Pneumosinus Dilatans: Over 100 Years without an Etiology

Publication date: Available online 21 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Joseph A. Ricci
PurposePneumosinus dilatans (PD) is a rare pathologic hyperaeration of the paranasal sinuses, which causes significant deformation of the overlying bone and soft tissue. The condition occurs most commonly in the frontal sinus of young adult males who present with a variety of complaints, including cosmetic. Over 100 cases have been reported in the literature since it was first described in 1898; however, the etiology of this condition remains unclear.MethodsA systematic review of all available clinical publications on the subject of PD was conducted in the PubMed electronic database. The resultant articles were grouped based on evidence supporting or refuting various theoretical etiologies to further characterize the condition.ResultsA total of 134 known cases have been reported in 117 articles. Most affected patients are young males in the third decade of life. Only 19 (16.2%) articles offered some form of evidence in support of a particular etiology. The most substantiated etiologies of PD include: a "ball-valve" mechanism of sinus outflow obstruction that leads to air trapping or a primary fibro-osseous pathologic process that disrupts the cellular milieu. Less substantiated theories include: hormonal dysregulation or a spontaneously draining mucocele. No data exists to support causation by a gas forming bacteria. A bimodal distribution of incidence, a younger population (16 to 25) and an older population (36 to 40), may suggest multiple possible etiologies.ConclusionsSeveral theories on the etiology of PD exist, but none have been substantiated by reliable scientific evidence. We believe that standardizing the clinical evaluation, classification, management, and pathologic analysis of patients with PD may aid in elucidating its true etiology.



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