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Dento Maxillo Facial Radiology Sep 2022CT-scan hyperdensities (HD) are described in more than 60% of all paranasal sinus fungus ball (FB) cases. Two types can be distinguished according to their density:...
OBJECTIVES
CT-scan hyperdensities (HD) are described in more than 60% of all paranasal sinus fungus ball (FB) cases. Two types can be distinguished according to their density: calcium and metal types. We aimed to establish the prevalence and density of the HD observed in sphenoid and maxillary sinus FB and their relation to dental factors.
METHODS
This retrospective study included 64 patients operated in a tertiary referral center for unilateral maxillary or sphenoid FB diagnosed by histology or mycology. Pre-operative CT scans were analyzed by three independent observers (two ENT and one radiologist).
RESULTS
There were 45 maxillary FB and 19 sphenoid FB. 63 FB showed HD. Metal-type HD were observed in 28 maxillary FB but not in sphenoid sinuses. Among maxillary FB, the prevalence of endodontic treatment was significantly more significant on the FB side than on the healthy side ( = 0.02). The prevalence of endodontic treatment on the pathological side was more significant in the metal-type group than in the group without metal-type HD ( = 0.01). Isolated calcium-type HD were evidenced in 17 maxillary FB and 18 sphenoid FB ( = 0.019).
CONCLUSION
This study highlights the existence of two different types of HD in FBs of the paranasal sinuses with an association between metal-type HD and endodontic treatments.
Topics: Calcium; Fungi; Humans; Maxillary Sinus; Paranasal Sinuses; Retrospective Studies; Sphenoid Sinus; Tomography, X-Ray Computed
PubMed: 35762348
DOI: 10.1259/dmfr.20180384 -
Neurologia Medico-chirurgica Jun 2021The complications of endonasal transsphenoidal surgery (ETSS) include meningitis and sinusitis, and these complications are troublesome. Some reports have investigated...
The complications of endonasal transsphenoidal surgery (ETSS) include meningitis and sinusitis, and these complications are troublesome. Some reports have investigated the type of bacteria and the susceptibility of sphenoid sinus mucosal flora to drugs. However, most specimens can be collected after perioperative antibiotic administration. In this study, 95 and 103 sphenoid sinus mucosal samples collected during ETSS from September 2013 to February 2015 and from June 2017 to January 2019, respectively, were examined for bacterial culture. Sphenoid sinus mucosal samples were collected after antibiotic administration in the first period, whereas samples were collected before antibiotic administration in the second period. Hence, the specimens in the second period were not affected by antibiotics. Moreover, drug susceptibility tests for the detected bacteria were performed. Overall, 52 and 51 bacterial isolates were collected during both periods. Gram-positive cocci (GPCs), including Staphylococcus aureus and Staphylococcus epidermidis, were more common in the non-antibiotic group than in the antibiotic group (p <0.01). However, the proportion of gram-negative rods (GNRs) did not significantly differ between the two groups (p = 0.54). The antibiotic group had a significantly higher proportion of bacteria resistant to ampicillin (p <0.01) and first-generation cephalosporin (p = 0.01) than the non-antibiotic group. In conclusion, there was a difference in bacterial flora in the sphenoid sinus mucosal samples collected before and after intraoperative antibiotic administration.
Topics: Anti-Bacterial Agents; Bacteria; Humans; Nose; Sphenoid Sinus; Staphylococcal Infections
PubMed: 33967178
DOI: 10.2176/nmc.oa.2020-0387 -
BMJ Case Reports Apr 2023Invasive fungal sinusitis (IFS) is more common in immunosuppressed patients but can also occur in immunocompetent hosts. While the non-invasive type of fungal sinusitis...
Invasive fungal sinusitis (IFS) is more common in immunosuppressed patients but can also occur in immunocompetent hosts. While the non-invasive type of fungal sinusitis has usually a good prognosis, IFS is a potentially lethal condition.We report the case of a woman in her 60s presenting an isolated fungal infection by of the right sphenoid sinus, causing extensive bone erosion of its walls and complicated by severe meningoencephalitis. She was healthy without any immunosuppressive conditions. Methods of diagnosis, multidisciplinary management, follow-up and outcomes are documented.Early-stage diagnosis of sphenoid sinus pathologies is often delayed because patients are usually asymptomatic. IFS of the sphenoid is more aggressive than other paranasal sinus and carries significant mortality. Early diagnosis and aggressive and multidisciplinary treatment are crucial to reduce sequels and improve patient's survival.
