Paranasal Sinus Fungus Ball, Anatomical Variations and Dental Pathologies: Is There Any Relation?

OBJECTIVE: The purpose of this study was to investigate the relationship between anatomical variations and the fungus ball (FB), and the association between odontogenic etiologies and the maxillary sinus FB. METHODS: We analyzed the clinical records of 66 patients who underwent endoscopic sinus surgery for FB. The anatomical variations determined were nasal septal deviation (NSD) and direction, presence of Onodi and Haller cell, concha bullosa and lateral recess of the sphenoid sinus. Further, dental X-ray records were reviewed to detect any possible odontogenic etiologies in patients with maxillary sinus FBs. RESULTS: There were 41 female and 25 male patients. Positive fungal culture was found in 60 patients (91%) and the causative fungus was Aspergillus species in all cases. The correlation between NSD and localization of the maxillary sinus FB was statistically significant (p=0.0409). Maxillary sinus FB was more common on the concave side of the NSD. Presence of dental pathologies was significantly associated with maxillary sinus FB compared to the healthy side (p=0.0011). For sphenoid sinus FB, NSD was detected in a similar number for both the affected and unaffected side and there were no significant correlations (p>0.05). However, the relationship between sphenoid sinus FB and presence of lateral recess was significant (p=0.0262). CONCLUSION: Our study revealed that the maxillary sinus FB was more common on the concave side of the deviated septum. Also, dental pathologies or a presence of dental treatment history were associated with maxillary sinus FB.