-
Ear, Nose, & Throat Journal May 2023Computed tomography (CT) is the preferred noninvasive method for the evaluation of osteitis in chronic sinusitis. Some scholars believe that the bone changes associated...
BACKGROUND
Computed tomography (CT) is the preferred noninvasive method for the evaluation of osteitis in chronic sinusitis. Some scholars believe that the bone changes associated with chronic sinusitis always show high attenuation (high density) and are positively correlated with the severity of the disease. However, sinus bone remodeling is a complex process that may cause high or low attenuation. There have been few reports on the spread of osteitis. Therefore, additional research on sinus CT is necessary.
OBJECTIVE
To observe bony changes in chronic maxillary sinusitis (CMS) by CT and reveal the mechanism.
METHODS
A retrospective study was conducted in 45 patients with unilateral CMS with bony changes in the sinus walls. The patients' clinical data and CT results were analyzed and compared between the affected and normal sides. We propose the location, involvement, attenuation, and thickness method to evaluate CMS with osteitis.
RESULTS
Of the 45 patients, 40 (88.9%), 2, 12, and 7 had posterior external, medial, anterior, and superior lesions, respectively. The nasal region, sphenoid bone, palatine bone, and zygomatic arch were involved in 3, 12, 8, and 18 (40%) patients, respectively. Computed tomography indicated high attenuation in 30 (75.0%) and low attenuation in 10 (25.0%) patients; 6 (15.0%) showed new bone marrow cavities. The bone thickness was significantly different between the affected and normal sides in 40 patients ( < .001), including members of both the high- and low-attenuation groups (high-attenuation group: < .001; low-attenuation group: < .01). However, there was no significant difference in the thickness of the affected side between the high- and low-attenuation groups ( > .05).
CONCLUSIONS
Chronic rhinosinusitis with bony changes may occur in the maxillary sinus walls and spread to adjacent bones. Both increased and decreased attenuation may occur in these circumstances. Analyzing the CT features of bone changes in unilateral CMS can improve the accuracy of disease diagnosis.
Topics: Humans; Maxillary Sinusitis; Osteitis; Retrospective Studies; Rhinitis; Sinusitis; Tomography, X-Ray Computed; Maxillary Sinus
PubMed: 33752463
DOI: 10.1177/0145561321993936 -
International Journal of Surgery Case... Nov 2023The paranasal sinuses are a group of four paired air-filled spaces located within the bony skull; maxillary, frontal, sphenoid, and ethmoid sinuses. Paranasal sinuses...
INTRODUCTION AND IMPORTANCE
The paranasal sinuses are a group of four paired air-filled spaces located within the bony skull; maxillary, frontal, sphenoid, and ethmoid sinuses. Paranasal sinuses aplasia is a rare condition that is mainly confined to the frontal sinus unilaterally. Combined aplasia of multiple sinuses along with hypoplasia of other sinuses is extremely rare. This rare case should be considered in mind before scheduling any endoscopic sinus surgery to prevent complications during these surgeries.
CASE PRESENTATION
A 13-year-old male patient presented to our ENT clinic complaining of a prolonged history of persistent headache, nasal obstruction, and nasal discharge. He also complained of bilateral ears fullness and facial pain. On physical examination, bilateral purulent nasal discharge with congested inflamed nasal mucosa and both inferior turbinate. The patient was diagnosed to have sinusitis and was started on treatment. The patient returns to our clinic after several weeks with minimal improvement. Computed tomography (CT was obtained and showed completely absent pneumatization of bilateral frontal and sphenoid sinuses.
CLINICAL DISCUSSION
The development of the paranasal sinuses appears prenatally which can lead to a variety of PNS anomalies. However, the aplasia or hypoplasia of the PNS is found to be rare. Aplasia is mainly found in frontal and maxillary sinuses with a prevalence of 12 % and 6 %, respectively. While the prevalence of sphenoid sinus aplasia is extremely rare and found to be less than 0.7 %. Moreover, aplasia of multiple sinuses "combined aplasia" is an incredibly unusual finding.
CONCLUSION
this patient is one of the extremely rare cases of the combined aplasia of frontal and sphenoid sinuses who was diagnosed and confirmed at an early age without any skeletal, systemic, or hematological abnormalities. Despite that, this rare case should be considered in mind before scheduling any endoscopic sinus surgery to prevent complications during these surgeries.
