal stenosis were markedly reduced.

CONCLUSIONS

This case report represents a challenging differential diagnostic topic urging the importance of a medical and dental interdisciplinary dialogue. The use of cone-beam computed tomographic imaging was crucial for the surgical retreatment.

Association between maxillary sinus pathologies and healthy teeth

INTRODUCTION

The proximity of the roots to the maxillary sinus can create a variety of risks.

OBJECTIVE

To evaluate the relationship between the roots of healthy teeth and the maxillary sinus, as well as the occurrence of sinus pathologies.

METHODS

Three radiologists analyzed 109 cone beam computed tomography (CBCT) images. The Kappa test was used to assess the intra- and inter-rater agreement. The chi-squared test and prevalence ratio were used to test the hypothesis that roots of healthy teeth in the maxillary sinus favored the occurrence of sinus pathologies (p=0.01).

RESULTS

Intra- and inter-rater agreement ranged from good to excellent. The chi-squared test demonstrated a statistically significant difference (p=0.006) between the tooth roots in diseased maxillary sinuses (6.09%) and those in normal sinuses (3.43%). The prevalence ratio test showed a statistically significant higher prevalence of tooth roots in diseased sinuses than in normal sinuses (p<0.0001). Roots in the maxillary sinus were 1.82 times more associated with diseased sinuses.

CONCLUSION

Dental roots in the maxillary sinus are almost twice as likely to be associated with diseased sinuses than normal sinuses. Healthy teeth whose roots are inside the maxillary sinus may induce an inflammatory response in the sinus membrane. It is suspected that dental procedures may exacerbate the condition.

Post endodontic Aspergillosis in an immunocompetent individual

Non-invasive aspergillosis in immunocompetent individuals subsequent to post endodontic treatment can involve the maxillary antrum. An early and accurate diagnosis will aid in prompt and effective treatment. A 35 year old female patient reported with a painful nasomaxillary swelling. Previous records revealed the failure of the endodontic treatment of maxillary left second premolar which was subsequently extracted. Root piece was accidently left behind which resulted in a painful nasomaxillary swelling. The extraction socket was curetted and tissue was sent for histopathological examination, which revealed abundant septate fungal hyphae with numerous spores characteristic of Aspergillus. The patient showed marked improvement in the symptoms with systemic itraconazole at 3 months follow up and complete resolution occurred within 6 months. Inclusion of aspergilloma infections in the differential diagnosis is advocated when patients present with post-endodontic nasomaxillary swelling.

Key words:Aspergillosis, fungal sinusitis, post root canal treatment.

Proximity of Posterior Teeth to the Maxillary Sinus and Buccal Bone Thickness: A Biometric Assessment Using Cone-beam Computed Tomography

INTRODUCTION

The aims of this study were to evaluate the vertical and horizontal relationships between the maxillary sinus floor (MSF) and the root apices of maxillary posterior teeth with various root configurations and the distance from the root apex to the MSF and the buccal cortical plate.

METHODS

Serial axial, coronal, sagittal, and paraxial cone-beam computed tomographic images of 132 Korean patients with fully erupted bilateral maxillary posterior teeth were analyzed. The vertical and horizontal relationships between the roots of maxillary posterior teeth and the MSF were determined. Distances from the apex to the MSF and the buccal bone plate were measured. The data were correlated with age, sex, side, and tooth type.

RESULTS

In total, 2159 apices in 1056 teeth were evaluated. For the vertical relationships, the frequency in group 1, in which a root apex protruded into the MSF, significantly increased toward the posterior (first premolars: 1.5%, second premolars: 14.8%, first molars: 40.5%, second molars: 44.7%, P < .001). The apices of the mesiobuccal roots of the second molars were found frequently in group 1 (35.8%) and had the shortest mean vertical distance to the MSF (0.18 mm) and the thickest mean horizontal distance to the buccal cortical plate (4.99 mm) among buccal roots of 3-rooted molars (P < .001). The frequency of group 1 differed significantly by age (P < .05). No statistically significant difference was found in sex or side analysis. For the horizontal relationship between the molar roots and the MSF, most teeth were in group BP, in which the lowest point of the MSF was located centrally, relative to the roots (94.3% for first molars, 81.0% for second molars). For the first molars, no significant difference according to sex or side was found. However, the right side (P = .003) and males (P = .005) showed higher incidences for second molars.

