Endoscopic sinus surgery for removal of maxillary sinus fungal ball: a case report


  • Wijaya Juwarna Department of Otorhinolaryngology, Murni Teguh Memorial Hospital and USU Hospital, Medan, Indonesia
  • Delfitri Munir Department of Otorhinolaryngology, Murni Teguh Memorial Hospital and USU Hospital, Medan, Indonesia






The incidence of fungal rhinosinusitis (FRS) has been increasing over the past decade. FRS is categorized into invasive and non-invasive based on the histopathological evidence of tissue invasion by fungi. According to Hardik Shah, among FRS, 48% were non-invasive, and 52% were invasive. Fungal ball is the most frequent cause of non-invasive FRS, and the most commonly involved sinus is the maxillary sinus, and most cases are unilateral. Nowadays, Endoscopic sinus surgery (ESS) has become the gold standard in treatment of non-invasive FRS, due to its low morbidity and the easy access to the affected paranasal sinus. However, removal of maxillary sinus fungal ball (MSFB) may be long and difficult. Therefore, it is important to keep a sufficient field of view in order to remove the fungal debris completely. Good handling of endoscopic is needed, and furthermore, although the risk of complication of ESS for FRS is low, it is important to understand the potential complications.


Bosi GR, Braga GL, Almeida TS, Carli A. Fungus ball of the paranasal sinuses: Report of two cases and literature review. Int Arch Otorhinolaryngol. 2012;16(2):286-90.

Basurrah M, Lee IH, Kim DH, Kim SW, Kim SW. Anatomical Variations Associated with Maxillary Sinus Fungal Ball. Ear Nose Throat J. 2021;1-6.

Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Bernal-Sprekelsen M, Mullol J et al. European Position Paper on Rhinosinusitis and Nasal Polyps. 2020;24.

Garofalo P, Griffa A, Dumas G, Perottino F. Gauze Technique in the Treatment of the Fungus Ball of the Maxillary Sinus: A Technique as simple as It Is Effective. Int J Otolaryngol. 2016;1-6.

Higuera JG, Mullins CB, Duran LR, Sandoval H, Akle N, Figueroa R. Sinonasal Fungal Infections and Complications: A Pictorial Review. J Clin Imaging Sci. 2016;6(2):1-5.

Sawatsubashi M. Endoscopic Surgical Procedures for Fungal Maxillary Sinusitis: How to Do It, a Review. Int J Otolaryngol Head Neck Surg. 2018;7:287-97.

Chaganti PD, Rao NB, Devi KM, Janani B, Vihar PV, Neelima G. Study of fungal rhinosinusitis. J Dr. NTR University of Health Sci. 2020;9(2):103-6.

Gariuc L. Fungus ball of the maxillary sinus: clinical and diagnostic characteristics. Rom J Rhinol. 2020;10(40):108-16.

Dufour X, Kaufmann-Lacroix C, Ferrie JC, Goujon JM, Rodier MH, Klossek JM. Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989-2002. ISHAM. 2006;44:61-7.

Eva-Maria D, Konstantinos M, Georgios K, Konstantinos A. Erosive and Expansile Lesion of the Maxillary Sinus by a Sinus Fungus Ball Mimicking Malignancy. Int J Case Rep Med. 2013;1-13.






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