PDF: Endodontic Treatment - A Significant Risk Factor for the Development of Maxillary Fungal Ball

The risk factors for maxillary fungal ball are largely unknown. The aim of this study was to determine whether endodontic treatment of maxillary teeth is a risk factor for fungal ball development in the maxillary sinus, and to identify other possible risk factors.

A fungal ball of the maxillary sinus is the most common fungal disease that usually develops unilaterally in the maxillary sinus without bony invasion.

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It is most frequently found in older individuals, especially in their sixties, and has a female preponderance. 

A maxillary fungal ball is frequently diagnosed in patients with prolonged history of symptoms of recurrent maxillary sinusitis, or is incidentally diagnosed on imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI).

They can also be found during endoscopic sinus surgery (ESS) in patients diagnosed with chronic paranasal rhinosinusitis, even without typical CT findings. 

The treatment of choice for a fungal ball is complete surgical removal by ESS. After the surgery, the recurrence rate is very low.

Although invasive types of fungal sinusitis are common in immune-compromised patients, non-invasive fungal ball of the maxillary sinus is frequently found in healthy individuals without risk factors for fungal infection.

The pathogenesis of the fungal ball of the maxillary sinus remains largely unknown. However, it is generally considered to be related to the inflammatory process associated with dental procedures on the maxillary teeth.

Therefore, a case-control study was performed to determine whether the history of endodontic treatment on maxillary teeth is an independent risk factor for the development of a fungal ball in the maxillary sinus, and to identify other possible risk factors for the development of fungal balls in the maxillary sinus.