PubMed: 37852096
DOI: 10.1016/j.ijscr.2023.108927 -
Ear, Nose, & Throat Journal Jul 2022
Topics: Humans; Pituitary Neoplasms; Sinusitis; Sphenoid Bone; Sphenoid Sinus; Sphenoid Sinusitis
PubMed: 32965127
DOI: 10.1177/0145561320961205 -
Pediatrics International : Official... Jan 2022
Topics: Acute Disease; Child; Headache; Humans; Sleepiness; Sphenoid Sinusitis
PubMed: 36198394
DOI: 10.1111/ped.15312 -
Proceedings (Baylor University. Medical... Jul 2020Streptococci bacteremia is an unusual source of sepsis from spontaneous cerebrospinal fluid (CSF) rhinorrhea due to sphenoid meningoencephalocele. A spontaneous cause of...
Streptococci bacteremia is an unusual source of sepsis from spontaneous cerebrospinal fluid (CSF) rhinorrhea due to sphenoid meningoencephalocele. A spontaneous cause of CSF rhinorrhea should be on the differential along with trauma and congenital and neoplastic lesions. Moxifloxacin 400 mg daily for 2 weeks has a satisfactory CSF penetration to treat bacteremia due to CSF rhinorrhea.
PubMed: 32675980
DOI: 10.1080/08998280.2020.1756631 -
Life (Basel, Switzerland) Jul 2023This paper presents a literature review and a case of an 83-year-old otherwise healthy female patient with a history of recent syncope, a sudden-onset right-sided... (Review)
Review
This paper presents a literature review and a case of an 83-year-old otherwise healthy female patient with a history of recent syncope, a sudden-onset right-sided temporal headache, diplopia, and vision loss. An exam revealed right-sided upper eyelid ptosis, myosis, vision loss, ophthalmoplegia, and a positive relative afferent pupillary defect on the right eye. CT showed sphenoid sinus opacification, eroded lateral sinus wall, Vidian canal, disease extension to the posterior ethmoid air cells, orbital apex, medial orbital wall, and pterygopalatine fossa. An orbital apex syndrome (Jacod's syndrome), Horner syndrome, and pterygopalatine fossa infection were diagnosed due to the acute invasive fungal sinusitis developed from a sphenoid sinus fungal ball. The patient was treated with antimicrobial therapy and transnasal endoscopic surgery twice to decompress the orbital apex, drain the abscess and obtain specimens for analysis. The right-sided ptosis, visual loss, ophthalmoplegia, and headache resolved entirely. No immune or comorbid diseases were identified, microbiological and histopathological analyses were negative, and MRI could not be performed on the presented patient. For that reason, the diagnostic procedure was non-standard. Nevertheless, the treatment outcome of this vision and life-threatening disease was satisfactory. Treating the fungal ball in an older or immunocompromised patient is essential to prevent invasive fungal rhinosinusitis and fatal complications.
PubMed: 37629515
DOI: 10.3390/life13081658 -
BMJ Case Reports Aug 2023Sphenoid sinusitis is a rare disease associated with life-threatening complications that can be avoided with early recognition and timely treatment. Here, we present a...
Sphenoid sinusitis is a rare disease associated with life-threatening complications that can be avoided with early recognition and timely treatment. Here, we present a case of a woman in her 80s admitted for symptomatic anaemia likely secondary to a gastrointestinal bleed with left cranial nerve (CN) VI palsy incidentally discovered on physical examination. CT and MRI were suggestive of chronic left sphenoid sinusitis with possible involvement of the left cavernous sinus. Surgical treatment was deferred due to high cardiac risk for perioperative mortality and recent ischaemic stroke. Despite antibiotic treatment, the patient's CN VI palsy remained unchanged. This report contributes to the current understanding of sphenoid sinusitis by presenting a complex case of chronic sphenoid sinusitis in which urgent surgical intervention was deferred due to the patient's multiple comorbidities. Furthermore, it highlighted the importance of the CN examination and imaging modalities in diagnosing sphenoid sinusitis.
Topics: Female; Humans; Brain Ischemia; Sphenoid Sinusitis; Stroke; Abducens Nerve Diseases; Chronic Disease; Paralysis
PubMed: 37620105
DOI: 10.1136/bcr-2022-253773 -
Iranian Journal of Otorhinolaryngology Mar 2020Isolated sphenoid sinus inflammatory diseases (ISSIDs) are responsible for about 75% of isolated sphenoid sinus opacifications. Computer tomography (CT) and magnetic...