Topics: Female; Humans; Sphenoid Sinusitis; Sinusitis; Mycoses; Paranasal Sinuses; Sphenoid Sinus; Invasive Fungal Infections
PubMed: 37085281
DOI: 10.1136/bcr-2022-253788 -
The Journal of Craniofacial SurgeryA mononostril endoscopic approach was attempted for bilateral sphenoid sinus lesions. The objective of this study was to introduce the surgical method along with...
INTRODUCTION
A mononostril endoscopic approach was attempted for bilateral sphenoid sinus lesions. The objective of this study was to introduce the surgical method along with treatment results for patients.
METHODS
We retrospectively analyzed 16 patients who underwent a mononostril endoscopic surgery for bilateral sphenoid lesions from 2018 to 2022.
RESULTS
Endoscopic mononostril surgery for bilateral sphenoid lesions was performed for 13 cases under general anesthesia and 3 cases under local anesthesia. The surgical approach to the sphenoid sinus was transnasal approach in 8 cases and transethmoidal in 8 cases. Among those with bilateral sphenoid sinuses lesions, fungal ball and sinusitis were the most common. After surgery, the size of the sphenoid sinus opening remained almost the same in 14 patients. It decreased but maintained in 2 patients. There was no recurrence of sphenoid lesions.
CONCLUSION
The mononostril endoscopic approach for bilateral sphenoid lesions is a feasible, safe, effective, and minimally invasive surgical technique.
Topics: Humans; Sphenoid Sinus; Retrospective Studies; Sinusitis; Endoscopy; Treatment Outcome
PubMed: 36123764
DOI: 10.1097/SCS.0000000000008939 -
International Forum of Allergy &... Sep 2019Nasal irrigation is an important component of medical management in chronic rhinosinusitis. Nasal irrigations facilitate topical medication of therapies and lavage of...
BACKGROUND
Nasal irrigation is an important component of medical management in chronic rhinosinusitis. Nasal irrigations facilitate topical medication of therapies and lavage of mucin. In this study we aim to compare the influence of increasing surgical sphenoid openings on the distribution, force, and clearance of nasal irrigations.
METHODS
A study was performed on fresh-frozen adult cadaver heads. The surgical ostium was modified on one side via a simple sphenoidotomy, a sphenoid sinusectomy (type 1), and sphenoid sinusectomy (type 3a). The nasal cavity was irrigated using a 240-mL squeeze bottle with 0.1% fluoroscein. An endoscope passed through the contralateral side through the sphenoid septum recorded the irrigation. Videos were recorded and blindly assessed. The distribution was defined as either no irrigation, less than one third of the sinus, less than or equal to two thirds of the sinus, or the complete sinus. The force was defined as minimal, minor, or major. The clearance was defined as no residual, less than one third of volume, less than or equal to two thirds of volume, and more than two thirds volume. Ordinal correlation scores were assessed using the Kendall tau-B test.
RESULTS
Nine specimens (sphenoid sinuses) were assessed (44.4% female; age, 75.0 ± 12.7 years). The use of a sphenoid sinusectomy or larger produced better distribution (percent specimens with more than one third: 100% vs 59%, p < 0.01), more force (percent major: 83% vs 29%, p < 0.01), and better clearance (percent with one third or less remaining: 56% vs 18%, p < 0.01).
CONCLUSION
Increasing sphenoid ostial size improves nasal irrigation penetration. We propose that greater sphenoid sinusectomy size allows for improved lavage and irrigation penetration. Complete removal of the anterior face appears to mitigate pooling of irrigation.
Topics: Aged; Aged, 80 and over; Cadaver; Chronic Disease; Female; Humans; Male; Middle Aged; Nasal Cavity; Nasal Lavage; Organ Size; Rhinitis; Sinusitis; Sphenoid Bone; Sphenoid Sinus
PubMed: 31259472
DOI: 10.1002/alr.22371 -
Analysis Of The Anatomical Variations Of The Sphenoid Sinus In Patients With Chronic Rhinosinusitis.Indian Journal of Otolaryngology and... Apr 2023Introduction - To study the anatomical variations of sphenoid sinus and its related structures and to know the association of extension of pneumatisation of sphenoid...
