Analysis of sinonasal anatomical variations associated with maxillary sinus fungal balls

Objective: The pathogenesis of MSFB development remains unclear, but it has been suggested that poor sinus ventilation is associated with disease development; such a ventilation is influenced by anatomical variation of the paranasal sinuses. Thus, we sought to determine whether sinonasal anatomical variations were associated with MSFB development. Methods: Thirty-one patients with MSFB and 28 gender-matched control patients were included in the present study. The presence or absence of Haller cells and a concha bullosa were scored, and the angle of septal deviation and the minimal and maximal lengths of the infundibulum were measured on preoperative computed tomography images. Results: In the MSFB group, both a concha bullosa (61.3% vs. 28.6%, p = 0.006) and Haller cells (41.9% vs. 30.4%) were present at higher frequencies than in the control group, although the between-group difference in Haller cell occurrence was not statistically significant (p = 0.348). In addition, MSFB patients had a significantly lower mean infundibular width (3.23 +/- 0.69 mm vs. 3.99 +/- 1.17 mm, p < 0.001) and a longer infundibular length (9.71 +/- 1.43 mm vs. 8.23 +/- 1.72 mm, p < 0.001) than controls. Conclusions: Sinonasal anatomical variations, especially the presence of a concha bullosa, and/or a narrow and long infundibulum, may play roles in the development of maxillary sinus fungal balls (MSFBs). (C) 2016 Elsevier Ireland Ltd. All rights reserved.