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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 -
Ear, Nose, & Throat Journal Jul 2022
Topics: Humans; Pituitary Neoplasms; Sinusitis; Sphenoid Bone; Sphenoid Sinus; Sphenoid Sinusitis
PubMed: 32965127
DOI: 10.1177/0145561320961205 -
European Annals of Otorhinolaryngology,... Feb 2017
Topics: Cavernous Sinus Thrombosis; Diplopia; Empyema, Subdural; Eye; Headache; Humans; Jugular Veins; Magnetic Resonance Imaging; Male; Middle Aged; Sphenoid Sinusitis; Venous Thrombosis
PubMed: 27751696
DOI: 10.1016/j.anorl.2016.09.001 -
Cureus Jun 2023Sphenoid sinus lesions grasp the attention of Otorhinolaryngologists due to their prime location and vital surrounding structures. Once detected, these lesions require...
Sphenoid sinus lesions grasp the attention of Otorhinolaryngologists due to their prime location and vital surrounding structures. Once detected, these lesions require prompt investigation to identify the underlying cause, usually attributed to a tumor, fungal infection, sinusitis, or polyps, thus allowing tailored treatment. We report a case of an elderly lady whose neurological presentation lead to the diagnosis of sphenoid sinus lymphoma. We discuss the diagnostic challenge in view of its interesting presenting symptoms as well as the surgical approach risk and limitations.
PubMed: 37519496
DOI: 10.7759/cureus.41058 -
Science Progress 2023The atresia rate of sphenoid ostium after endoscopic sphenoidotomy for isolated sphenoid disease is 9.4%-10.2%.
BACKGROUND
The atresia rate of sphenoid ostium after endoscopic sphenoidotomy for isolated sphenoid disease is 9.4%-10.2%.
AIMS
To reduce sphenoid sinus ostium atresia rate after sphenoidotomy surgery.
MATERIALS AND METHODS
The data of patients with isolated sphenoid sinus disease at our hospital between 2015 and 2022 were retrospectively analyzed. The age, gender, disease course, pathology, postoperative follow-up time, anatomy data of sphenoid sinus and postoperative sinus ostium atresia rate were compared between the two groups of patients with traditional sphenoidotomy and modified sphenoidotomy.
RESULTS
A total of 117 patients with isolated sphenoid sinus disease underwent endoscopic sphenoidotomy. There were 76 cases in the traditional sphenoidotomy group, fungus ball in 59.2% of patients, the postoperative sinus ostium atresia rate was 14.5%. There were 41 cases in the modified sphenoidotomy group, fungus ball in 53.6% of patients, and 0 case of sinus ostium atresia. Statistical analysis showed significant differences in postoperative sinus ostium atresia rate. There was no significant difference in age, pathology, postoperative follow-up time, anatomy data of sphenoid, and other data.
CONCLUSIONS AND SIGNIFICANCE
The modified endoscopic sphenoidotomy may reduce the rate of postoperative sinus ostium atresia.
Topics: Humans; Sphenoid Sinus; Retrospective Studies; Paranasal Sinus Diseases; Endoscopy
PubMed: 37543182
DOI: 10.1177/00368504231189538 -
BMJ Case Reports Oct 2021We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and...
We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and oral antibiotics to treat chronic left sphenoid sinusitis. Initially presenting with right-sided weakness and aphasia, a diagnosis of acute ischaemic stroke was made. Antibiotics had been commenced 1 month prior to the ischaemic stroke. Imaging at that time showed changes in keeping with chronic sphenoid sinusitis along with a small dehiscence in the lateral wall of the left sphenoid sinus and thrombosis of the left superior ophthalmic vein. During that admission blood cultures grew , a member of the Streptococcus milleri group. We discuss the unusual aetiology of this stroke, the emerging evidence associating chronic rhinosinusitis with stroke and the complex multidisciplinary approach required for management in this case.