Introduction - To study the anatomical variations of sphenoid sinus and its related structures and to know the association of extension of pneumatisation of sphenoid sinus with sphenoid sinusitis. Materials And Methods - This was a prospective study. Analysis of 100 patients CT PNS scans who was attending Otolaryngology clinic OPD with signs/symptoms of chronic sinusitis evaluated between September 2019 to April 2021. The pneumatization of adjacent structures of sphenoid sinuses and its relation with the protrusion of neurovascular structures surrounding the sinus and the association between the extension of pneumatisation of sphenoid sinus and presence of sphenoid sinusitis have been investigated. Chi-square test was used for statistical analysis. The p value < 0.05 was expressed as significant. Result - The association of extension of pneumatisation of sphenoid sinus with sphenoid sinusitis was statistically significant (p < 0.001) i.e. sphenoid sinusitis is seen more in patients having absence of extension of peumatization of sphenoid sinus. We also observed that seller type of pnematization (89%) is most common type. Type 1 variation (76%) is most common for Optic nerve variations, Type 3 is most common type (83%) for variation of Foramen rotendum, and Vidian canal (85%) passing through the sphenoid sinus. Conclusion - In conclusion we observed that seller type of pnematization is most common type. Type 1 variation is most common for Optic nerve variations, Type 3 is most common type for variation of Foramen rotendum, and Vidian canal passing through the sphenoid sinus, we also concluded that sphenoid sinusitis is more common in sphenoid sinus with absence of extension of pneumatisation.
PubMed: 37206718
DOI: 10.1007/s12070-022-03385-7 -
The Annals of Otology, Rhinology, and... Sep 2022The current classification system of invasive fungal sinusitis (IFS) includes acute (aIFS) and chronic (cIFS) phenotypes. Both phenotypes display histopathologic...
BACKGROUND
The current classification system of invasive fungal sinusitis (IFS) includes acute (aIFS) and chronic (cIFS) phenotypes. Both phenotypes display histopathologic evidence of tissue necrosis, but differ by presence of angioinvasion, extent of necrosis, and disease progression. aIFS is defined by a rapid onset of symptoms, while cIFS slowly progresses over ≥12 weeks. However, a subset of IFS patients do not fit into the clinical presentation and histopathologic characteristics of either aIFS or cIFS.
OBJECTIVES
To investigate the demographic, clinical, and histopathologic characteristics of a distinct subset of IFS.
METHODS
Retrospective review of patients with IFS from a single tertiary-care institution (2010-2020). Patients with symptoms for ≤4 weeks were classified as aIFS if they displayed endoscopic evidence of mucosal necrosis or fungal angioinvasion on pathology. Patients with slowly progressive IFS for ≥12 weeks were classified as cIFS. Patients with symptom duration between 4 and 12 weeks with evidence of invasive fungal disease were classified as a new entity and were further investigated.
RESULTS
Of the 8 patients identified, 50% were immunosuppressed at presentation. The mean symptom duration prior to presentation was 50.5 days (SD 16.8), and common symptoms included facial pain (100%), vision change (87.5%), and blindness (37.5%). Two patients (25%) died of their disease. Sites of fungal involvement confirmed by histopathology included sphenoid (62.5%) and ethmoid sinuses (12.5%), orbital apex (25%), optic nerve (12.5%), pterygopalatine fossa (12.5%), and clivus (12.5%). Fungal elements but without obvious angioinvasion, were identified in all specimens, and fungus balls (50%), granulomas (37.5%), and giant cells (25%) were also observed on histopathology. CT and MRI radiographic imaging showed findings consistent with orbital, intracranial, or skull base involvement in all patients.
CONCLUSION
We propose intermediate IFS as a new subgroup of patients with IFS who do not fit into the standard classification of aIFS or cIFS.
Topics: Endoscopy; Humans; Invasive Fungal Infections; Necrosis; Retrospective Studies; Sinusitis
PubMed: 34694144
DOI: 10.1177/00034894211052854 -
Cureus Jun 2023Introduction Due to the variable degree of pneumatization, the shape and size of the sphenoid sinus are irregular. An endoscopic intranasal transsphenoidal approach is...
