Local injection of amphotericin B: novel use in the treatment of fungal maxillary sinusitis.

This report highlights the role of local amphotericin B (AMB) injection in cases of maxillary mucormycosis. The COVID-19 pandemic has resulted in a dramatic rise in the number of rhino-orbital mucormycosis cases. Although extensive surgical debridement remains the gold standard treatment, tissue salvage is desirable. The cases of two patients treated with local AMB are reported here, indicating that early intervention for maxillary fungal sinusitis in the form of local AMB may avoid the need for more invasive treatment.

Diagnóstico y tratamiento de la sinusitis maxilar odontogénica / Diagnosis and treatment of odontogenic maxillary sinusitis

RESUMEN Introducción: La patología sinusal inflamatoria e infecciosa puede comprometer la mucosa sinusal maxilar, etmoidal, esfenoidal o frontal, y su etiología es variada. Se ha observado que la patología odontológica es uno de los factores causales de la sinusitis maxilar, con una incidencia del 10% al 40% según diversas series de casos. El diagnóstico y tratamiento se debe realizar de manera interdisciplinaria entre las especialidades de otorrinolaringología y de cirugía maxilofacial. Se elaboró un documento descriptivo sobre la sinusitis odontogénica y orientador sobre su manejo, de acuerdo a una revisión de la literatura. Se realizaron búsquedas en las bases de datos PubMed, Lilacs y Google Académico, utilizando términos relevantes para la sinusitis odontogénica, con el fin de elaborar el documento. Se utilizaron 43 artículos, todos publicados desde el año 1986 hasta la fecha. Se concluye que la sinusitis odontogénica difiere tanto en la clínica como en la microbiología de otras enfermedades sinusales. El tratamiento se basa en el trabajo interdisciplinario e incluye cirugía endoscópica funcional, realizada por el otorrinolaringólogo, en conjunto con el tratamiento odontológico, siendo fundamental la buena comunicación entre ambos equipos.

ABSTRACT Introduction: Infectious and inflammatory sinus diseases have a varied etiology and can be associated to the maxillary, ethmoidal, sphenoidal and frontal sinuses. Dental pathology can be one of the etiological factors associated to maxillary sinus disease, with frequency rates of 10-40%. Diagnosis and treatment require interdisciplinary work, with participation of otorhinolaryngology and oral and maxillofacial surgery. The development of a descriptive document on odontogenic sinusitis and management guidelines according to literature review. Pubmed, Lilacs and Google Academic database were searched using terms relevant to odontogenic sinusitis, in order to prepare the document. 43 articles were used, all published from 1986 onwards. We conclude that odontogenic sinusitis differs clinically and microbiologically from other sinus pathologies. Treatment modalities are based upon interdisciplinary surgery, including functional endoscopic surgery done by otolaryngologists and dental treatment, being fundamental close communication between the two teams.

Ectopic teeth in the maxillary sinus: A case report and literature review.

Ectopic eruption of teeth is a rare phenomenon although there have been reports of teeth in the nasal septum, mandibular condyle, and maxillary sinus. This impaction can present itself in a variety of ways such as chronic or recurrent sinusitis, sepsis, and facial numbness and can also be asymptomatic. The aim of this study was to describe, by means of research literature and by a case report, the characteristics and occurrence of ectopic eruption in the maxillary sinus. We have analyzed and compared clinical cases of ectopic teeth in the maxillary sinus with a search on PubMed utilizing keywords such as "ectopic," "teeth," "sinus," "maxillary," and Boolean operators "or" and "and" up until 2016. Fifty-one cases were found, of which 53% were female. The age ranged between 3 and 72 years, with an average age of 28.36 years. The higher prevalence of ectopic teeth is the 3rd molars. Ten of these teeth are associated with a dentigerous cyst, 1 by an osteoma, and 2 by soft tissue. Standard treatment for an ectopic tooth is extraction, but for other patients, treatment of choice in asymptomatic ectopic tooth cases is continued observation. Ectopic teeth tend to form a cyst or tumor if not managed.

