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The Laryngoscope Aug 2000To review experience with sphenoid marsupialization and describe the technique using new instrumentation.
OBJECTIVES
To review experience with sphenoid marsupialization and describe the technique using new instrumentation.
STUDY DESIGN
Retrospective review of five cases of chronic sphenoid sinusitis that were resistant to standard medical and surgical methods, which were treated by sphenoid marsupialization.
METHODS
Charts were reviewed and patients were interviewed regarding postoperative resolution of symptoms.
RESULTS
Five cases of recalcitrant sphenoid sinusitis were reviewed. All patients had headache before surgery, and two had visual disturbance. In follow-up ranging from 1 to 87 months, all were free of symptoms related to the sphenoid sinus.
CONCLUSIONS
Marsupialization is an effective method of exteriorizing a chronically infected sphenoid sinus. The use of functional endoscopic sinus surgery instruments and the TAC attachment of the Midas Rex drill make this surgery possible.
Topics: Adult; Aged; Chronic Disease; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Retrospective Studies; Sphenoid Sinusitis
PubMed: 10942139
DOI: 10.1097/00005537-200008000-00024 -
Current Opinion in Otolaryngology &... Feb 2011To review the current literature on isolated disease of sphenoid sinus, and to describe the various approaches to the sphenoid sinus. (Review)
Review
PURPOSE OF REVIEW
To review the current literature on isolated disease of sphenoid sinus, and to describe the various approaches to the sphenoid sinus.
RECENT FINDINGS
Due to its posterior location and subtle presenting symptoms, sphenoid lesions, in the past, have often been missed and were reported as rare occurrences. However, with the availability of current diagnostic modalities such as endoscopy and imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), diseases of the sphenoid sinus are now more frequently diagnosed. Since the introduction of endoscopic techniques in the mid 1980s, various endoscopic approaches to the sphenoid sinus, depending on the extent and type of disease, have been described. These approaches were subsequently 'extended' to remove pituitary tumours, and certain diseases of the parasellar region and the petrous apex. More recently, further extension of these approaches has led to the development of endoscopic skull base surgery, using the sphenoid sinus as the 'gateway' to the anterior, middle and the posterior cranial fossa. These approaches require a clear understanding of the anatomy of the sphenoid sinus and its surrounding regions.
SUMMARY
This paper presents a review of the various diseases of the sphenoid sinus and describes the approaches to the sinus with special emphasis on the transpterygoid approach to the lateral recess of the sphenoid sinus.
Topics: Diagnosis, Differential; Humans; Mucocele; Otorhinolaryngologic Surgical Procedures; Paranasal Sinus Diseases; Paranasal Sinus Neoplasms; Sphenoid Sinus; Sphenoid Sinusitis
PubMed: 21178620
DOI: 10.1097/MOO.0b013e32834251d6 -
The Pediatric Infectious Disease Journal Dec 1997
Topics: Acute Disease; Adolescent; Child; Female; Headache; Humans; Male; Sphenoid Sinusitis; Tomography, X-Ray Computed
PubMed: 9427468
DOI: 10.1097/00006454-199712000-00017 -
Journal of Neuro-oncology Jan 2009Rhinosinusitis/mucocele are rare complications of transsphenoidal surgery. We present a retrospective analysis of 323 patients who received transsphenoidal surgery for...
Rhinosinusitis/mucocele are rare complications of transsphenoidal surgery. We present a retrospective analysis of 323 patients who received transsphenoidal surgery for pituitary adenoma. Twenty of the 323 patients (6.2%) developed rhinosinusitis/mucocele after transsphenoidal surgery as shown by MRI. All 20 patients with rhinosinusitis/mucocele occurred in the group who received the small sphenoidotomy approach and simple postoperative nasal care. Medical management was successful in 13 of 20 cases (65%). The remaining seven patients received endoscopic sphenoidotomy. On re-operation, purulent pus was discovered in two, a necrotic fat graft in one, mucocele in one, a dropped tumor in two, and a bone chip in one. Sphenoid sinusitis resolved in all seven cases. The formation of sphenoid sinusitis/mucocele is related to the size of the sphenoidotomy, frequency of postoperative nasal care, and foreign body accumulation. Early surgical drainage is necessary in patients with rhinosinusitis/mucocele refractory to medical management to prevent ascending meningitis.
