Clinical Study of Mycosis and Caseous Sinusitis

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  • 乾酪様物質を伴う副鼻腔炎の手術例の検討
  • 臨床 乾酪様物質を伴う副鼻腔炎の手術例の検討
  • リンショウ カンラク ヨウ ブッシツ オ トモナウ フクビクウエン ノ シュジュツレイ ノ ケントウ

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Abstract

We retrospectively reviewed clinical features of subjects with sinusitis retaining fragile massive caseous materials, divided into fungal (mycosis) and non fungal infection (caseous sinusitis). Sinus caseous materials were found during sinus surgery in 50 with sinusitis, 17 men and 33 women, 23-83 years old (mean: 62), between April 1995 and March 2009. Of these 50, 34 (68%) were diagnosed with mycosis and 16 (32%) were with caseous sinusitis based on histopathological and/or bacteriological findings. The most frequent mycosis etiology was aspergillosis (53%, 18/34). Histopathological findings were more useful in diagnosing mycosis than bacteriological findings. Nasal symptoms were most widely seen (42%, 21/50), followed by buccal pain (20%, 10/50). Caseous materials were mostly seen in unilateral maxillary sinus (86%, 43/50), followed by sphenoid sinus (10%, 5/50). Treatment involved endoscopic sinus surgery (ESS) in 43 (86%), with an external approach (Caldwell-Luc procedure) in 7 (14%). Nasal septum deviatomy was also required in 14% (7/50) to improve nasal ventilation. Postoperatively, 16 with caseous sinusitis and 31 with non invasive myocetoma recovered uneventfully. In 3 with acute invasive cases, two survived with ongoing visual impairment. One with invasive candidiasis died of brain invasion. In conclusion, half of sinusitis retaining caseous materials was caused by fungal infection. Clinical courses varied, but early diagnosis and treatment was critical.<br>

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