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Purpose <p>Maxillary sinus marginal calcification (MSMC) is a novel radiological entity that closely mimics maxillary sinus fungal ball (MSFB), potentially leading to misdiagnosis and unwarranted endoscopic sinus surgery (ESS). This study aimed to delineate the clinical and imaging features that distinguish MSMC from MSFB, propose diagnostic criteria to aid in accurate identification, and briefly explore its potential pathogenesis.</p> Methods <p>Thirteen patients with MSMC (diagnosed by imaging/pathology) and 26 with histopathologically confirmed MSFB were enrolled. Clinical data, imaging features and histopathological findings were retrospectively analyzed and compared.</p> Results <p>Both groups showed similar age (48.82 ± 15.86 vs. 56.27 ± 14.04 years, <i>P</i> = 0.178) and exhibited a similar female predominance (69.2% vs. 61.5%, <i>P</i> = 0.733). The incidence of sclerosis of lateral sinus wall was also comparable (61.5% vs. 76.9%, <i>P</i> = 0.453). However, several distinguishing features were identified in the MSMC group: a significantly higher asymptomatic presentation (84.6% vs. 19.2%, <i>P</i> &lt; 0.001); exclusively perisinus hyperdensity (100%) compared to MSFB’s predominant intrasinus pattern (73.1%, <i>P</i> &lt; 0.001); universal OMC patency (100% vs. 7.6%, <i>P</i> &lt; 0.001); and complete absence of the inner sinus wall erosion (0% vs. 57.7%, <i>P</i> &lt; 0.001). The mean CT value of MSMC (483.6 HU) was significantly distinct from the surrounding mucosa (30.1 HU, <i>P</i> &lt; 0.001) and adjacent cortical bone (1283.0 HU, <i>P</i> &lt; 0.001). MSMC lacked history of endodontic treatment or periapical lesions (<i>P</i> &lt; 0.001), with significantly less direct contact between tooth roots and the sinus floor (<i>P</i> = 0.039) compared to MSFB. Histopathology confirmed MSMC as reactive bone hyperplasia.</p> Conclusion <p>In this study, MSMC is typically characterized by an asymptomatic status, perisinus calcific hyperdensity, a patent OMC, and an intact inner sinus wall. The absence of odontogenic risk factors further supports the diagnosis of MSMC. Its pathogenesis likely represents a localized bone remodeling response driven by the synergy of inflammatory and biomechanical factors. Accurate recognition of MSMC can help avoid unnecessary surgical intervention and support an expectant management strategy (clinical observation) for this benign radiological entity.</p>

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Maxillary sinus marginal calcification: A novel radiological entity distinct from maxillary sinus fungal ball

  • 期刊论文

  • 发表日期：

    2026年3月28日

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  • Xiuquan Liu,
  • Muhan Shi,
  • Nan Lin,
  • Tong Guo,
  • Xinzhu Wang,
  • Xunhui Ji,
  • Dingbao Chen,
  • Jingli Xu,
  • Min Wang

摘要

Purpose

Maxillary sinus marginal calcification (MSMC) is a novel radiological entity that closely mimics maxillary sinus fungal ball (MSFB), potentially leading to misdiagnosis and unwarranted endoscopic sinus surgery (ESS). This study aimed to delineate the clinical and imaging features that distinguish MSMC from MSFB, propose diagnostic criteria to aid in accurate identification, and briefly explore its potential pathogenesis.

Methods

Thirteen patients with MSMC (diagnosed by imaging/pathology) and 26 with histopathologically confirmed MSFB were enrolled. Clinical data, imaging features and histopathological findings were retrospectively analyzed and compared.

Results

Both groups showed similar age (48.82 ± 15.86 vs. 56.27 ± 14.04 years, P = 0.178) and exhibited a similar female predominance (69.2% vs. 61.5%, P = 0.733). The incidence of sclerosis of lateral sinus wall was also comparable (61.5% vs. 76.9%, P = 0.453). However, several distinguishing features were identified in the MSMC group: a significantly higher asymptomatic presentation (84.6% vs. 19.2%, P < 0.001); exclusively perisinus hyperdensity (100%) compared to MSFB’s predominant intrasinus pattern (73.1%, P < 0.001); universal OMC patency (100% vs. 7.6%, P < 0.001); and complete absence of the inner sinus wall erosion (0% vs. 57.7%, P < 0.001). The mean CT value of MSMC (483.6 HU) was significantly distinct from the surrounding mucosa (30.1 HU, P < 0.001) and adjacent cortical bone (1283.0 HU, P < 0.001). MSMC lacked history of endodontic treatment or periapical lesions (P < 0.001), with significantly less direct contact between tooth roots and the sinus floor (P = 0.039) compared to MSFB. Histopathology confirmed MSMC as reactive bone hyperplasia.

Conclusion

In this study, MSMC is typically characterized by an asymptomatic status, perisinus calcific hyperdensity, a patent OMC, and an intact inner sinus wall. The absence of odontogenic risk factors further supports the diagnosis of MSMC. Its pathogenesis likely represents a localized bone remodeling response driven by the synergy of inflammatory and biomechanical factors. Accurate recognition of MSMC can help avoid unnecessary surgical intervention and support an expectant management strategy (clinical observation) for this benign radiological entity.