Topics: Adult; Female; Humans; Incidence; Magnetic Resonance Imaging; Male; Middle Aged; Mucocele; Neuroendoscopy; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Sphenoid Sinus; Sphenoid Sinusitis
PubMed: 18704265
DOI: 10.1007/s11060-008-9681-7 -
La Tunisie Medicale Feb 1990
Topics: Adult; Child; Female; Humans; Male; Radiography; Sphenoid Sinusitis; Tomography Scanners, X-Ray Computed
PubMed: 2330615
DOI: No ID Found -
Internal Medicine (Tokyo, Japan) 2015A 61-year-old Japanese woman presented with a headache and appetite loss lasting for nine days and was admitted to our hospital, where she was diagnosed with...
A 61-year-old Japanese woman presented with a headache and appetite loss lasting for nine days and was admitted to our hospital, where she was diagnosed with pneumococcal meningitis associated with acute sphenoid sinusitis. While the administration of meropenem and dexamethasone ameliorated the meningitis, right third and sixth nerve palsy suddenly developed 10 days after admission. CT angiography subsequently demonstrated an aneurysm in the cavernous portion of the right internal carotid artery. This is the first reported case of sphenoid sinusitis simultaneously complicated by both pneumococcal meningitis and an infectious aneurysm in the intracavernous carotid artery.
Topics: Aneurysm, Infected; Angiography; Anti-Bacterial Agents; Carotid Artery, Internal; Cavernous Sinus; Dexamethasone; Embolization, Therapeutic; Female; Headache; Humans; Meningitis, Pneumococcal; Meropenem; Sphenoid Sinusitis; Spinal Puncture; Thienamycins; Treatment Outcome
PubMed: 26179539
DOI: 10.2169/internalmedicine.54.4462 -
The Journal of Emergency Medicine Aug 2012Acute, isolated sphenoid sinusitis is a rare but potentially devastating clinical entity. Missing this diagnosis can lead to permanent vision loss due to injury of the...
BACKGROUND
Acute, isolated sphenoid sinusitis is a rare but potentially devastating clinical entity. Missing this diagnosis can lead to permanent vision loss due to injury of the optic nerve. Patients may present with preseptal inflammation, lid edema, chemosis, or ophthalmoplegia.
OBJECTIVE
We report a case of acute sphenoid sinusitis in a 10-year-old child who presented to the Emergency Department with essentially painless vision loss.
CASE REPORT
Previously healthy, the patient reported progressive decrease in vision in her right eye for the 5 days prior. Other than blurred vision in the right eye, she complained of a mild frontal headache and right eye irritation the past week, which had abated. On examination, she was reading a book with her head tilted to one side. She had no photophobia, or facial or eyelid swelling. Her pupils were 5 mm bilaterally, but the right was non-reactive to light. She was unable to see two fingers 6 inches in front of her face (right eye), whereas her visual acuity on the left was 20/25. She had bilateral elevated intraocular pressures and a Marcus Gunn pupil on the right. Ophthalmology was consulted and the diagnosis of acute sphenoid sinusitis causing compression and vascular compromise to the optic nerve was diagnosed ultimately by magnetic resonance imaging. The patient was transferred to the nearest pediatric specialty hospital, where an emergent endoscopic sphenoidotomy was performed. The patient's vision subsequently returned.
CONCLUSION
Sphenoid sinusitis should be considered in patients presenting with acute vision loss. Awareness, early diagnosis, and intervention help prevent permanent complications.
Topics: Acute Disease; Blindness; Child; Female; Humans; Magnetic Resonance Imaging; Sphenoid Sinusitis
PubMed: 22070879
DOI: 10.1016/j.jemermed.2011.06.122 -
European Annals of Otorhinolaryngology,... Sep 2016This study was designed to retrospectively review the postoperative results of transnasal transostial sphenoidotomy in 79 patients with isolated chronic sphenoid...
OBJECTIVE
This study was designed to retrospectively review the postoperative results of transnasal transostial sphenoidotomy in 79 patients with isolated chronic sphenoid sinusitis operated between 1995 and 2013 and evaluate the recurrence rate due to postoperative closure of the sphenoidotomy.
