Complication and Salvage of Sinus Floor Elevation in the Maxillary Sinus With Asymptomatic and Noncalcified Fungus Colonization: A Case Report
The present study aimed to report (1) the sequela of sinus floor elevation (SFE) in the posterior maxilla with severe sinus membrane thickening and an undiagnosed fungal colonization but a patent ostium and (2) a treatment course without implant removal. A 73-year-old woman underwent dental implant placement in the left posterior maxillary area. Although the patient was asymptomatic, severe sinus membrane thickening with Haller cells was observed on a radiographic examination, but the ostium was patent. After SFE and simultaneous implant placement, the patient developed acute sinusitis and was referred to an otolaryngologist. Functional endoscopic sinus surgery (FESS) was performed, resulting in resolution of the infection and salvage of the augmentation and the implant. The histopathologic examination revealed the fungal ball that could not be diagnosed on preoperative dental radiography. During the 2 years after the delivery of the final prosthesis, a significant reduction in membrane thickness was observed. The implants were functioning well. Clinicians should recognize fungal colonization as an etiology of sinus membrane thickening and provide proper pre- and postoperative management, including FESS.
Radiographic findings. (a–d) Preoperative situation. Severe mucosal thickening was noteworthy, but the ostium was patent (yellow arrow). Large Haller cells were found (white arrow). (e–h) Immediately after sinus floor elevation (SFE) and implant placement. No bone grafting was performed during SFE. (i–l) One year after the final prosthesis delivery. Sinus membrane thickening was markedly reduced. (m–p) Two years after the final prosthesis delivery. No recurrence of the sinus membrane thickening was observed.
Nasal endoscopic findings. (a, b) Findings prior to sinus floor elevation (SFE). Anterior ethmoid sinus (yellow arrow) and large Haller cells (white arrow) were observed. (c, d) Finding at the time of functional endoscopic sinus surgery (FESS). (c) The ostium was enlarged, and purulent exudate was drained. (d) The brownish-yellow masses (fungal ball) were removed. (e, f) Findings 2 months after FESS. (e) An enlarged ostium was observed (blue arrow). (f) The sinus membrane became healthy.
Clinical photograph. (a) Preoperative clinical situation. (b) A bony access hole was made on the lateral wall of the maxillary sinus. (c) The sinus membrane was elevated, and dental implants were placed. (d) Clinical situation at 2 years after the insertion of the final prosthesis.
Histopathological findings of the removed masses during endoscopic sinus surgery. (a) Presence of hyphae was confirmed (magnification, ×400). (b) Splendore-Hoeppli phenomenon around densely packed hyphae was observed (magnification, ×100; hematoxylin-eosin stain).
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