上颌窦蠊缨滴虫病

Blattarum Lophomoniasis of the Maxillary Sinuses

本文报告极为罕见的上颌窦蠊缨滴虫病，表现为局部疼痛、窦腔内充满暗褐色干酪样物。当时将该物抹片镜极可见活跃的滴虫，该HE染色照片经专家鉴定为超鞭毛虫目、缨滴虫科、缨滴虫属的蠊缨滴虫。经上颌窦柯氏术等手术处理及灭滴灵上颌窦腔冲洗治愈，观察一年无复发，且CT复查见上颌窦外侧壁略有骨质增生外，窦内含气充分；鼻中、下道窗口通畅。鼻内窥镜复查除手术改变外均无殊。虽然本病为偶然发现，而上颌窦内有干酪样物却非少见。因此有必要对鼻腔及鼻窦任何干酪样物仔细镜检，以免漏诊。

The maxillary sinusitis due to lophomonas blattarum is rarity in the medical documemts. In this report,a case was found occasionally on Dec. 9. 1996. The patient complained of pain over the right antral area, which referred to ipsilateral temporal region for one month,but without nasal obstruction or rhinorrhea.On inspection of the nasal cavity,there was neither edema rlor inflammation seen in the middle turbinate,and there was no any discharge found in the nasal passage. The opacification of the right maxillary sinuse was demonstrated by Water's radiographic view and CT axial scans. During the caldwell -Luc operation,trans antral ethmoidectomy and partial middle turbnectomy,we found that the right maxillary antrum was filled with dark brown caseous paste. The paste smear was examined under microscope and it demonstrated some pyriform uninuclear protozoa (about 20 X 10μm in diameter)with one anterior flagellated turft which moved even actively, After HE stained,the slide has been examined by prot. Chang Zheng -Shan (in Institute of par asitology,Chinese Academy of Preventive Medical Sciences,Shanghai) and the protozoa were identified as hypermastigida (order), lophomonadina (suborder ), lophomonadae (family), lophomonas (genus ), lophomonas blattarum (species). After operation and antral irrigation with metronidazole 100 mg added in normal saline 250 ml,a satisfying reault was achieved,and without recurrence by 12 months follow-up,We considered, it is easily to neglect to diagnose the disease. For this reason,it is suggested that any caseous paste in nasal cavity and or maxillary sinuse encountered should be sent to microscopic examination.By the way,strong suspicion is the first important for diagnonsis.