Is canine fossa access necessary for successful maxillary fungus ball treatment?

Background: Sinus fungus ball (FB) is a non-invasive mycosis that affects immunocompetent hosts, most frequently localized in the maxillary sinus. The current golden standard treatment is surgical removal. Objective: To evaluate the effectiveness of an endonasal endoscopically assisted approach to remove a maxillary FB combined or not with a transoral approach (sinusoscopy via canine fossa). Methods: A retrospective evaluation of paranasal FB treated by functional endoscopic sinus surgery (FESS) + transoral approach, compared to those treated by a sole FESS procedure. Results: In total, 65 out of 90 patients presented with a maxillary localization and were treated by FESS. Thirthy-three patients received a combined FESS + transoral approach and 32 received solely a FESS procedure. Antimycotic medical therapy was not used in any case. With a mean follow-up of 93 months, the treatment was successful in 62 patients (95,4%) without significant differences between the two groups. Conclusions: Our data confirm the efficacy of FESS in the treatment of maxillary FB. A similarity in long-term results in both groups demonstrated that transoral sinusoscopy can be avoided. With the assistance of lateral-view and flexible endoscopes, angled surgical equipment and maxillary saline solution irrigations, complete removal of the diseased material and sinus clearance can be achieved by a sole middle meatotomy, reducing both morbidity and operating time.