CONCLUSIONS

The data in this study highlight the close proximity between the root apex of maxillary posterior teeth and the MSF and provide estimated distances from the root apex to the buccal cortical plate. Special care must be taken in treatment planning in the maxillary posterior region.

Potential correlations of dentogenic factors to the development of clinically verified fungus balls: A retrospective computed tomography-based analysis

OBJECTIVES/HYPOTHESIS

Fungus balls are a common disease of the paranasal sinuses, usually involving the maxillary sinus. To clarify the pathology, we analyzed patients treated for maxillary sinus fungus balls to see whether the latter correlated with dentogenic factors.

STUDY DESIGN

Retrospective case analysis.

METHODS

Cases of maxillary sinus fungus balls diagnosed between January 2000 and December 2013 were analyzed retrospectively. Patients' charts were reviewed for diagnosis, gender, and age. Paranasal sinus computed tomography (CT) scans were reviewed according to the side of the fungus ball, calcifications/opacifications, and dentogenic factors.

RESULTS

In 98/102 patients (96.1%), 157 dentogenic factors could be identified on the side affected by a fungus ball. On the contralateral healthy side, there were 125 dentogenic factors. In four (3.9%) of the patients, no dentogenic pathology was identified on the CT scan. The presence of dentogenic factors (regardless of number) was significantly associated with a fungus ball compared to the healthy side (P = .024, χ(2) test, odds ratio: 2.72 [95% confidence interval: 1.02-7.23]).

CONCLUSIONS

Dentogenic factors regardless of type potentially correlate with the presence of maxillary sinus fungus ball. Unlike the overall presence of dentogenic factors, the particular dentogenic factors in an individual patient do not significantly influence the development of fungus balls. After diagnosis of dentogenic pathology in penetrated maxillary sinus floors, patients should be closely monitored and informed about their higher risk of developing a fungus ball.

Retrieval of extensive gutta-percha extruded into the maxillary sinus: use of 3-dimensional cone-beam computed tomography

INTRODUCTION

Close proximity of the maxillary sinus to the roots of maxillary teeth can predispose to the inadvertent deposition of endodontic products into the maxillary sinus. One such material is thermoplasticized injectable gutta-percha, which has gained popularity of late. As a consequence of overfilling, some patients warrant surgical retrieval.

METHODS

A case report of extreme overextension of gutta-percha within the maxillary sinus after endodontic retreatment on tooth #14 was provided. The distobuccal and palatal canals had been obturated with gutta-percha master cones and backfilled with thermoplasticized injectable warm gutta-percha. The mesiobuccal canal had only been filled with thermoplasticized injectable warm gutta-percha, the origin of the extrusion. Imagery with 3-dimensional cone-beam computed tomography was performed for localization of the gutta-percha.

RESULTS

The patient underwent a Caldwell-Luc approach for removal of the extruded material. The gutta-percha was successfully removed intact, and the patient had an unremarkable postoperative course. However, the patient continues to have mild tenderness in the sinus region.

CONCLUSIONS

The featured case exemplified the consequence of overinstrumentation and ensuing inadequate apical stop. In these situations, the obturation of a maxillary tooth with thermoplasticized injectable gutta-percha, without master cones, can potentially result in overfilling and deposition into the antrum. Use of 3-dimensional cone-beam computed tomography could enhance endodontic diagnosis, serve as an aid for visualization of foreign materials within the sinus and contiguous soft tissue structures, and improve clinical outcome.

