Surgical Approach for Maxillary Fungal Sinusitis

Fungal sinusitis incidence is increasing with societal aging and steroids administration, and head imaging has lead to increased detection. With nebulizers and medicinal therapy mostly ineffective in treating fungal sinusitis, surgery becomes the preferred choice.Subjects with maxillary fungal sinusitis undergoing endoscopic sinus surgery between 2000 and 2009 numbered 38: 19 men and 19 women, aged 30-80 years (average: 66.4 years).Of these, 15 underwent mid-meatus antrostomy and 23 through mid and inferior meatus. One underwent reoperation through the inferior meatus. Fungal sinusitis recurred in 4 cases, 2 requiring a second surgery. One underwent mid-meatus antrostomy again due to mid-meatal window closure. The other underwent inferior meatus antrostomy due to a fungal ball at the bottom of the maxillary sinus. The antrostomy approach was decided after confirming fungal ball location in the maxillary sinus using computed tomography (CT) and magnetic resonance imaging (MRI). If the fungal ball is near the mid-meatal window, antrostomy should be through the mid-meatus, while location at the bottom of the maxillary sinus or anterior wall requires antrostomy through the mid-meatus and inferior meatus.With surgery through the inferior meatus was useful in 2 subjects, maintenance of the nasoantral window is vital in preventing fungal sinusitis recurrence. We tried to use the inferior meatal mucosal flap during antrostomy. The nasoantral window opening ratio was 88.9% for this procedure.