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

Fungal ball is a non-invasive accumulation of the fungal element within the paranasal sinuses, most commonly affecting the maxillary sinus. This lesion often remains asymptomatic and is typically identified incidentally during imaging. This case report described the unexpected discovery of a maxillary 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 surgeries 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.