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Sinus aspergillosis
C De Foer1, E Fossion, J M Vaillant
1Dept. of Oral and Head and Neck Surgery, University Hospital Leuven, Belgium.
Abstract:
The prevalence of Aspergillus sinusitis is often underestimated because the vast majority of cases are classified as "unspecified sinusitis". Two possible aetio-pathogenic mechanisms can be involved in the development of this fungal infection. Traditionally, the literature emphasised the "anglophone" hypothesis which is based on the inhalation of spores. More recently, the "french" model, based on oro-sinusal fistula and/or the perforation of the maxillary sinus by root canal-filling material, is believed to explain the majority of cases in our industrialised environments. Still, neither model explains the totality of cases and several remain beyond comprehension. The disease most commonly presents as a chronic bacterial sinusitis. The process can however become invasive, thus resembling malignancy, with eventually a fatal outcome. Doctors and dentists should know the possible danger, presented by zinc-oxide-eugenol-paste in the sinus. Radical surgery is the treatment of choice, since a prolonged conservative approach (antibiotics, corticosteroids) can only worsen the prognosis. This paper discusses different aspects of the disease, and presents 10 cases, observed at the University Hospitals of Paris (France) and Leuven (Belgium).
Insights
Aspergillus sinusitis is often misdiagnosed. This fungal infection can be caused by spore inhalation or dental procedures, sometimes becoming invasive and fatal.
Area of Science:
- Otorhinolaryngology
- Mycology
Background:
- Aspergillus sinusitis prevalence is underestimated, often misclassified as unspecified sinusitis.
- Two etio-pathogenic mechanisms are proposed: spore inhalation (anglophone model) and oro-sinusal fistula/dental material perforation (French model).
Observation:
- The disease commonly mimics chronic bacterial sinusitis but can become invasive.
- Cases observed in Paris and Leuven highlight the need for awareness.
- Zinc-oxide-eugenol paste poses a significant risk when present in the sinus.
Findings:
- Neither the anglophone nor the French model fully explains all cases of Aspergillus sinusitis.
- Invasive forms can resemble malignancy, leading to fatal outcomes.
Implications:
- Accurate diagnosis and prompt radical surgery are crucial for effective treatment.
- Conservative treatments like antibiotics and corticosteroids may worsen the prognosis.
- Increased awareness among physicians and dentists regarding fungal sinusitis and dental materials is essential.