Analysis of sinonasal anatomical variations associated with maxillary sinus fungal balls

ObjectiveThe 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.MethodsThirty-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.ResultsIn 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.ConclusionsSinonasal 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).