## 2 Materials and Methods
### Patient Cases
#### 2.1.2 Case 2: Fungal Sinusitis with Involved BRONJ Case  
A 79-year-old female patient was referred from a local dental clinic to our institution for treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in 2019. The patient had a chief complaint of pain and swelling on both sides of the maxilla and the  
Figure 1: Preoperative radiographic examination of case 1. The panoramic radiograph shows generalized alveolar bone loss and calculi deposition; fraction involvement of the #36, #37, #46, and #47 teeth; and a round retention pseudocyst surrounding the #16i and #17i implants (marked with arrows) (**A**). Upon CT examination, the #16i implant fixture had a missing abutment and, together with the #17i implant in the right maxillary sinus (marked with arrows), mucosal thickening and retention pseudocyst were observed in the right maxillary sinus in the axial view (**B**). Intraoperative view of #16i implant removal (**C**). The #16i implant was removed using forceps and trephine burr (**D**).  
left mandible area. The patient had a medical history of osteoporosis, rheumatism, and heart valve defect and reported that she receives daily injections of osteoporosis drugs and consumes medication for high blood pressure.  
Upon clinical examination, buccal bone exposure was observed in the #16 and #26i areas. The panoramic radiograph and [PERSON]'s view showed generalized alveolar bone loss and calculi deposition, apical involvement of the #36 tooth; fraction involvement of the #37 tooth; peri-implant bone loss around the #15, #24, #25, and #26 teeth; and left maxillary sinus opacification (Figure 2A). CT imaging showed bone fracture and sequestrum formation in the right and left sides of the maxilla and left mandible. Cortex destruction, sequestrum, calculated marrow attachment, and adjacent bone sclerosis were observed in the areas of #11 through #17, #24 through #27, and #36 and #37 teeth, and the upper and lower cortices were overserved, thus being lost in the area of maxillary bone destruction (Figure 2B). The laboratory complete blood count showed a reduced red blood cell (RBC) count of 3.14 \(\times\) 10\({}^{6}\) / \(\mu\)L (reference range: 4-5.40 \(\times\) 10\({}^{6}\) / \(\mu\)L), hemoglobin (Hgb) concentration of 9.7 g/dL (reference range: 12-16 g/dL), and hematocrit of 30.4% (reference range: 36%-48%) and an increased absolute neutrophil count of 7354/\(\mu\)L (reference range: 1800-7000/\(\mu\)L).  
Based on the clinical, radiological and laboratory findings, MESS on combination with mass excision of the left maxillary sinus (#25i, #26i, and #27i alveolotomy) were planned under conscious sedation (Figure 2C,D) [9]. After administration of the local anesthesia in the surgical site using 2% lidocaine with 1:1,000,000 epinephrine, an incision line was made using blade no. 15 from the first premolar to the second molar. A full mucoperiosteal flap was elevated exposing the inflamed necrotic bone tissue. The osteolytic bone destruction was already expanded into the maxillary anterior sinus wall. The inflammatory exudate from the sinus was immediately aspirated using a 5 cc syringe. Since the bone destruction was already expanded, after the necrotic bony removal, the left maxillary sinus was exposed. With the utilization of 0\({}^{\circ}\), 15\({}^{\circ}\), 30\({}^{\circ}\), and 75\({}^{\circ}\) endoscopes, the sinus was carefully inspected and the remaining inflammatory tissue was removed and irrigated. After maxillary sinus packing with osteomeatal unit enlargement, the window on the anterior maxillary wall was fixed using two pieces of six-hole miniplate and predrilled holes. The surgical wound was sutured in two layers using 5-0 and 4-0 Vicryl(Polysdactin 910(Polys