PATIENTS AND METHODS
Seventy-nine patients, 44 women and 35 men (M:F sex ratio: 0.79) aged 10 to 84 years (mean age: 48), were included. The most common presenting symptom was headache in 61% of cases. Visual disturbances were present in three cases. The diagnostic work-up comprised nasal endoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) of the sinuses. The surgical indication was based on failure of antibiotic therapy and/or the nature and severity of sphenoid sinusitis. All patients were operated by endoscopic transnasal transostial sphenoidotomy. Samples were taken for histological, bacteriological and mycological examination.
RESULTS
No intraoperative or immediate postoperative complications were observed. Nature of the lesion: forty-seven patients (59.5%) presented nonspecific inflammatory lesions with negative bacterial or fungal culture and inflammatory mucosal changes, 19 patients (24%) had fungal sinusitis presenting as a fungus ball and 13 patients (16.4%) had documented bacterial sinusitis. Mean postoperative follow-up was 7.4 months (range: 6-48). No recurrence of the sinusitis or symptoms was observed in 71 cases (89.8%). Recurrence: eight cases (10.2%) of postoperative closure of the sphenoidotomy were observed, requiring one (6 cases) or several (2 cases) reoperations with a mean of 16.4 months after the initial procedure. Symptoms of recurrence consisted of varying degrees of headache, with similar symptoms to those of the first episode in 7 cases, and retro-orbital headache in 1 case. Reoperation was performed via a transnasal transostial approach in 6 cases and a transethmoidal approach in 2 cases.
CONCLUSION
The transnasal transostial surgical approach is a safe and effective procedure for the treatment of isolated sphenoid sinusitis. However, the recurrence rate due to postoperative closure of the sphenoidotomy observed in our series raises the question of postoperative maintenance of a patent and functional sphenoidotomy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Recurrence; Reoperation; Retrospective Studies; Sphenoid Sinus; Sphenoid Sinusitis; Young Adult
PubMed: 27079741
DOI: 10.1016/j.anorl.2016.02.002 -
Acta Neurochirurgica Mar 2019Clival osteomyelitis is a life-threatening complication of untreated malignant otitis externa or paranasal sinus infection. Although various pathogens have been...
Clival osteomyelitis is a life-threatening complication of untreated malignant otitis externa or paranasal sinus infection. Although various pathogens have been implicated, to our knowledge, primary nocardial clival osteomyelitis has never been reported. We describe a 74-year-old woman who presented with headaches, abducens and hypoglossal nerve palsies, facial numbness, photophobia, and neck stiffness. Imaging revealed a heterogeneous mass within the sphenoid sinus with clival extension. The lesion was extirpated via a binostril endoscopic endonasal transsphenoidal approach. Histopathological and microbiological examination revealed a nocardial source. Clival osteomyelitis associated with sphenoid sinusitis should be included in the differential diagnosis of progressive skull base lesions in the setting of an underlying infection. Early recognition and intervention with antibiotics and surgical debridement is essential in the management of this rare entity.
Topics: Aged; Debridement; Female; Humans; Natural Orifice Endoscopic Surgery; Nocardia Infections; Nose; Osteomyelitis; Skull Base; Sphenoid Sinusitis
PubMed: 30607637
DOI: 10.1007/s00701-018-3768-5 -
International Journal of Pediatric... Feb 2005Isolated sphenoid sinusitis in childhood is a rare clinical entity which is often very difficult to diagnose, hence, it can easily be misdiagnosed. The rarity of this...
Isolated sphenoid sinusitis in childhood is a rare clinical entity which is often very difficult to diagnose, hence, it can easily be misdiagnosed. The rarity of this entity is related to the absence at the sinus in children and the lack of development in patients with sinopathology. The first presentation of this disorder might be disguised by another disease. We present a case sphenoid sinusitis in ten years old girl where precocious puberty and slight headache were the main symptoms. Surgical drainage and antimicrobial treatment were administered. Clinical features, diagnostic tools and treatment options for this entity are discussed.
Topics: Anti-Infective Agents; Child; Drainage; Female; Headache; Humans; Metronidazole; Penicillins; Puberty, Precocious; Sphenoid Sinusitis
PubMed: 15656965
DOI: 10.1016/j.ijporl.2004.09.008