Foreign body of endodontic origin in the maxillary sinus

Foreign bodies found in the maxillary sinus include tooth roots, burs, dental impression material, root-filling materials, dental implants, and needles. The purpose of this paper was to present an unusual case of a large foreign body of endodontic origin (root-filling material) removed from the maxillary sinus. A 45-year-old generally healthy male patient reported to the Department of Conservative Dentistry with Endodontics of the Medical University of Silesia, because of orbital and buccal pain on the right side of his face and headaches in the preceding 6 months. Those symptoms were associated with the end of endodontic treatment of teeth 14 and 16. Periapical X-rays, including of teeth 14 and 16, showed the presence of root canal filling with extrusion of endodontic obturation material beyond the apices of tooth 14. In the case of tooth 16, a completely filled palatal canal and incompletely filled buccal canals were found. There was also an irregular dimness at the upper edge of the X-ray image. Panoramic radiography and computed tomography demonstrated a foreign body in the right sinus. Sinus exploration was performed via a surgical procedure conducted using topical anesthesia. The root apices of tooth 14 were resected, and foreign substance was removed. The practitioner did not correctly recognize a complication that occurred during endodontic treatment, which resulted in extrusion of endodontic material beyond the root apices of tooth 14. This case emphasizes the potential impact that an involved maxillary sinus may have on endodontic therapy. Detailed diagnostic identification based on the medical interview, physical and histopathological examinations, and diagnostic imaging allowed rapid surgical intervention and prevented local and general complications. It is important to realize that the range of the periapical X-ray projection is not always sufficient.

Rare mycoses of the oral cavity: a literature epidemiologic review

Stomatologic fungal infections display different etiologies, pathogenesis, and clinical presentations. The incidence of rare mycoses of oral cavity is very low. These infections can involve both immunocompromised and immmunocompetent patients with common predisposing factors, such as diabetes or suffering from diseases causing immune system impairment. Oral mycoses can cause acute, chronic, and mucocutaneous lesions. Candidiasis is the most common mouth mycosis. Although occasionally primary mouth pathogens, Cryptococcus spp. or filamentous fungi (Aspergillus spp. and zygomycetes) can cause oral mycoses, with the oral localization more commonly secondary to a more serious systemic infection. The diagnosis of oral mycoses is based on clinical examination; for yeasts, culture is necessary to identify the etiologic agents; for filamentous fungi, in particular for zygomycetes and dimorphic, a definitive diagnosis can be made by histologic examination and pertinent stains with or without isolation of the fungus from the same site.

Fungal infection as a complication of sinus bone grafting and implants: a case report

Sinus bone grafts have been used successfully to augment atrophic posterior maxilla for dental implant placement. Even though sinus bone grafting is generally considered to be a safe surgical procedure, postoperative maxillary sinus infections can occur and therefore need to be considered. Bacteria, as well as viruses and fungi, have been identified as causative agents. Because fungal infection of the maxillary sinus after sinus bone grafting is not well known, we report a case of a middle-aged male patient along with the clinical, radiographic, and histologic findings. The patient was referred from his private dentist because of failed sinus bone grafting and osseointegration of implants. The surgical approach to the sinus yielded a friable mass of brownish-red material from the sinus. Review of pathology slides revealed a noninvasive hyphal mass caused by Aspergillus and polypous mucosa. After surgical removal of the mycotic masses, sinus bone grafting, using allograft, was performed. Bone formation after the healing period was favorable and dental implants were placed. There was no recurrence of fungal sinusitis.

Five-year follow-up of a root canal filling material in the maxillary sinus: a case report

This report describes the 5-year clinical and radiographic follow-up of an accidental extrusion of a root canal filling material into the maxillary sinus and emphasizes the importance of monitoring of similar cases. The most favorable prognosis is achieved by surgically removing the extruded material from the sinus. Excess zinc oxide-eugenol-based materials in the sinus might cause aspergillosis sinusitis, and this entity often needs many years to develop. In this case, endomethasone was the filling material; however, the patient refused to undergo any surgical intervention. After a follow-up period of 5 years, the patient had no symptoms and radiographic examination disclosed no pathologic changes in the antrum.

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.

