Data di Pubblicazione:
2000
Abstract:
In recent years there has been a marked increase in mycosis infections of the
paranasal sinuses, attributed both to an increase in the survival of subjects at
risk and improved diagnostic techniques (endoscopy, CT, MR) able to identify
cases which had previously gone unrecognized and treated as aspecific chronic
sinusitis. The present study involves 45 cases (4.3%) out of a total of 1050
patients who had undergone endoscopic surgery for sinusopathy between April 1994
and December 1998. Following the Katzenstein classification, the cases were
broken down into non-invasive chronic mycoses or fungus ball (34 cases), allergic
mycoses (7), chronic indolent invasive mycoses (3) and fulminating invasive
mycosis (1 case). The mycetes most often involved was Aspergillus Fumigatus
(76.9%). The recurrent symptom was facial algia, followed by nasal obstruction.
Paranasal sinuses endoscopy did not modify the specific picture. CT presented
such indicative signs as focal areas with non-homogeneous intensity, images of
metal-like foreign bodies and endosinus calcifications in 84.4% of the cases.
MR--performed in only 6 cases--always presented T2 images showing the typical
signal void area corresponding to pathological lesions. All patients underwent
endoscopic surgery of the paranasal sinus. The effectiveness of this treatment
differed according to the clinical form. In the fungus balls surgery always
resolved the pathology without requiring subsequent pharmacological treatment. In
allergic mycosis, surgery improved the symptom of nasal respiratory obstruction
but local drug treatment was required. With the aid of drug treatment, surgery
resolved chronic indolent invasive mycoses and prevented the endocranial
progression of complications. In the cases of fulminating invasive mycosis,
timely surgery prevented the onset of endocranial complications and made it
possible to perform antimycotic polychemotherapy to control the disease. This
experience shows how important a protocol involving several different tests is in
diagnosing the many clinical forms of paranasal sinus mycoses and distinguishing
them from sinusopathies. Endoscopic surgery is indicated for all forms of
paranasal sinus mycoses although the realistic objectives differ according to
type.
paranasal sinuses, attributed both to an increase in the survival of subjects at
risk and improved diagnostic techniques (endoscopy, CT, MR) able to identify
cases which had previously gone unrecognized and treated as aspecific chronic
sinusitis. The present study involves 45 cases (4.3%) out of a total of 1050
patients who had undergone endoscopic surgery for sinusopathy between April 1994
and December 1998. Following the Katzenstein classification, the cases were
broken down into non-invasive chronic mycoses or fungus ball (34 cases), allergic
mycoses (7), chronic indolent invasive mycoses (3) and fulminating invasive
mycosis (1 case). The mycetes most often involved was Aspergillus Fumigatus
(76.9%). The recurrent symptom was facial algia, followed by nasal obstruction.
Paranasal sinuses endoscopy did not modify the specific picture. CT presented
such indicative signs as focal areas with non-homogeneous intensity, images of
metal-like foreign bodies and endosinus calcifications in 84.4% of the cases.
MR--performed in only 6 cases--always presented T2 images showing the typical
signal void area corresponding to pathological lesions. All patients underwent
endoscopic surgery of the paranasal sinus. The effectiveness of this treatment
differed according to the clinical form. In the fungus balls surgery always
resolved the pathology without requiring subsequent pharmacological treatment. In
allergic mycosis, surgery improved the symptom of nasal respiratory obstruction
but local drug treatment was required. With the aid of drug treatment, surgery
resolved chronic indolent invasive mycoses and prevented the endocranial
progression of complications. In the cases of fulminating invasive mycosis,
timely surgery prevented the onset of endocranial complications and made it
possible to perform antimycotic polychemotherapy to control the disease. This
experience shows how important a protocol involving several different tests is in
diagnosing the many clinical forms of paranasal sinus mycoses and distinguishing
them from sinusopathies. Endoscopic surgery is indicated for all forms of
paranasal sinus mycoses although the realistic objectives differ according to
type.
Tipologia CRIS:
Articolo su Rivista
Elenco autori:
Castelnuovo, PAOLO GIOCONDO MARIA; Gera, R.; Di Giulio, G.; Canevari, F. R.; Benazzo, M.; Emanuelli, E.; Galli, J.; Di Girolamo, S.; Staffieri, A.
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