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Han SA, Kim S, Seo Y, Yang SK, Rhee CS, Han DH. Dental implant as a potential risk factor for maxillary sinus fungus ball. Sci Rep 2024; 14:2483. [PMID: 38291074 PMCID: PMC10827791 DOI: 10.1038/s41598-024-52661-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/22/2024] [Indexed: 02/01/2024] Open
Abstract
Fungus ball is the most common form of non-invasive fungal sinusitis, and maxillary sinus is the most commonly involved site. Maxillary sinus fungus ball (MFB) accounts for a considerable proportion of unilateral maxillary sinusitis. The prevalence of MFB has recently increased; however, its contributing factors are unclear. This study analyzed the association between MFB and dental implants. One hundred one patients who underwent unilateral maxillary sinus surgery were divided into two groups based on surgical biopsy results: unilateral bacterial sinusitis (UBS, n = 45) and MFB (n = 56). Stratified random sampling of 30 patients from each group was performed to adjust for age. The number of dental implants on maxillary teeth and degree of penetration into the maxillary sinus was radiologically evaluated. The number of patients with dental implants was greater (P = 0.085) and the number of implants was significantly higher (P = 0.031) in the MFB group. Dental implant can be a potential risk factor for MFB development. Therefore, dental implant surgeons should take caution in penetrating the maxillary sinus floor during implant insertion and otolaryngologists should consider the possibility of fungus ball when assessing patients with sinusitis who have dental implants.
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Affiliation(s)
- Sun A Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Republic of Korea
| | - Sungtae Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Yuju Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Daehakro 101, Jongno-gu, Seoul, Republic of Korea
| | - Seung Koo Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Daehakro 101, Jongno-gu, Seoul, Republic of Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Daehakro 101, Jongno-gu, Seoul, Republic of Korea
- Graduate School of Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Allergy and Clinical Immunology and Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul, Republic of Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Daehakro 101, Jongno-gu, Seoul, Republic of Korea.
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Kim K, Lim CY, Shin J, Chung MJ, Jung YG. Enhanced artificial intelligence-based diagnosis using CBCT with internal denoising: Clinical validation for discrimination of fungal ball, sinusitis, and normal cases in the maxillary sinus. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107708. [PMID: 37473588 DOI: 10.1016/j.cmpb.2023.107708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND OBJECTIVE The cone-beam computed tomography (CBCT) provides three-dimensional volumetric imaging of a target with low radiation dose and cost compared with conventional computed tomography, and it is widely used in the detection of paranasal sinus disease. However, it lacks the sensitivity to detect soft tissue lesions owing to reconstruction constraints. Consequently, only physicians with expertise in CBCT reading can distinguish between inherent artifacts or noise and diseases, restricting the use of this imaging modality. The development of artificial intelligence (AI)-based computer-aided diagnosis methods for CBCT to overcome the shortage of experienced physicians has attracted substantial attention. However, advanced AI-based diagnosis addressing intrinsic noise in CBCT has not been devised, discouraging the practical use of AI solutions for CBCT. We introduce the development of AI-based computer-aided diagnosis for CBCT considering the intrinsic imaging noise and evaluate its efficacy and implications. METHODS We propose an AI-based computer-aided diagnosis method using CBCT with a denoising module. This module is implemented before diagnosis to reconstruct the internal ground-truth full-dose scan corresponding to an input CBCT image and thereby improve the diagnostic performance. The proposed method is model agnostic and compatible with various existing and future AI-based denoising or diagnosis models. RESULTS The external validation results for the unified diagnosis of sinus fungal ball, chronic rhinosinusitis, and normal cases show that the proposed method improves the micro-, macro-average area under the curve, and accuracy by 7.4, 5.6, and 9.6% (from 86.2, 87.0, and 73.4 to 93.6, 92.6, and 83.0%), respectively, compared with a baseline while improving human diagnosis accuracy by 11% (from 71.7 to 83.0%), demonstrating technical differentiation and clinical effectiveness. In addition, the physician's ability to evaluate the AI-derived diagnosis results may be enhanced compared with existing solutions. CONCLUSION This pioneering study on AI-based diagnosis using CBCT indicates that denoising can improve diagnostic performance and reader interpretability in images from the sinonasal area, thereby providing a new approach and direction to radiographic image reconstruction regarding the development of AI-based diagnostic solutions. Furthermore, we believe that the performance enhancement will expedite the adoption of automated diagnostic solutions using CBCT, especially in locations with a shortage of skilled clinicians and limited access to high-dose scanning.
