Pneumosinus dilatans multiplex associated with hormonal imbalance

Abstract

Pneumosinus dilatans describes an abnormal dilation of one or more paranasal sinuses without radiological evidence of localised bone destruction, hyperostosis or mucous membrane thickening. Dilation of mastoid air cells also occurs rarely along with involvement of paranasal sinuses. This rare combination of unknown aetiology was reported in two cases in the literature and termed 'Pneumosinus Dilatans Multiplex' (PSDM). It is usually asymptomatic, and is detected incidentally on plain radiography, CT or MRI. If left untreated, it can further erode the bone leading to complications such as facial asymmetry, neurological disorders and pathological fractures. The aetiology of the condition remains obscure. Various hypotheses proposed are the presence of gas-forming microorganisms, spontaneous drainage of a mucocele, the presence of a one-way valve, dysregulation of hormonal levels leading to a disturbance of osteoblastic and osteoclastic activity. This paper describes a case of PSDM possibly secondary to hormonal disturbance.

Figure 1

Facial symmetry.

Figure 2

Midline diastema.

Figure 3

Hyperpneumatisation of the maxillary sinus extending to the anterior nasal spine along with a radiolucent lesion on the left mandible.

Figure 4

(A) Osteolysis of the maxillary, temporal and mastoid region. (B) Abnormal dilation of the frontal sinus. (C) Abnormal dilation of the maxillary and ethmoid sinuses. (D) Hyperpneumatisation of mastoid air cells. (E) Abnormal dilation of maxillary, sphenoid and ethmoid sinuses, as well as mastoid air cells.

Figure 5

Radiolucent lesion on the left mandible.