A 67-year-old patient of indo-European origin was referred by his dentist after the incidental finding of an orthopantomography of intrasinusal images of metallic radiopacity.
As personal history, only one gunshot wound 12 years before the consultation in the left temporal region stood out.
The patient presented headache and pansinusal occupation sensation more marked at the level of the left maxillary sinus, accompanied by occasional rhinorrhea by the left nasal fossa.
Physical examination again showed anodyne, no vestibular bulging in the second quadrant, and no visible orosinusal fistulas.
The imaging tests performed (orthopantomography, DentaScan and facial CT) showed the presence of material at the intrasinusal level of metallic radiopacity in the form of a single circular nodule of the maxillary sinus mucosa.
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Given the history of the patient's gunshot wound, it was thought that it could be intrasinusal foreign bodies derived from it, so a Cadwell-Luc procedure was performed without intrasinusal mucosa removal or sinus antrostomy.
A white material with fibroelastic consistency similar to that obtained in the case presented above was obtained.
The pathological study reported sinus mucosa with signs of chronic inflammation associated with white material formed by branched hyphae compatible with intrasinusal fungal ball caused by Aspergillus.
Microbiological studies returned to negative results.
In this case the mucosa was not affected at any level, so the patient was discharged 48 h after surgery without complications or need for intravenous antifungal treatment.
In subsequent revisions, the patient reported clinical disappearance and absence of complications in a follow-up period of 8 years.
