Incidental discovery of a fungal ball during esthetic malar reduction surgery: a case report

Abstract

Fungal ball is a non-invasive accumulation of the fungal element within the paranasal sinuses, most commonly affecting the maxillary sinus. This le-sion often remains asymptomatic and is typically identified incidentally during imaging. This case report described the unexpected discovery of a max-illary fungal ball during elective esthetic facial contouring surgery in a healthy, asymptomatic 37-year-old female. Preoperative cone-beam computed tomography imaging revealed a chronic sinusitis-like lesion, which intraoperatively was confirmed as a dark-brown, fluffy mass in the right maxillary sinus. Histopathological analysis identified septate fungal hyphae consistent with non-invasive aspergillosis. Postoperative follow-up demonstrated no recurrence or sinus-related symptoms. This case showed the importance of thorough preoperative imaging and intraoperative vigilance in esthetic sur-geries involving facial bones adjacent to sinus structures. Recognizing the potential for undiagnosed sinus pathology, even in asymptomatic patients, is essential for minimizing surgical complications and optimizing patient outcomes.