INTRODUCTION
Isolated sphenoid sinus inflammatory diseases (ISSIDs) are responsible for about 75% of isolated sphenoid sinus opacifications. Computer tomography (CT) and magnetic resonance imaging (MRI) should be used in a complementary manner for the assessment of ISSIDs. This evaluation sheds some light on the extent of disease and intracranial and intra-orbital involvement.
MATERIALS AND METHODS
The current study aimed to evaluate the medication histories of 14 patients who underwent endoscopic sinus surgery (ESS) for ISSIDs within 2015-2018. This assessment was carried out to analyze the presenting symptoms, diagnostic work-up, additional therapies, and complications. Moreover, it can help us compare our data with pertinent literature.
RESULTS
As evidenced by the obtained results, ISSID lesions included bacterial sphenoiditis (42.9%), fungus ball (21.4%), invasive fungal sphenoiditis (14.3%), mucocele (14.3%), and retention cysts (7.1%). In addition, headache was found to be the major complaint, followed by nasal symptoms. Diplopia, and signs and symptoms of the involvement of other cranial nerves were less frequent. All patients underwent endoscopic transnasal sphenoidectomy. The overall survival rate was reported as 92.9% (13/14), and all patients with cranial nerve palsies demonstrated complete clinical remission.
CONCLUSION
Both the review of related literature and our clinical cases were indicative of the dangerous consequences of ISSIDs. Their varied and unspecific presentation and the limited reliability of nasal endoscopy required the cooperation of ENT (ear, nose, and throat) team with other specialists to make an accurate diagnosis and decide on the most appropriate therapeutic choices. If the signs of intracranial complications were detected, surgery should be promptly performed to maximize the chances of recovery.
PubMed: 32219076
DOI: 10.22038/ijorl.2019.39416.2304 -
The American Journal of Case Reports May 2023BACKGROUND Optic neuritis is a rare but possible complication of sphenoid sinusitis. CASE REPORT We present a case of a young woman with recurrent optic neuritis... (Review)
Review
BACKGROUND Optic neuritis is a rare but possible complication of sphenoid sinusitis. CASE REPORT We present a case of a young woman with recurrent optic neuritis associated with chronic sphenoid sinusitis. A 29-year-old woman with visual impairment of the left eye to Snellen distance best-corrected visual acuity (DBCVA) of 0.5 and migraine headaches accompanied by vomiting and dizziness reported to the ophthalmic emergency room. The preliminary diagnosis was demyelinating optic neuritis. On head computed tomography, a polypoid lesion of the sphenoid sinus was found and qualified for elective endoscopic treatment. During a 4-year follow-up, evaluation of DBCVA, fundus appearance, visual field, ganglion cells layer (GCL), peripapillary retinal nerve fiber layer (RNFL) thickness, and ganglion cells and visual pathway function (pattern electroretinogram - PERG, pattern visual evoked potentials - PVEPs) were performed. Four years after the occurrence of the initial symptoms, surgical drainage of the sphenoid sinus was performed, which revealed a chronic inflammatory infiltrate and a sinus wall defect on the left side around the entrance to the visual canal. After surgery, headaches and other neurological symptoms resolved, but DBCVA deteriorated in the left eye to finger counting/hand motion, partial atrophy of the optic nerve developed, the visual field defect progressed to 20 central degrees, GCL and RNFL atrophy appeared, and deterioration of ganglion cells and visual pathway function were observed. CONCLUSIONS In patients with optic neuritis and atypical headaches, sphenoid sinusitis should be considered in the differential diagnosis. Delayed laryngological intervention can cause irreversible damage to the optic nerve.
Topics: Female; Humans; Adult; Sphenoid Sinusitis; Evoked Potentials, Visual; Optic Neuritis; Vision Disorders; Chronic Disease; Headache; Tomography, Optical Coherence; Atrophy
PubMed: 37179452
DOI: 10.12659/AJCR.939267 -
Journal of Neuro-ophthalmology : the... Mar 2024
Topics: Humans; Sphenoid Sinusitis; Optic Nerve Diseases; Optic Nerve; Rare Diseases
PubMed: 36255078
DOI: 10.1097/WNO.0000000000001702