[Contiguous cutaneous inflammation secondary to an aspergillus sinusitis]. / Inflammation cutanée de contiguïté secondaire à une sinusite aspergillaire.

BACKGROUND: Contiguous skin inflammation is a poorly described entity. It constitutes a cutaneous manifestation of an underlying ongoing process (infectious, inflammatory or neoplastic). Sinusitis is a known cause. PATIENTS AND METHODS: We report the case of a 70-year-old patient consulting for an ongoing centrofacial inflammatory plaque. Cutaneous biopsy revealed a polymorphic inflammatory infiltrate, and cutaneous microbiological specimens were negative. A facial CT-scan showed left maxillary sinusitis. Intra-sinus samples obtained at surgery showed aspergillus. Voriconazole combined with maxillary sinus surgery resulted in healing of the facial plaque. DISCUSSION: There have been only two published cases of contiguous skin inflammation related to sinusitis but no reported cases caused by aspergillus sinusitis. Herein we report the third case of contiguous skin inflammation associated with sinusitis, which is also the first related to aspergillus sinusitis.

[Pseudo-tumoral invasive fungus infection of the maxillary sinus in Abidjan]. / Infection invasive à champignon filamenteux pseudotumorale du sinus maxillaire à Abidjan.

INTRODUCTION: The invasive fungal infection of the maxillary sinus is a rare and serious disease generally favored by immunosuppression. We report an exceptional case of pseudotumoral invasive fungal infection of the maxillary sinus in an immunocompetent patient. OBSERVATION: A 32-year-old patient consulted for labial and left temporal swelling associated with proptosis and chemosis that has been developing for 18 months. The scanner objectified a filling of the left maxillary sinus, and the ipsilateral orbital cavity, and the surrounding muscles. Histological examination of the surgical specimen revealed invasive fungal infection of the left maxillary sinus. The relevant antifungal therapy, namely voriconazole, could not be administered due to the unavailability of the medicine. However, the patient has received 200mg of itraconazole every 12hours for three weeks. The change proved disappointing with recurrence and significant sequelae, sort of sagging of the right hemifacial, severe limitation of mouth opening and functional loss of the right eye. CONCLUSION: The invasive fungus infections of the maxillary sinus and the orbit are exceptional in immunocompetent patient. Healing is based on early diagnosis and administration of the reference antifungal to face the risk of recurrence.

A 44-Year-Old Man with Waldenstrom Macroglobulinemia and Bilateral Maxillary Sinusitis.

Waldenstrom macroglobulinemia is a chronic, indolent, lymphoproliferative disorder, which is characterized by the presence of a high macroglobulin (IgM) level, elevated serum viscosity, and the presence of a lymphoplasmacytic infiltrate in the bone marrow. Clinical manifestations may be found due to the presence of IgM paraprotein and malignant lymphoplasmacytic cell infiltration of the bone marrow and other tissues. We reported a case of male patient with Waldenstrom macroglobulinemia and bilateral maxillary sinusitis. He had received symptomatic and antibiotic treatment for his sinusitis, FFP and PRC transfusion to improve his general condition and chemotherapy with CHOP regimen as definitive treatment.

Clinical features and treatment outcomes of dental implant-related paranasal sinusitis: A 2-year prospective observational study.

OBJECTIVES: As dental implant-related paranasal sinusitis has different pathophysiology and clinical features from primarily rhinogenic paranasal sinusitis, the standard treatment protocol for dental implant-related paranasal sinusitis has not yet been established. The aim of this study was to analyze the clinical characteristics and treatment results of dental implant-related paranasal sinusitis. MATERIAL AND METHODS: We conducted a prospective single-center study of 19 patients who were treated for odontogenic sinusitis developing in relation to dental implant from September 2008 through May 2012. The age of the patients ranged from 33 to 78 years, with the mean age of 54.5 years. Foul odor and postnasal dripping were the two most common complaints. All patients underwent nasal endoscopic examination and paranasal sinus CT before treatment, and initial conservative treatment for 1 week. Patients unresponsive to medical treatment underwent endoscopic sinus surgery (ESS). All patients were classified into the conservative and surgical groups for analysis and followed up for 2 years after initial diagnosis. RESULTS: Four patients (21%) were successfully treated conservatively, while 15 patients (79%) underwent surgical treatment. One of these 15 patients required revision surgery. After 2 years, all patients were successfully treated, so there were no more clinical signs of recurrent sinusitis in any patients. The survival rate of implants was 100%. Compared to those of the conservative group, symptom duration, the Lund-MacKay CT score, status of the ostiomeatal unit (OMU), and the condition of the maxillary sinus floor were significantly more severe in the surgical group. CONCLUSION: In our study, the majority of patients who once developed paranasal sinusitis associated with dental implants required surgical treatment. Findings of paranasal sinus CT may be important in determining treatment option.

