Isolated Pneumosinus Dilatans of Maxillary Sinus Combined with Generalized Hypersinus: An Atypical Cause of Acute Facial Pain

BACKGROUND: Pneumosinus dilatans is a rare disease of unknown etiology characterized by expansion of 1 or more paranasal sinuses. The lesion includes an abnormal enlargement of the sinus cavity, but no evidence of bony destruction or pathological changes of the underlying mucosa. In some reports the symptoms involve compression of the optical nerve and associations with meningiomas or arachnoidal cysts. Osteoplasty or decompression surgery seem to be the only effective treatments.
CASE REPORT: We describe the case of a 28-year-old man presenting an aggressive pneumosinus dilatans. All the paranasal sinuses showed expansion, although symptoms presented only on the left maxillary sinus. Previous radiographs made 5 years before for dental treatment allowed us to evaluate the evolution of the lesion. Due to the pansinusal dilatation, multidisciplinary investigations were performed. The patient initially consulted his dentist for an acute painful swelling of the left facial side. Since no dental cause could explain the maxillary “swelling”, he was referred to a maxillo-facial surgeon. A CT scan revealed dilatation of others sinuses, and an intraoral anthrotomy of the left maxillary sinus was performed. In the same procedure, a biopsy of the mucosa was taken, revealing normal findings. Definitive drainage was performed by an ENT specialist using endoscopic meatotomy. Evolution was satisfactory without any complaints, although signs of optical nerve edema were noticed during ophthalmological examination. The 5-month follow-up showed that the disease was stabilized with no need for further treatment. The patient was then lost to follow-up.
CONCLUSIONS: A rare disease of the paranasal sinuses, pneumosinus dilatans should be part of the differential diagnosis for recurrent facial pain.

Keywords: Causality, facial pain, Paranasal Sinus Diseases