Fungal Ball of the Sphenoid Lateral Recess with Infraorbital Nerve Hypoesthesia: A Case Report and Literature Review Fungal Ball Lateral Recess Sphenoid
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Abstract
A fungal ball in the lateral recess of the sphenoid sinus (LRSS) is a rare entity, particularly when it presents atypically as facial hypoesthesia. Due to its deep location and proximity to critical neurovascular structures, it can present with atypical symptoms and radiological features that can mimic skull base malignancy, complicating diagnosis. Only one similar case has been previously reported in the literature. We report a case of a 59-year-old male who presented with a one-month history of progressive headache and left facial numbness. Neurological examination revealed diminished pinprick sensation in the infraorbital nerve distribution. A computed tomography showed a hypodense mass with rim calcification and pterygoid bone erosion adjacent to the left sphenoid sinus, raising suspicion of an invasive skull base lesion. The patient underwent endoscopic transpterygoid sphenoidotomy, which revealed fungal concretions encased within a bony partition in the LRSS. Histopathological analysis confirmed Aspergillus spp. without mucosal invasion or malignancy. Postoperatively, the patient recovered from facial numbness and had an uneventful one-year follow-up.
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