Osteoradionecrosis of the Posterior Maxilla: A New Approach Combining Erbium: Yttrium Aluminium Garnet Laser and Bichat Bulla Flap.

Osteoradionecrosis (ORN) of the jaw is a complication of radiation therapy for head and neck cancers. We report a case of ORN of the posterior maxilla treated with Er: YAG laser and a pedicled buccal fat pad (bichat bulla adipose) flap. A 69-year-old man presented complaining of pain on left maxilla. He had received high-dose radiotherapy (90 Gy) for squamous cell carcinoma of the left soft palate 2 years earlier. Clinical and radiographic examinations revealed ORN of the left maxillary molar region and maxillary sinusitis. Daily home care consisted of 0.9% saline irrigation and 0.8% H2O2 gel application. Sequestrectomy and tooth extraction were followed by debridement with Er: YAG laser and repair with a pedicled buccal fat pad flap. Complete resolution of ORN and maxillary sinusitis was established one year postsurgically. The excellent clinical outcome suggests that Er: YAG laser debridement and pedicled buccal fat pad flap are a viable option to treat ORN of the posterior maxilla.

Implications of endodontic-related sinus aspergillosis in a patient treated by infliximab: a case report.

INTRODUCTION: Sinus aspergillosis is a potential complication after root canal therapy of antral teeth. Indeed, zinc oxide-eugenol cement overfilling in the sinus may promote fungal infection. Moreover, if sinus aspergillosis triggers chronic sinusitis with aspergilloma, it may also lead to invasive phenomena, especially for immunocompromised patients. METHODS: We reported a sinus aspergillosis case of a patient treated with infliximab (Remicade; Janssen Biologics BV, Leiden, Netherlands). The purpose of this article was to explore the mechanisms of this pathosis, especially the impact of the root canal sealer overextension, which is a contributing factor for fungal infection. The surgical management and the follow-up are also described. RESULTS: Six months after surgery, the patient showed no clinical signs and presented with a healthy and airy right maxillary sinus on the computed tomography scan. CONCLUSIONS: In conclusion, prevention and screening of aspergillosis of maxillary sinus may be considered before starting an anti-tumor necrosis factor alpha therapy.

[The 'black turbinate sign' in a case of rhinocerebral mucormycosis]. / Signo del cornete negro en un caso de mucormicosis rinocerebral.

TITLE: Signo del cornete negro en un caso de mucormicosis rinocerebral.

Maxillary sinusitis after sinus lift due to Gemella morbillorum: antibiotic and surgical treatment.

Sinus lift is a predictable procedure for increasing alveolar bone height in the posterosuperior alveolar regions to allow oral prosthetic rehabilitation. Several complications have been documented in the literature and vary from sinus membrane perforation to maxillary rhinosinusitis. The authors present a case of Gemella morbillorum acute sinusitis after sinus lift surgery. The purpose of this report is to describe the surgical and pharmacological management of a patient allergic to penicillin.

A case of Schizophyllum commune sinusitis following unrelated cord blood transplantation for acute lymphoblastic leukemia.