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Affiliation(s)
- Kyungsu Kim
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chae Yeon Lim
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Joongbo Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Gi Jung
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Khademi B, Dehghan A, Zia Z, Dehghan Y. Imaging Spectrum of Coronavirus Disease- 2019 Associated Rhino-Orbital-Cerebral Mucormycosis; From Sinonasal Inflammation to Intracranial Involvement. Acad Radiol 2023; 30:1904-1914. [PMID: 36581530 PMCID: PMC9731934 DOI: 10.1016/j.acra.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES Rhino‑Orbital‑Cerebral Mucormycosis (ROCM) is a life-threatening opportunistic fungal infection, which mostly affects immunocompromised patients. There has been a notable rise in the incidence of ROCM during the COVID-19 outbreak. In this study we described imaging characteristics of ROCM in detail, from early sinonasal inflammation to late intracranial involvement. MATERIALS AND METHODS In this retrospective study, Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) of 48 patients with proven ROCM in biopsy or culture were evaluated. All the patients had a history of COVID-19 infection within the previous three months. The imaging findings were described and the frequency of different parameters was reported. RESULTS Paranasal inflammation was detected in all the patients on imaging. The most common involved paranasal sinuses were ethmoid sinuses (97.9%). On diffusionweighted images, restricted diffusion was seen in the paranasal sinuses of 81.1% of the patients. In addition, sinus wall bone involvement was observed in 87.5% of the cases. The most common anatomical sites for extrasinus involvement were the retroantral soft tissue (89.6%) and orbital cavity (87.5%). Dacryocystitis in 50%, optic nerve inflammation in 43.2%, globe involvement in 18.9%, and trigeminal nerve involvement in 16% of the patients were detected. There was extension of inflammation through the cavernous sinuses and alongside the internal carotid arteries in 24% of the patients. CONCLUSION Characteristic imaging findings of ROCM not only play a vital role in the early diagnosis of this infection, but they also contribute to the assessment of the extension of inflammation, which is vitally important in surgical planning.
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Affiliation(s)
- Behzad Khademi
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (B.K., Z.Z.)
| | - Alireza Dehghan
- Department of Radiology, Medical Imaging Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Zia
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (B.K., Z.Z.)
| | - Yasamin Dehghan
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Doo JG, Min HK, Choi GW, Kim SW, Min JY. Analysis of predisposing factors in unilateral maxillary sinus fungal ball: the predictive role of odontogenic and anatomical factors. Rhinology 2022; 60:377-383. [PMID: 35856790 DOI: 10.4193/rhin22.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The pathogenesis of maxillary sinus fungal ball (MSFB) is explained by aerogenic and odontogenic factors. We evaluated the predisposing factors, including intranasal anatomical and dental factors for increased diagnostic accuracy. METHODOLOGY In this study, 117 patients who underwent endoscopic sinus surgery for unilateral MSFB were included. Preoperative computed tomography (CT) scans were used to analyze the presence of anatomical variations (anterior and posterior nasal septal deviation (NSD), concha bullosa (CB), infraorbital cell (haller cell), paradoxical middle turbinate, everted uncinate process and MS size). Dental factors including history of dental procedures and findings on CT scans were reviewed. RESULTS Anterior and posterior NSD toward non-affected side were significantly associated with the presence of FB. The presence of CB and infraorbital cell was higher in the non-affected side rather than in the lesion side. Compared to non-affected MS, FB-presence MS was shallower and had a larger height to depth ratio. The presence of dental history was significantly higher on FB-presence MS than non-affected MS. In multivariable analysis, posterior NSD toward non-affected side, dental history increased the aOR of MSFB, while the presence of CB and infraorbital cell decreased the aOR of MSFB. CONCLUSIONS The occurrence of MSFB seems to be associated with ipsilateral odontogenic factors, followed by anatomic variations including posterior NSD toward non-affected side and absence of CB and infraorbital cell.