Gross extrusion of endodontic obturation materials into the maxillary sinus: a case report

A gross extrusion of endodontic obturation materials occurred from tooth 3 into the right maxillary sinus. The patient had never been conscious of uncomfortable symptoms, both at tooth 3 or buccal regions. A computed tomographic (CT) scan showed cord-like foreign substances extruded from the apex of the tooth and the hyperplasticity of the sinal mucosa. The surgical removal of foreign substances and partial curettage of sinal mucosa were indicated to prevent the possibility of sinus infection. At the 4-month recall, the patient was symptom free. This case emphasizes that an open apex can become potentially dangerous when the vertical condensation method is used. If massive overfilling is recognized radiographically in molar regions, an examination using panoramic radiograph is indispensable to detect the gross extrusion into the maxillary sinus, such as in this case.

Post-operative aspergillosis

While invasive aspergillosis occurs typically in severely immunocompromised patients, cases of surgical site infection have been reported in immunocompetent individuals. The Medline, LILACS and EMBASE databases were searched for descriptions of cases of post-operative aspergillosis, and references from relevant articles and conference abstracts were reviewed. More than 500 cases of post-operative aspergillosis were found. Cardiac surgery (n = 188), ophthalmological surgery (n > 90) and dental surgery (n > 100) were associated with the majority of cases. Other cases involved wound infections (n = 22), bronchial infections (n = 30), mediastinitis (n = 11), pleural aspergillosis (n = 1), infections following orthopaedic surgery (n = 42), vascular prosthetic surgery (n = 22), breast surgery (n = 5), abdominal surgery (n = 10) and neurosurgery (n = 25). In most patients, the source was presumed to be airborne infection during the surgical procedure. Prevention of these infections requires special care of the ventilation system in the operating room. Successful treatment requires rapid diagnosis, surgical debridement and antifungal therapy, often with voriconazole. In order to improve the outcome, better diagnostic methods are needed, particularly for cases of endocarditis and aortitis.

Aspergillus mycetoma of the Maxillary Sinus Secondary to Overfilling of a Root Canal

In nonimmunocompromised patients aspergillosis of the paranasal sinuses is a relatively rare disease. Root canal treated teeth with overextension of the root canal sealer or solid materials such as gutta-percha or silver cones into the sinus might be the main etiological factor for aspergillosis of the maxillary sinus in healthy patients. Root-filling materials based zinc oxide-eugenol is considered to be a growth factor for aspergillus. Aspergillus fumigatus needs heavy metals such as zinc oxide for proliferation and metabolism. Prognostic and histological studies showed that instrumentation and obturation should not extend beyond the apical foramen. When the sealer and/or gutta-percha is extruded within the sinus, this produce an inflammatory reaction and then Aspergillus growth. We report one case of healthy 60-yr-old male with overextension of root canal sealer in maxillary sinus. After surgical procedure, microscopic examination revealed aspergillosis. Overextension into the maxillary sinus with root canal cements has to be avoided.

Histopathologic assessment of fungal involvement of the paranasal sinuses in Turkey

OBJECTIVE

To assess paranasal sinus material histopathologically for the presence of fungus.

MATERIAL AND METHODS

Paraffin-embedded archival biopsy samples of patients who underwent endonasal sinus surgery between 1992 and 2002 were retrospectively assessed for the presence of fungi. Hematoxylin-eosin-stained sections of the materials were re-evaluated, and Gomori's methanamine silver stain was also applied as required.

RESULTS

Fungus (Aspergillus) was detected histopathologically in only 21476 patients, both of whom were immunocompetent. One patient was considered to have chronic indolent sinusitis and the other allergic fungal sinusitis.

CONCLUSIONS

Although histopathologic assessment is one of the most important diagnostic tools, on its own it may lead to underestimation of fungal involvement of the paranasal sinuses. Alternatively, fungal involvement of the paranasal sinuses may be very infrequent in Turkey.

Endodontic implications of the maxillary sinus: a review

The anatomical and clinical significance of the maxillary sinus in relation to conventional and surgical endodontic therapy is considered. The discussion includes a review on the development, anatomy and physiology of the maxillary sinus, the diagnostic evaluation of the sinus and the differential diagnosis of sinusitis. Endodontic implications of the maxillary sinus include extension of periapical infections into the sinus, the introduction of endodontic instruments and materials beyond the apices of teeth in close proximity to the sinus and the risks and complications associated with endodontic surgery.