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Atypical Skull-Base Osteomyelitis: Comprehensive Review and Multidisciplinary Management Viewpoints.Tropical Medicine and Infectious Disease Apr 2023Atypical skull-base osteomyelitis is a rare but fatal disease that usually involves infection of the ethmoid, sphenoid, occipital, or temporal bones that form the skull... (Review)
Review
Atypical skull-base osteomyelitis is a rare but fatal disease that usually involves infection of the ethmoid, sphenoid, occipital, or temporal bones that form the skull base. Unlike typical (so-called otogenic), atypical skull-base osteomyelitis has no otogenic cause. Instead, some authors call atypical skull-base osteomyelitis sinonasal, since the infection most often originates from the nose and paranasal sinuses. Diagnosing and treating this disease is challenging. To assist in managing atypical skull-base osteomyelitis, a review of the most recent literature, with patient cases and multidisciplinary perspectives from otolaryngologists, neurosurgeons, radiologists, infectious disease specialists, pathologists, and clinical microbiologists, is provided in this paper.
PubMed: 37235302
DOI: 10.3390/tropicalmed8050254 -
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 -
Neuroradiology Aug 2023The sphenoid sinus (SS) is one of the four paired paranasal sinuses (PNSs) within the sphenoid bone body. Isolated pathologies of sphenoid sinus are uncommon. The...
The sphenoid sinus (SS) is one of the four paired paranasal sinuses (PNSs) within the sphenoid bone body. Isolated pathologies of sphenoid sinus are uncommon. The patient may have various presentations like headache, nasal discharge, post nasal drip, or non-specific symptoms. Although rare, potential complications of sphenoidal sinusitis can range from mucocele to skull base or cavernous sinus involvement, or cranial neuropathy. Primary tumors are rare and adjoining tumors secondarily invading the sphenoid sinus is seen. Multidetector computed tomography (CT) scan and magnetic resonance imaging (MRI) are the primary imaging modalities used to diagnose various forms of sphenoid sinus lesions and complications. We have compiled anatomic variants and various pathologies affecting sphenoid sinus lesions in this article.
Topics: Humans; Sphenoid Sinus; Paranasal Sinus Diseases; Sphenoid Sinusitis; Multidetector Computed Tomography; Magnetic Resonance Imaging; Mucocele
PubMed: 37202536
DOI: 10.1007/s00234-023-03163-4 -
Vestnik Otorinolaringologii 2023Treatment of patients with fungal sinusitis, in some cases, does not lead to complete sinus sanitation, which may be due to insufficient surgical intervention and/or...
Treatment of patients with fungal sinusitis, in some cases, does not lead to complete sinus sanitation, which may be due to insufficient surgical intervention and/or incorrectly selected antimycotic therapy. Treatment of such patients must necessarily include the complete removal of fungal masses from the affected sinus and the further use of antimycotics that ensure complete elimination of the pathogen. A clinical case of chronic fungal operated isolated sphenoiditis caused by the fungus is presented. For extensive drainage of the sphenoid sinus, the patient underwent translamellar sphenoidotomy on the right with further antifungal therapy.
Topics: Humans; Schizophyllum; Sinusitis; Mycoses; Paranasal Sinuses
PubMed: 37184561
DOI: 10.17116/otorino20228802189 -
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 -
Auris, Nasus, Larynx Dec 2023Chronic rhinosinusitis (CRS) is common and often requires surgical intervention. Surgical failure may lead to persistent symptoms and recalcitrant disease, often...
OBJECTIVE(S)
Chronic rhinosinusitis (CRS) is common and often requires surgical intervention. Surgical failure may lead to persistent symptoms and recalcitrant disease, often secondary to synechiae between the middle turbinate (MT) and lateral nasal wall. Synechiae prevention techniques have been extensively investigated, however evidence for the effect of synechiae on sinonasal physiology is lacking. We aimed to model the effects of MT synechiae on a post-functional endoscopic sinus surgery (FESS) sinonasal cavity using computational fluid dynamics (CFD).
METHODS
DICOM data from a CT-sinus of a healthy 25-year-old female was segmented to create a three-dimensional model. Virtual surgery was performed to simulate a "full-house" FESS procedure. Multiple models were created, each with a single unilateral virtual MT synechia of varying extent. CFD analysis was performed on each model and compared with a post-FESS control model without synechiae. Airflow velocity, humidity and mucosal surface and air temperature values were calculated.
RESULTS
All synechiae models demonstrated aberrant downstream sinonasal airflow. There was reduced ventilation of the ipsilateral frontal, ethmoid and sphenoid sinuses, with a concentrated central "jet" in the middle meatus region. Effects were proportionate to the size of synechiae. The impact on bulk inspired airflow was negligible.
CONCLUSION
Post-FESS synechiae between the MT and lateral nasal wall significantly disrupt local downstream sinus ventilation and nasal airflow. These findings may explain the persistent symptoms seen in post-FESS CRS patients with MT synechiae, reinforcing the importance of prevention and adhesiolysis. Larger cohort studies with multiple models of actual post-FESS patients with synechiae are required to validate these findings.
Topics: Female; Humans; Adult; Turbinates; Hydrodynamics; Endoscopy; Paranasal Sinuses; Nasal Cavity; Sinusitis
PubMed: 37137797
DOI: 10.1016/j.anl.2023.04.003 -
Asian Journal of Surgery Sep 2023
Topics: Humans; Sphenoid Sinusitis; Brain Abscess; Tomography, X-Ray Computed
PubMed: 37105816
DOI: 10.1016/j.asjsur.2023.04.036 -
Journal of Surgical Case Reports Apr 2023In this paper, we aim to study the different clinical presentations of pediatric allergic fungal sinusitis (AFS) in the Eastern Province of Saudi Arabia, and to review...
In this paper, we aim to study the different clinical presentations of pediatric allergic fungal sinusitis (AFS) in the Eastern Province of Saudi Arabia, and to review the experience in the diagnosis & management of AFS in children at King Fahad Specialist Hospital. This study is a retrospective case series of pediatric patients diagnosed and managed as AFS at a tertiary referral hospital in Saudi Arabia. The clinical presentation of pediatric AFS varies widely and includes unilateral, unilateral with proptosis, bilateral, alternating, isolated sphenoid and extensive with intracranial & intraorbital involvements. Children with AFS present with different clinical features when compared to adults. Therefore, they require a high index of suspicion for evaluation and early aggressive treatment.
PubMed: 37096120
DOI: 10.1093/jscr/rjad149 -
Cureus Mar 2023species have been implicated as a cause of pulmonary, cutaneous, ocular, and disseminated central nervous system disease. Dissemination to the bones, commonly the...
species have been implicated as a cause of pulmonary, cutaneous, ocular, and disseminated central nervous system disease. Dissemination to the bones, commonly the spine, has also been described in the literature. However, isolated osteomyelitis of the skull base is rare. Additionally, advances in the use of molecular techniques have identified many new species, including that was thought to be clinically insignificant when it was first identified. Here, we report the clinical features and treatment approach for a lung transplant patient who developed clivus osteomyelitis secondary to sphenoid sinusitis. It is the first case of skull base osteomyelitis caused by this rare species of .
PubMed: 37090387
DOI: 10.7759/cureus.36487 -
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