Association between maxillary sinus fungus ball and sinus bone grafting with deproteinized bovine bone substitutes: a case-control study

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jun;121(6):e143-7. doi: 10.1016/j.oooo.2016.01.022. Epub 2016 Feb 13.


Objective: To evaluate the association between sinus bone graft and the development of fungus ball (FB) of the maxillary sinus.

Study design: The charts of all patients seen for surgical treatment of maxillary sinus FB following sinus bone grafting between 2006 and 2014 were reviewed. The charts of 49 participants were selected from our internal registry for comparison as controls. The association between FB and age, gender, smoking habits, associated co-morbidities, and bone grafting material was evaluated. FB of the maxillary sinus was estimated by using an odds ratio with a Yates' correction. P values were computed using Fisher's exact test, and the statistical significance was set at a P value < .05.

Results: All 13 cases (100%) with FB of the maxillary sinus had received anorganic bovine bone as the bone substitute (P = .0001). There were significantly more women in the case group than in the control group (84.6% in the cases vs 40.8% in the controls; P = .01).

Conclusions: This study demonstrated a significant association between a specific deproteinized bovine bone substitute use as sinus bone graft material and subsequent development of FB of the maxillary sinus.

MeSH terms

  • Animals
  • Aspergillosis / diagnostic imaging*
  • Aspergillosis / microbiology
  • Aspergillosis / surgery
  • Aspergillus / isolation & purification*
  • Bone Substitutes / adverse effects*
  • Bone Transplantation
  • Case-Control Studies
  • Cattle
  • Female
  • Humans
  • Male
  • Maxillary Sinus / diagnostic imaging
  • Maxillary Sinus / microbiology*
  • Maxillary Sinus / surgery*
  • Maxillary Sinusitis / diagnostic imaging
  • Maxillary Sinusitis / microbiology*
  • Maxillary Sinusitis / surgery*
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed


  • Bone Substitutes