Selection Of Surgical Approaches And Analysis Of Curative Effect For Fungal Ball Maxillary Sinusitis

Objective:To analyze the curative effect of 3 different surgical approaches in the treatment of fungal ball maxillary sinusitis in order to provide reference for clinical practice.Methods:The data of 90 patients with fungal spherical maxillary sinusitis admitted to the Department of Otolaryngology and Head and Neck Surgery,Affiliated Hospital of North Sichuan Medical College from January 2020 to June 2021 were collected.The clinical characteristics of the included subjects were analyzed.The surgical methods were selected according to the paranasal sinus CT findings.Nasal endoscopic maxillary sinus natural ostium enlargement surgery,endoscopic fenestration of the middle nasal tract combined with the windowing of inferior nasal meatus and endoscopic fenestration of the middle nasal tract combined with the anterior lacrimal recess approach were adopted respectively.There were 30 cases in every group.Endoscopic Lund-Kennedy score,visual analog score,Chinese version of SNOT-22 were filled in before operation and at 1 month,3 months,and 6 months after operation,and the curative effect was evaluated.Some patients were followed up to 1 year after operation,and related scores and efficacy evaluation were carried out.A paranasal sinus CT scanning was performed at the 6th month after surgery.Using SPSS 24.0 software to process the data,and P<0.05 was considered statistically significant.Results:All patients underwent operations successfully.Fungal masses were seen during the operation and confirmed by pathological examination,and no mucosal invasion was observed.Patientswere discharged in stable condition 3 days after the operation.At 6 months or 1 year follow-up,the maxillary sinuses ostiummaintained well.Except for5cases in the maxillary sinus ostiumenlargement group and 1 case in the middle and inferior meatus fenestration group,the others had not recurred.The others were subjected to sinus CT at 6 months post-operation which suggested that the high-density mass shadow in the sinus cavity disappeared,and the preoperative symptoms were basically relieved.No patient had nasolacrimal duct injury,severe epistaxis,necrosis of inferior turbinateand nasal dryness.One patient with anterior lacrimal recess approach had tooth numbness after surgery,which disappeared after 3 months.Conclusion:Fungal ball maxillary sinusitis with nasal endoscopic surgery has a good effect.Based on the location of high-density shadows in the sinus cavity and the relationship between the bottom of the nasal cavity and the lower wall of the maxillary sinus,the surgical method is conducive to the removal of fungal lesions,and the curative effect is significant.Among them,endoscopic sinus ostium enlarging the combined anterior lacrimal recess approach has the best effect,followed by the middle and inferior meatus fenestration group,while the recurrence of the maxillary sinus opening alone is relatively more frequent.