title: Is canine fossa access necessary for successful maxillary fungus ball treatment?
abstract: BACKGROUND
  Sinus fungus ball (FB) is a non-invasive mycosis that affects immunocompetent hosts, most frequently localized in the maxillary sinus. The current golden standard treatment is surgical removal.
  
  
  OBJECTIVE
  To evaluate the effectiveness of an endonasal endoscopically assisted approach to remove a maxillary FB combined or not with a transoral approach (sinusoscopy via canine fossa).
  
  
  METHODS
  A retrospective evaluation of paranasal FB treated by functional endoscopic sinus surgery (FESS) + transoral approach, compared to those treated by a sole FESS procedure.
  
  
  RESULTS
  In total, 65 out of 90 patients presented with a maxillary localization and were treated by FESS. Thirthy-three patients received a combined FESS + transoral approach and 32 received solely a FESS procedure. Antimycotic medical therapy was not used in any case. With a mean follow-up of 93 months, the treatment was successful in 62 patients (95,4%) without significant differences between the two groups.
  
  
  CONCLUSIONS
  Our data confirm the efficacy of FESS in the treatment of maxillary FB. A similarity in long-term results in both groups demonstrated that transoral sinusoscopy can be avoided. With the assistance of lateral-view and flexible endoscopes, angled surgical equipment and maxillary saline solution irrigations, complete removal of the diseased material and sinus clearance can be achieved by a sole middle meatotomy, reducing both morbidity and operating time.
authors: Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico S. Matteo, Pavia, Italy. tpagella@libero.it
authors: Fabio
authors: F
authors: Pagella
authors: Elina
authors: E
authors: Matti
authors: Georgios
authors: G
authors: Giourgos
authors: Andrea
authors: A
authors: Colombo
authors: Francesca
authors: F
authors: De Bernardi
authors: Paolo
authors: P
authors: Castelnuovo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005157:Facial Pain / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000382:microbiology* / Q000601:surgery; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery*; D055815:Young Adult