Bartynski, Jeffrey M.

Allergic fungal sinusitis is a newly recognized entity consisting of a pansinusitis with allergic mucinous infiltrates in all involved sinuses. The disease process itself is very different from all other types of rhinosinusitis. Pathophysiologically the disease is a combination of both IgE‐mediated and antibody‐antigen reactions to the specific fungal antigens. Here we present two cases of allergic fungal sinusitis—one caused by Curvularia lunata species (an ubiquitous soil fungi), another caused by Alternaria. Only one other case of allergic fungal sinusitis caused by curvularia in which extensive immunologic testing was done has appeared in the literature. No reports of alternaria causing allergic fungal sinusitis have appeared in the literature. Diagnostic criteria for allergic fungal sinusitis include radiologic evidence of pansinusitis in an atopic individual; findings at surgery of allergic mucin; positive fungal cultures; and specific immunologic testing, including both humoral and cellular arms of the immune system. Treatment options for allergic fungal sinusitis are discussed and include surgery alone, surgery and steroids, or steroids alone. The role of allergy immunotherapy injections remains to be defined. In general, fungal infections—and especially phaeohyphomycosis—are very rare, but appear to be increasing in frequency, especially in the paranasal sinus region.

Injection of autologous adipose tissue removed via liposuction has been used clinically for facial contouring, the aging face, furrows, facial atrophy, acne scars, nasolabial folds, chin, and various other surgical defects. Survival rates for autografts of fat have been quoted anywhere from 30% to 80%. Our study uses a reproducible rabbit animal model for autotransplantation of adipose tissue and examines the histopathologic changes that occur to the graft over time. Autogenous subcutaneous fat was removed from a dorsal scapular donor site, treated to stimulate cannula damage as in liposuction, then reinjected at the base of the ear. Histologic examination of the grafts were made at 5, 10, 15, 20, 40, and 100 days after transplantation. Hematoxylin‐eosin sections were graded on degree of fibrosis present (0 to 4+), viable fat (1 to 10), degree of inflammation (0 to 4+), and neovascularization (+ or ‐). Viability of fat decreased from 8.5 to 10 at 5 days to 2 viability at 40 days. Acute inflammation peaked at 10 days, followed by the chronic inflammatory response with macrophages and multinucleated giant cells scavenging the dying fat graft. Neovascularization began at 5 days, peaked at 10 days, and remained constant thereafter only at the edge of the graft. Microcysts appeared at 15 days and increased in number in proportion to the decrease in viable fat. In summary, the temporal histologic events are progressive fibrosis; decreased amount of viable fat; inflammation beginning with a neutrophilic response, later a macrophage and giant cell response; and neovascularization at the periphery of the graft insufficient to maintain graft viability. In our animal model, autografts of fat appear to have limited long‐term viability and are replaced by fibrous tissue. This may have clinical implications in autografting of fat in facial plastic and reconstructive surgery.