Schizophyllum commune is a globally distributed basidiomycete fungus that is known as a rare cause of sinusitis, for which no prompt treatment has been established. We describe the first report of S. commune sinusitis following unrelated cord blood transplantation for acute lymphoblastic leukemia. Thirteen days after transplantation, a 23-year-old female developed maxillary and ethmoid sinusitis. The sinusitis was antimicrobial-resistant, and the sinus aspirate culture revealed white wooly mold, which was identified as S. commune by nucleotide sequencing. The patient was successfully treated with intravenous administration of liposomal amphotericin B for 2 months, followed by oral voriconazole. This report suggests the effectiveness of liposomal amphotericin B and voriconazole for S. commune infection in immunocompromised patients. Given the difficulty in distinguishing S. commune infection from aspergillosis by standard culture methods, the incidence of S. commune infection following allogeneic hematopoietic stem cell transplantation may be underestimated. Nucleotide sequencing may be useful in the diagnosis of S. commune infection.

Imaging of silastic cheek implant penetration into the maxillary sinus.

IMPORTANCE: Silastic implants are popular for cosmetic cheek augmentation. We describe the computed tomographic (CT) and magnetic resonance imaging (MRI) findings in 5 cases (4 patients) with penetration of the medial aspect of Silastic cheek implants through the anterior maxillary sinus wall. OBSERVATIONS: Three cases demonstrated associated sinus mucosal thickening, and 3 cases demonstrated infection surrounding the implant. In 3 cases, the implants migrated into the maxillary sinus, and in 1 case the implant also eroded through the nasoantral wall and extended into the nasal cavity. CONCLUSIONS AND RELEVANCE: Maxillary sinus penetration is a potential complication of Silastic cheek implants. The extent of this complication can be characterized by CT and MRI.

[Experience with treatment of chronic polypoid rhinosinusitis using low doses of clarithromycin in the postoperative period].

A total of 37 patients at the age from 25 to 65 years presenting with chronic polipoid rhinosinusitis (CPRS) were available for the observation. They were allocated to two groups based on the results of endoscopic polyposinusotomy. The patients in group 1 (n=18) were instructed at discharge from the clinic to take 250 mg of clarithromycin daily for 3 months in combination with the local application of a topical corticosteroid. The patients in group 2 (n=19) were prescribed topical corticosteroids alone. It was shown that clarithromycin at low doses caused significant stabilization of CPRS remission and prevented the development of relapses in the majority of the patients (66%). Therapy of CPRS with low doses of clarithromycin was associated with a significant decrease of the frequency of acute retroviral infections (ARVI). The intake of clarithromycin had no effect on the development and/or aggravation of intestinal dysbacteriosis nor did it provoke deviation of blood biochemical characteristics from the normal values both at the onset of therapy and after a follow-up period of 3 months.

Idiopathic inflammation of the orbit and contiguous structures.

Idiopathic orbital inflammation is a common cause of acute orbital signs and symptoms. It is typically confined to the bony orbit; however, it can rarely involve contiguous structures with or without lytic change raising clinical suspicion for malignancy. Three cases of idiopathic inflammation of the orbit that affected adjacent structures are reported here; 2 cases had maxillary sinus involvement, while a third had extension in the temporal fossa.

Maxillary sinusitis and fungal infection.

This cross sectional study was done to identify the fungal etiology of maxillary sinusitis. This study was done in the department of Otolaryngology & Head-Neck Surgery, Shahid Suhrawardy Medical College Hospital, Dhaka, Bangladesh. The study period was 5 years (January 2003 to December 2007). Total 63 patients who were diagnosed clinically and radiologically as a maxillary sinusitis were enrolled in this study. All the patients were included randomly. Among 63 patients 8(12.69%) patients had laboratory proved fungal maxillary sinusitis. Collection of the laboratory specimen was done from antral wash out and biopsy for histopathology was taken by endoscopic surgery. By histopathological and fungal stain revealed noninvasive type of fungal infection in all cases. Post nasal drip (100%), Headache (100%), Nasal obstruction (65% cases) were the main presenting symptoms in case of fungal maxillary sinusitis. Anti fungal treatment along with systemic antibiotic was given in case of proven maxillary sinusitis and 100% cure rate was observed after treatment.