Analysis of pathogenetic process of fungal rhinosinusitis: Report of two cases

Geo-climatic risk factors for chronic rhinosinusitis in southwest Iran

Chronic rhinosinusitis (CRS) is a prevalent and disabling paranasal sinus disease associated with some environmental factors. In this study, we evaluated the effect of geo-climatic factors on CRS in a region of southwest Iran. The study mapped the residency addresses of 232 patients with CRS who lived in Kohgiluyeh and Boyer-Ahmad province and had undergone sinus surgery from 2014 to 2019. The effects of Mean Annual Humidity (MAH), Mean Annual Rainfall (MAR), Mean Annual Temperature (MAT), maximum MAT (maxMAT), minimum MAT (minMAT), Mean Annual Evaporation (MAE), wind, elevation, slope, and land cover were assessed on the occurrence of CRS using Geographical Information System (GIS). Statistical analysis was performed using univariate and multivariate binary logistic regression. Patients came from 55 points including villages, towns, and cities. In univariate analysis, climatic factors including MAT (OR = 0.537), minMAT (OR = 0.764), maxMAT (OR = 0.63), MAR (OR = 0.994), and MAH (OR = 0.626) were significantly related to CRS occurrence. Elevation (OR = 0.999), slope (OR = 0.9), and urban setting (OR = 24.667) were the significant determinants among geographical factors when analyzed independently. The multivariate analysis found maxMAT (OR = 0.5), MAR (OR = 0.994), elevation (OR = 0.998), and urban (OR = 16.8) as significant factors affecting CRS occurrence. The urban setting is the most critical factor affecting CRS disease. Cold and dry areas and low attitude are the other risk factors for CRS in Kohgiluyeh and Boyer-Ahmad province, southwest Iran.

Mycotic Infection (Fungal Ball) of the Paranasal Sinuses: A Clinicopathological Observation

Mycotic infections of the nasal cavity and paranasal sinuses represent a wide spectrum of disorders that vary in clinical presentation, histopathologic appearances, and biological significance. The second most common form is a fungal ball. The objective of the research was to describe the cases of paranasal sinus fungal ball found in the files of patients with chronic rhinosinusitis. Materials and Methods. There were demonstrated clinical and histopathological data of two patients. Results. A 42-year-old woman and a 40-year-old man with chronic hypertrophic sinusitis had a large amount of friable cheesy mass in the maxillary sinus. The female patient previously underwent upper dental arch sanation. Histology revealed dense laminated masses of matted fungal hyphae that were separate from the mucosa. Sinonasal mucosa showed mild chronic inflammation (male) and severe non-specific chronic active inflammation (female). No evidence of fungal invasion in the mucosa was found. Conclusions. Fungal ball represents a non-invasive form of mycotic rhinosinusitis with favourable prognosis. Biopsy examination plays an important role in the diagnostic process. Although the diagnosis can also be achieved by polymerase chain reaction assays, biopsy is the only way to explore the status of an inflammatory damage to adjacent tissue and, thus, to rule out potential invasive mycotic sinus disease with much worse clinical outcome.

Anatomical Considerations and Study of the Fractal Dimension around the Posterior Superior Alveolar Artery

The Posterior Superior Alveolar Artery (PSAA) provides vascular support to molars, gingiva, and maxillary sinus. A tear of the PSAA may cause profuse hemorrhages which may lead to complications at a surgical level. As such, it becomes crucial to anatomically analyse several features regarding the PSAA as well as the area surrounding it. In this paper, we are particularly interested in the study of the complexity of the periodontal tissue structure which appears close to the location of the PSAA. A total amount of 400 cone beam computed tomography (CBCT) scans (two per subject) were performed to explore the presence of the PSAA, the thickness of the Schneider’s membrane, and the existence of septa. Several parameters were evaluated including the location of the artery in the maxillary sinus, the distance from the PSAA to the alveolar ridge, the thickness of the membrane, the diameter of the cavities produced by the septa, and the fractal dimension of the trabecular tissue that surrounds the PSAA. They were found strong linear relationships between Distal and Central Measures (a Pearson’s R 2 = 0.9952 ), Mesial and Central Measures ( R 2 = 0.9950 ), and Distal and Mesial Measure ( R 2 = 0.997 ). We hypothesised that the loss of dental pieces would imply a distinct complexity of the trabecular tissue structure surrounding the PSAA. In this way, a p-value equal to 0.001 was provided by the Mann-Whitney test, which supports our hypothesis. Furthermore, the mean of the fractal dimensions of the group of edentulous patients (equal to 1.56 ) was found to be lower than the one of the group of non-edentulous patients (equal to 1.61 ) with small standard deviations in both cases. Our study suggests that accurate calculations of the fractal dimension combined with the use of CBCT do provide valuable information regarding the area that surrounds the PSAA.