Surgical treatment of diseases of ENT organs
Foreign body of the maxillary sinus
Foreign body (fungal body) of the maxillary (maxillary) sinuses
In this article I will touch on the most common disease that is encountered today by ENT surgeons – this is the so-called non-invasive form of fungal sinusitis. There are many names that are often used by the doctor – mycetoma, fungal sinusitis, fungal body, fungal ball. Sometimes a diagnosis is used – odontogenic sinusitis, which is not entirely consistent with reality.
What is fungal sinusitis? The mechanism of development of the disease is quite simple. Surely, each person has treated the teeth, and often the treatment is accompanied by a filling of the canals of the tooth. The fact is that the roots of the upper teeth, especially on the 5th and 6th, often protrude into the maxillary sinus and are covered only by the mucous membrane on the side of the sinus. Thus, the dentist, completely without malice, carrying out work on the root of the tooth, can pierce its top and push the filling material into the sinus. Moreover, sometimes even a fragment of the root of the tooth itself or a root can fall into the sinus.
This is where the fun begins. By itself, the filling material is a completely harmless substance. And he could be in the bosom for years, but not so simple. The fact is that on the surface of the mucous membrane of the sinuses live fungi that are completely harmless to us. But when a substrate appears – a filling material, the growth of a fungal colony begins to form around it. Over time, the so-called fungal body is formed, which can gradually fill the entire bosom and even destroy its walls. The following points should be noted:
– The process does not develop quickly. It may take up to 10 years from the time you visit the dentist to form a large fungal body.
– Since the process takes place in the cavity (in the sinus) – it is as if isolated. The mucous membrane for a long time does not react at all to its own fungi. Therefore, an overwhelming number of patients have no complaints for a long time.
– Often these patients are treated for a long time with antibiotics, punctures and
– For the overwhelming number of patients who are given such a diagnosis – this is a perfect sensation, since they have no complaints. Often, such a disease is detected, for example, during examination of the brain or prophylactic medical examinations.
How to confirm the diagnosis and what to look for.
In almost 100% of cases, the exact diagnosis allows you to install COMPUTER tomography of the sinuses. Regular x-ray and MRI give a less informative picture. On the results of computed tomography, it is often possible to clearly see both the filling and the forming fungal body, as shown in the figure.
Patients may experience some discomfort in the upper jaw, sometimes there is purulent sinusitis on the side of the fungal body. And, of course, in the past, patients treated their upper teeth at the dentist.
Unfortunately, there are simply no other characteristic symptoms of the disease.
This disease is ABSOLUTELY SURGICAL and full stop!
Puncture and antibiotics are useless here. Foreign body must be removed.
The foreign body in the maxillary sinus should be removed from the sinus along with fungal masses. Currently this is done with the help of endoscopic techniques – through the nose. Rarely resort to additional – external access from under the lips. After complete removal – recovery occurs, although recurrences of the growth of the fungal body occur. The operation is simple. Personally, it takes me no more than 15 minutes and is performed under local anesthesia. Hospital monitoring is usually required for no more than 1-2 days. Endoscopic removal may not be possible if the patient has a sharp curvature of the nasal septum, which simply creates a mechanical obstruction to the operation through the nose. In this case, the patient is offered a one-step correction of the curved portion of the nasal septum. Often I am asked about the urgency of the operation. If there are no complications, then the operation is carried out exclusively in a planned manner.
I hope that this information will be useful to you. I am ready to answer your questions by email or by phone indicated in the CONTACTS section.
ENT Surgeon, Candidate of Medical Sciences,
Head of Endoscopic Microsurgery Department
Upper respiratory tract ENT clinic Medakademii them