Introduction Due to the variable degree of pneumatization, the shape and size of the sphenoid sinus are irregular. An endoscopic intranasal transsphenoidal approach is made in sphenoid sinus pathologies, sphenoid sinusitis, and sellar and parasellar diseases. A diagnostic approach to the sphenoid sinus is also done to get a better MRI scan of the pituitary. The present study aims to describe the variant types of sphenoid sinus, morphometry, anatomy, and relations of sphenoid sinus, which will be helpful to surgeons during an endoscopic approach to the sphenoid sinus. Materials and methods We studied 76 cadaveric sphenoid sinuses that were exposed by taking a sagittal section of 38 formalin-fixed cadaveric heads. After examining the inter-sphenoidal septum, it was removed to observe the inside aspect of the sphenoid sinus. Different dimensions of the sinus were noted down. The bulges inside the sinus due to neurovascular structures in relation to the sinus were observed. Results The most prominent type found was the sellar in 68.4% of cases preceded by the postsellar in 23.7% of cases. Presellar type of pneumatization was seen only in 7.9% of cases and the conchal type was absent. Intersphenoid septum was seen in 92,1% of cases, out of which 11.4% of septums were deficient on the posterior aspect. An internal carotid artery bulge in the sphenoid sinus was seen in 46% of cases. In 27.6% and 19.7% of sphenoid sinuses, bulging of the optic and vidian nerves, respectively, were seen. Some of these structures were dehiscent in the sphenoid sinus. Conclusions To get more space in the sphenoid sinus, the septa in the sinus are removed by surgeons, which may damage the walls of the sphenoid sinus. Knowledge of the relations of neurovascular structures with the sphenoid sinus will be helpful to surgeons during the transsphenoidal endoscopic approach to avoid any injury to these structures.
PubMed: 37431332
DOI: 10.7759/cureus.40187 -
Indian Journal of Otolaryngology and... Oct 2022Describe experience of managing paranasal sinus mucoceles, with either endoscopic endonasal approach (EESS) or combined external with EESS approach. Retrospective study...
Describe experience of managing paranasal sinus mucoceles, with either endoscopic endonasal approach (EESS) or combined external with EESS approach. Retrospective study done at SDMCMS&H, between 2007 and 2019, on patients undergoing surgical excision of mucocele. Results described as mean, median, mode, percentages. Twenty-one patients were included, with male to female ratio (0.75:1), mean age (42.95 years). Commonest presentation were facial pain (42.85%),visual symptoms (28.57%), headache (23.80%). Signs included, proptosis (52.38%), facial deformity (23.80%). Imaging: showed frontal mucoceles (42.85%), fronto-ethmoid (38.09%), ethmoid (14.28%), sphenoid (4.76%). Orbital extension in 42.85%, sinusitis (33.33%), skull base erosion (23.80%). EESS or combined external and EESS approach (61.90%, 38.09% respectively) were performed. Complete excision of mucocele wall done. Recurrence in two cases(average-2.5 years),revision surgery performed without further recurrences. Either EESS or combined external and EESS approach used based on site and extension of mucoceles. Complete peeling of mucocele wall without obliteration of the sinus cavity was the mode of surgical management in all cases.
PubMed: 36452573
DOI: 10.1007/s12070-020-02206-z -
Journal of Immunology Research 2021The inflammatory mucosa of the sinus cavities is called sinusitis and is divided into various types based on its appearance and sign. Chronic rhinosinusitis is an...
BACKGROUND
The inflammatory mucosa of the sinus cavities is called sinusitis and is divided into various types based on its appearance and sign. Chronic rhinosinusitis is an inflammatory-infectious disease that involves the frontal, sphenoid, ethmoid, and maxillary sinuses. Chronic sinusitis is a multifactorial disease and the range of causes varies from environmental factors to genetic factors. The purpose of this study was to compare blood and tissue eosinophils and serum IgE levels in patients with chronic sinusitis with nasal polyp in Vali-e-Asr hospital in 1397.
METHODS
In this descriptive-analytical study, the population under study included those with chronic sinusitis referred to Birjand Valiasr Hospital in 1397.3 cc of blood samples were taken 1 day before surgery to evaluate eosinophil counts and serum IgE levels. Also, samples taken from patients during surgery were counted, and then, 100 cells were counted, and eosinophil counts and percentages were calculated. The data were entered into the SPSS software after data collection.
RESULTS
This study was performed on 70 patients with chronic rhinosinusitis which included 43 men (61.4%) and 27 women (38.6%) with mean age of 39.11 ± 13 13.72 years. There was no significant difference between sex of patients and mean serum IgE level ( < 0.05). The mean percentage of eosinophils in blood samples and tissues of patients with chronic sinusitis was significantly increased with the increase in CT scan ( < 0.05).
CONCLUSIONS
Tissue or blood eosinophilia was not observed in patients with chronic rhinosinusitis. Also, the mean eosinophil percentage of blood and tissue increased significantly in patients with increased scanning computed tomography ( < 0.05).
Topics: Adult; Biomarkers; Chronic Disease; Eosinophils; Female; Humans; Immunoglobulin E; Leukocyte Count; Male; Middle Aged; Nasal Mucosa; Nasal Polyps; Organ Specificity; Sinusitis; Young Adult
PubMed: 33628852
DOI: 10.1155/2021/6680676