The Clinical Observation on Therapeutic Efficacy of Different Approaches for Treating Fungal Ball Maxillary Sinusitis
|Course||Department of Otolaryngology Head and Neck Surgery|
|Keywords||Fungal ball Dua approaches Endoscopic surgery Maxillary sinusitis|
Objective and backgroundNoninvasive fungal rhinosinusitis belongs to non-specific fungal infection, mostly attack unilateral sinus and especially the maxillary sinus, the fungal ball sinusitis is the most common type. The causes Of NIFRS can be divided into:①The extensive application of antibiotics, immunosuppressants, anticancer drugs, radiotherapy, etc;②anatomical structure variation and blocking of Ostiomeatal complex, such as:deviated septum, bubble-like in the middle turbinate, retention cyst, narrow nasal cavity, maxillary sinus polyps, etc.③Autoimmune disease and chronic wasting disease, such as:vasculitis, diabetes, etc.④Immunodeficiency disease, such as:infection AIDS;⑤Environmental factors.Fungal ball sinusitis is characterized by:(1)Light green or dark brown caseous matter can be found in the the prevalence of the sinus cavity under Nasal endoscopy;(2)CT scan shows high density soft tissue which is similar to ground glass in the maxillary sinus is scattered in the high density of calcified plaque;(3) Histopathological examination and fungal detection find that a large number of fungal hyphae gathered and twisted into a group within the cheesy material or soil-like material, mainly aspergillosis and Aspergillus fumigatus.But the sick sinus mucosa was not found in fungal invasion.The treatment principle of fungal ball maxillary sinusitis is completely eliminating the fungal mass within the sinus. Removing the anatomical structure variation and blocking of Ostiomeatal Complex, and improving the drainage of the sinus ostium. Eliminating the hypoxic low-acid anaerobic environment which the fungal survive in. Postoperative patients have to flush the sinus and executed nasal endscopy Regularly. The surgical procedures include single path surgery and joint path surgery under nasal endoscopy. Endoscopic single-path technique include:fenestration of the middle meatus, inferior nasal meatus or middle meatus with gauze. Joint path surgery included:endoscopic surgery plus small windows through canine fossa surgery or plus inferior meatus etc.This paper were statistically analyzed on the postoperative effect of the differences between the intranasal endoscopic fenestration of the middle meatus and endoscopic surgery plus small windows through canine fossa surgery and discusses the option the choice of the fungal ball sinusitis surgical approach.Method1. The clinical data:To collect50cases diagnosed as fungal ball sinusitis patients with information from January2008to August2010of the First Affiliated Hospital of Zhengzhou University, Department of Otolaryngology. All patients with complete case follow-up data. Time for1-2years, an average of1.5years.2. The surgical approach and efficacy assessment:25cases in50patients with endoscopic surgery plus small windows through canine fossa surgery (treatment group), The other25cases of simple nasal endoscopic fenestration of the middle meatus (control group).Postoperative patients were followed up for a mean of1.5years, flushed the sinus and executed nasal endscopy on time. The evaluation standard is the implementation of the Haikou standards in accordance with1997.3. Etiological detection:in50patients after underwent maxillary sinus cavity exudates fungal detection, sick sinus contents and mucosa line pathogenic detection.4. The statistical analysis:to SPSS17.0packages rank sum test, inspection level a=0.05. Result1. Fungi and pathogen detection:Secretions in the nasal cavity and paranasal sinuses for fungal detection, the detection rate of78%,28cases of aspergillus (56%), three cases of mucormycosis (6%), penicillium (2%), other mold in seven cases (14%). Sinus mucosal manifestations of inflammatory edema, mucous membranes and secretions seen a large number of eosinophils infiltration, no fungi violation of the mucosa. See a large number of fungal hyphae wrapped in cheese-like material into the group.2. Postoperative disease outcome:The treatment group were cured22cases (88%), improved in2cases (8%), invalid recurrence one cases (4%),efficiency of96%; control group,16patients were cured (64%), improved in3cases (12%), no recurrence in6cases (24%), efficiency of76%. The two groups were statistically analyzed, x~2=4.268, p<0.05, the difference was statistically significant.Conclusion1. The most common pathogen of the fungal ball sinusitis is aspergillus, the fungus ball exists only in the sick sinus sinuses, but the sick sinus mucosa was not found in fungal invasion.2. Fungus ball type maxillary sinusitis treatment principle is operation for the removal of mold. For endonasal expanded natural export difficulties, should add with the windowing of inferior nasal meatus help check and clean the maxillary sinus lesions, for inferior nasal meatus stenosis adverse fenestration, with small incision labial gingival sulcus, canine fossa and small bone window to facilitate thorough examination and removal of the lesion, it will not bring the patient facial numbness and pain. Single path nasal endoscopic operation in treatment of fungal maxillary sinusitis, as long as the complete removal of sinus complex lesions, enough to expand the bony maxillary sinus natural ostium, intraoperative and complete removal of lesion, washing cavity, can also achieve the purpose of cure.