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Affiliation(s)
- J G Doo
- Department of Otorhinolaryngology-Head and Neck Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.,Department of Medicine, Graduate school, Kyung Hee University, Seoul, Korea
| | - H K Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - G W Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - S W Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - J-Y Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea
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Kikuta S, Han B, Yoshihara S, Nishijima H, Kondo K, Yamasoba T. High CT Attenuation Values Relative to the Brainstem Predict Fungal Hyphae Within the Sinus. Front Surg 2022; 9:876340. [PMID: 35784936 PMCID: PMC9243468 DOI: 10.3389/fsurg.2022.876340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives There is currently no established objective diagnostic indicator for the differentiation of sinus fungal ball (SFB) from unilateral nonfungal chronic sinusitis (UCRS). This study evaluated whether computed tomography (CT) attenuation values relative to those of the brainstem (relative CT number) are useful for differentiating SFB from UCRS. Materials and Methods Consecutive patients who were pathologically diagnosed with SFB or UCRS between 2013 and 2021 were retrospectively identified. The relative CT numbers of region of interest (ROIs) within the sinuses were compared between the two patient groups. Factors with predictive power for differentiating SFBs from UCRSs were identified by uni/multivariable logistic regression analyses. Results One hundred and eighty-three patients with unilateral chronic sinusitis were finally analyzed (SFB, 86 cases; UCRS, 97 cases). Regardless of the presence or absence of calcified lesions, the relative CT numbers in SFB were significantly higher than those in UCRS. ROIs showing high relative CT numbers were those where fungal hyphae were present. In the uni/multivariable logistic regression analysis, age (p < 0.001), relative CT number (p < 0.001), and calcification (p = 0.002) had predictive value for distinguishing SFB from UCRS. Within those cases not showing calcification, age (p = 0.004) and relative CT number (p < 0.001) were predictive factors for differentiating SFB from UCRS. A relative CT number >1.5 was significantly associated with SFB (sensitivity, 70%; specificity, 91%), with a significantly larger area under the receiver operating characteristics curve than age. Conclusions High relative CT numbers within the sinus are strongly associated with the presence of fungal hyphae, and measurement of relative CT number is a powerful adjunctive diagnostic method for distinguishing between SFB and UCRS.
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Kim KS, Kim BK, Chung MJ, Cho HB, Cho BH, Jung YG. Detection of maxillary sinus fungal ball via 3-D CNN-based artificial intelligence: Fully automated system and clinical validation. PLoS One 2022; 17:e0263125. [PMID: 35213545 PMCID: PMC8880900 DOI: 10.1371/journal.pone.0263125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background This study aims to develop artificial intelligence (AI) system to automatically classify patients with maxillary sinus fungal ball (MFB), chronic rhinosinusitis (CRS), and healthy controls (HCs). Methods We collected 512 coronal image sets from ostiomeatal unit computed tomography (OMU CT) performed on subjects who visited a single tertiary hospital. These data included 254 MFB, 128 CRS, and 130 HC subjects and were used for training the proposed AI system. The AI system takes these 1024 sets of half CT images as input and classifies these as MFB, CRS, or HC. To optimize the classification performance, we adopted a 3-D convolutional neural network of ResNet 18. We also collected 64 coronal OMU CT image sets for external validation, including 26 MFB, 18 CRS, and 20 HCs from subjects from another referral hospital. Finally, the performance of the developed AI system was compared with that of the otolaryngology resident physicians. Results Classification performance was evaluated using internal 5-fold cross-validation (818 training and 206 internal validation data) and external validation (128 data). The area under the receiver operating characteristic over the internal 5-fold cross-validation and the external validation was 0.96 ±0.006 and 0.97 ±0.006, respectively. The accuracy of the internal 5-fold cross-validation and the external validation was 87.5 ±2.3% and 88.4 ±3.1%, respectively. As a result of performing a classification test on external validation data from six otolaryngology resident physicians, the accuracy was obtained as 84.6 ±11.3%. Conclusions This AI system is the first study to classify MFB, CRS, and HC using deep neural networks to the best of our knowledge. The proposed system is fully automatic but performs similarly to or better than otolaryngology resident physicians. Therefore, we believe that in regions where otolaryngology specialists are scarce, the proposed AI will perform sufficiently effective diagnosis on behalf of doctors.
