摘要
Abstract
Objective To analyze the causes of clinical misdiagnosis of fungal maxillary sinusitis(FMS)and to sum-marize the preventive measures,so as to improve the level of clinical diagnosis and treatment.Methods The clinical data of 2 misdiagnosed patients with FMS from May 2022 to June 2023 were retrospectively analyzed.Results A patient with right maxillary posterior tooth pain for 2 months was referred to the stomatology department of a local hospital for several times.Pul-pitis of 16 and 17 teeth was considered,and the patient was treated with pulp opening surgery,sealing with paraformaldehyde inactivating agent,and even extraction of 16 and 17 teeth,but the pain was not relieved.Based on further examination and analysis,combined with previous medical history,magnetic resonance imaging(MRI)and sinus CT,diagnosis of"right max-illary sinus and ethmoid sinusitis,suspected to be combined with fungal infection was considered,the right maxillary sinus opening under nasal endoscope and sinusoidal neobiotomy were performed in a superior hospital,and the postoperative patholo-gy confirmed FMS.After 6 months of follow-up,the prognosis was good and the symptoms did not recur.Another case had toothache and numbness on the left side of the upper group without obvious inducement for 2 months,and was treated twice in a local oral clinic.Pulpitis and trigeminal neuralgia were considered;therefore,root canal therapy was given and Carbamaz-epine was taken orally for treatment,but the pain did not improve or even worsened,seriously affecting sleep.Further curved surface tomography and CT examination of sinuses were performed to consider FMS,and endoscopic left maxillary sinusitis in-tranasal fenestration and removal of sinus lesions were performed in superior hospitals.Postoperative pathological diagnosis of FMS was made.There was no recurrence of symptoms at 1-year follow-up.Conclusion When the patients with suspected toothache as the main manifestation do not respond to symptomatic treatment of pulpitis,vigilance should be increased.The possibility of FMS should be considered,and MRI and sinus CT examination should be performed as soon as possible to reduce the misdiagnosis rate.关键词
真菌/上颌窦炎/误诊/牙髓炎/牙痛/鉴别诊断/磁共振成像/鼻内镜Key words
Fungus/Maxillary sinusitis/Misdiagnosis/Pulpitis/Toothache/Differential diagnosis/Magnetic reso-nance imaging/Nasal endoscope分类
医药卫生
