Three cases of aspergillosis of maxillary sinus

Aspergillosis of the paranasal sinuses is considered relatively rare. In this report, We describe three cases of aspergillosis of maxillary sinus. Case1: A 48-year-old man was referred to our department because of headache and nasal congestion. Computed tomographic examination revealed edematous swelling of sinus mucosa, which contained a high density region. The clinical diagnosis was aspergillosis of right maxillary sinus. Case2: A 40-year-old woman was referred to our department because of a feeling of wrongness of the right cheek. X-ray examination revealed a swelling of sinus mucosa, and there was radiopacity like a dental root canal filling in the center of the maxillary sinus. The clinical diagnosis was aspergillosis. Case3: A 58-year-old man was referred to our department with an introduction from other department because of the shadow of the left maxillary sinus. X-ray examination revealed a swelling of the maxillary sinus mucosa, there was no radiopacity in the maxillary sinus. The clinical diagnosis was left odontogenic maxillary sinusitis due to the left first molor. At all cases, Caldwell-Luc operation was performed under general anesthesia, a fungus ball was found near the semilunar hiatus. Postoperative histological diagnosis revealed aspergillosis. Follow up examination after the operation showed no recurrence of symptoms, and the patient's course has been uneventful.上顎洞アスペルギルス症は、口腔外科領域では比較的稀な疾患であり、その発症要因は日和見感染、菌交代現象などと言われている｡今回私達は特に関連すると思われる全身的異常を認めない上顎洞アスペルギルス症の3例を経験したので報告する｡症例1･48歳男性。主訴:頭痛,鼻閉。X線所見:5根尖部骨透過像あり｡右側上顎洞は全体に不透過性が増加しており、CTで右側上顎洞粘膜の肥厚および自然孔付近に直径5mm程度の不透過像を認める｡骨破壊像なし｡臨床診断:右側上顎洞真菌症｡症例2･40歳女性。主訴:頬部違和感、鼻閉感｡Ⅹ線所見:6根尖部に骨透過像を認める。右側上顎洞中央部に根充材様不透過物を認め、右側上顎洞は全体に不透過性が高まっていた。骨破壊像なし。臨床診断:右側上顎洞真菌症。症例3･58歳男性。主訴:レントゲンで左側上顎洞に不透過像を指摘された｡Ⅹ線所見:6根尖に透過像あり。左側上顎洞は全体に不透過性が上昇していたが、不透過物は認められなかった｡臨床診断:左側歯性上顎洞炎｡いずれの症例とも、上顎洞根治手術を行い、上顎洞内に黒褐色の固形物を認めた｡病理組織学的所見では、上顎洞粘膜に炎症性細胞浸潤がみられた｡黒褐色の固形物は変性壊死のみられる真菌塊で、菌糸は細く,隔壁を有し、Y字状を呈することからアスペルギルスと考えられた｡病理組織学的診断:上顎洞アスペルギルス症。3例とも術後経過は良好である