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Affiliation(s)
- Kyung-Su Kim
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Byung Kil Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Bin Cho
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Beak Hwan Cho
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (YGJ); (BHC)
| | - Yong Gi Jung
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (YGJ); (BHC)
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Wu PW, Lee TJ, Yang SW, Huang Y, Lee YS, Ho CF, Huang CC. Differences in clinical and imaging presentation of maxillary sinus fungus ball with and without intralesional hyperdensity. Sci Rep 2021; 11:23945. [PMID: 34907314 PMCID: PMC8671531 DOI: 10.1038/s41598-021-03507-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Abstract
Maxillary sinus fungal balls (MSFBs) mostly occur in older individuals and demonstrate female predominance. Early diagnosis is important to avoid treatment delays. Intralesional hyperdensity (IH) indicates the presence of heavy metal deposition within fungal hyphae and has been the most specific characteristic of MSFB on computed tomography (CT). For those without IH on CT, the diagnosis of MSFB remains challenging. This study aimed to characterize clinical presentation of MSFB with and without IH and to study factors contributing to MSFB with no IH formation. We retrospectively identified 588 patients with MSFB. The clinical characteristics and CT findings were reviewed. Patients with unilateral MSFB had a mean age of 57.4 years and demonstrated female predominance (64.63%). The female-to-male ratio was highest at 51–60 years (2.02) and rose to 2.60 in MSFB with IH only. Compared to those with IH, MSFB without IH was significantly more common in males (OR = 2.49), in those with diabetes mellitus (DM) (OR = 1.87), adjacent maxillary odontogenic pathology (OR = 1.75). Complete opacification on CT was less common in MSFB without IH (OR = 0.60). Patients with MSFB without IH were more likely to have DM, no female predominance, adjacent maxillary odontogenic pathology, and partial opacification of the sinus, compared to those with IH. These may be helpful in better understanding of the formation of MSFBs without IH, early identification of them and prevention of post-operative recurrence.
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Affiliation(s)
- Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, ROC.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan, ROC
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, ROC.,School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Xiamen Chang Gung Hospital, Xiamen, People's Republic of China
| | - Shih-Wei Yang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan, ROC.,School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yenlin Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yun-Shien Lee
- Department of Biotechnology, Ming Chuan University, Taoyuan, Taiwan, ROC.,Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Che-Fang Ho
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan, ROC
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, ROC. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
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8
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Clinical features in maxillary sinus fungus ball in patients with malignant hematological disease. Eur Arch Otorhinolaryngol 2021; 279:1919-1927. [PMID: 34216265 DOI: 10.1007/s00405-021-06973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies on fungus balls have primarily focused on immunocompetent patients, and only a few studies have described the clinical characteristics of fungus balls in malignant hematological disease (MHD) patients. Therefore, we compared the clinical features of maxillary sinus fungus ball (MSFB) between immunosuppressive patients with MHD and immunocompetent patients. METHODS Twenty patients with MHD and 40 randomly selected immunocompetent patients were enrolled and divided into MHD and non-MHD groups. All patients were diagnosed with MSFB and their clinical features were retrospectively analyzed. RESULTS Patients in the MHD group had non-specific clinical symptoms and endoscopic manifestations of MSFB, similar to those in the non-MHD group. On computed tomography (CT), the MHD group showed higher Lund-Mackay scores, lesser single sinus opacifications, more multiple sinus opacifications on the affected side, and more bilateral opacifications compared to the non-MHD group. The MHD group had a lower frequency of central hyper-density and heterogeneous opacifications than the non-MHD group. There were no significant differences between the two groups in terms of the fungal-infected side, lateral sinus wall ratio, sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and nasal septum deviation. CONCLUSION The clinical symptoms and endoscopic manifestations of MSFB in patients with MHD were similar to those of immunocompetent patients. However, more atypical signs and wider mucosal inflammation were found on CT scans of MSFB patients with MHD. These results indicate that caution should be executed when excluding the possibility of fungus balls in immunosuppressive patients.
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Lee JH, Lee BD. Characteristic features of fungus ball in the maxillary sinus and the location of intralesional calcifications on computed tomographic images: A report of 2 cases. Imaging Sci Dent 2021; 50:377-384. [PMID: 33409149 PMCID: PMC7758261 DOI: 10.5624/isd.2020.50.4.377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022] Open
Abstract
This report presents 2 cases of sinus fungus ball and describes the characteristic radiographic features of fungus ball in the maxillary sinus. Two female patients, aged 62 and 40 years, sought consultations at a dental hospital for the treatment of dental implants and tooth pain, respectively. Panoramic radiography and small field-of-view (FOV) cone-beam computed tomography (CBCT) did not provide detailed information for the radiographic diagnosis of fungus ball due to the limited images of the maxillary sinus. Additional paranasal sinus computed tomographic images showed the characteristic features of fungus ball, such as heterogeneous opacification and intralesional calcification of the maxillary sinus. The calcified materials of the fungus balls were located in the middle and superior regions of the maxillary sinus. It is necessary to use large-FOV CBCT for the detection of calcified materials in the upper maxillary sinus to confirm the diagnosis of fungus ball.
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Affiliation(s)
- Jae-Hoon Lee
- Department of Otolaryngology, Institute of Wonkwang Medical Science, School of Medicine, Wonkwang University, Iksan, Korea
| | - Byung-Do Lee
- Department of Oral and Maxillofacial Radiology and Research Institute of Dental Education, College of Dentistry, Wonkwang University, Iksan, Korea
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Abstract
Unilateral diseases of the maxillary sinus are among the most common rhinologic diagnoses. The diversity of these diseases can represent a challenge for the treating physician. The spectrum ranges from harmless maxillary sinus cysts that seldom require treatment, to highly aggressive malignant tumors. Special attention should be given to the management of inverted papilloma. These benign tumors are characterized by high recurrence rates and the potential for malignant transformation. The key to minimizing recurrence is precise surgical intervention. Other unilateral maxillary sinus diseases such as the antrochoanal polyp and the fungus ball (aspergilloma) are also discussed in depth.
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Affiliation(s)
- E Giotakis
- Erste HNO-Universitätsklinik Athen, Hippokrateio-Krankenhaus, Athen, Griechenland.
| | - S Knipping
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, Städtisches Klinikum Dessau und Martin-Luther-Universität Halle-Wittenberg, Dessau, Deutschland
| | - T Kühnel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universität Regensburg, Regensburg, Deutschland
| | - R K Weber
- HNO-Klinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland.,Sinus Academy, Karlsruhe, Deutschland
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Cho SH. Unveiling the Diverse Spectrum of Fungal Rhinosinusitis. Clin Exp Otorhinolaryngol 2020; 13:89-90. [PMID: 32434307 PMCID: PMC7248611 DOI: 10.21053/ceo.2019.02026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/02/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Seok Hyun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
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