Topics: Brain Ischemia; Female; Humans; Ischemic Stroke; Middle Aged; Sphenoid Sinusitis; Stroke; Tomography, X-Ray Computed
PubMed: 34607813
DOI: 10.1136/bcr-2021-242943 -
World Neurosurgery Mar 2019The Medpor porous polyethylene implant is reported to be safe and effective for sellar reconstruction after transsphenoidal surgery (TSS). However, we have observed...
OBJECTIVE
The Medpor porous polyethylene implant is reported to be safe and effective for sellar reconstruction after transsphenoidal surgery (TSS). However, we have observed several cases of delayed chronic sphenoid sinusitis related to the implant. The purpose of this study is to describe the presentation and management of implant-related sphenoid sinusitis after sellar reconstruction.
METHODS
This is a retrospective study of patients who underwent endonasal TSS with Medpor sellar reconstruction between December 2008 and January 2013 at a tertiary care institution. Patient demographics, initial surgical management, sinonasal symptoms, postoperative imaging, sinusitis management, and resulting outcomes were analyzed.
RESULTS
From 2008-2013, 139 patients underwent sellar reconstruction using Medpor. Five patients (3.6%) presented between 8 and 60 months after surgery with chronic sphenoid sinusitis that required surgical management. All 5 patients presented as outpatients for management of headaches and nasal drainage, 4 patients experienced chronic nasal congestion, and 3 patients noted recurrent sinusitis. At the time of revision surgery, all 5 patients were found to have mucosal inflammation and edema surrounding the implant, and 4 of the 5 had an exposed or partially extruded implant that was removed.
CONCLUSIONS
Reconstruction of the sellar floor may be performed after TSS to prevent postoperative complications. Although porous polyethylene implants have previously been described as safe and effective for this purpose, surgeons should be aware of the risk of subsequent implant extrusion and chronic sphenoid sinusitis that can occur in a delayed manner.
Topics: Adenoma; Adult; Aged; Aged, 80 and over; Biocompatible Materials; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Pituitary Neoplasms; Polyethylenes; Postoperative Complications; Prostheses and Implants; Retrospective Studies; Sella Turcica; Sphenoid Sinusitis; Tertiary Care Centers; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 30579017
DOI: 10.1016/j.wneu.2018.12.034 -
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 -
Acta Otorhinolaryngologica Italica :... Feb 2022Stenosed sphenoid sinus ostia are among the most common findings in revision endoscopic sinus surgery. This study sought to identify the optimal intraoperative...
OBJECTIVE
Stenosed sphenoid sinus ostia are among the most common findings in revision endoscopic sinus surgery. This study sought to identify the optimal intraoperative sphenoidotomy size for prevention of postoperative stenosis.
METHODS
32 patients affected by chronic rhinosinusitis not associated with nasal polyps (CRSsNP) underwent 52 sphenoidotomies. Sphenoidotomy size was assessed using a ruler intraoperatively and at the first, third and sixth months postoperatively. Ostia sizes, SNOT-22 questionnaire findings, episodes of recurrent sinusitis and need for revision surgery were recorded.
RESULTS
All sphenoidotomies exhibited a significant size reduction (mean 43.4 ± 6.8%) at the first month postoperatively, with a tendency to enlarge at 3 months and stabilise at 6 months. Ostia larger than 61.3 mm did not exhibit stenoses postoperatively. Stenosis was observed in 11 sphenoidotomies (21.2%); however, only five presented with recurrent symptoms (9.6%), while three required revision sphenoid surgery (5.8%).
CONCLUSIONS
Sphenoidotomy size significantly reduced during the first postoperative month and then stabilised. A baseline sphenoidotomy size of 61.3 mm at the time of the operation seemed sufficient to prevent ostium stenosis. Half of stenosed ostia presented with recurrent symptoms.
Topics: Chronic Disease; Endoscopy; Humans; Kinetics; Nasal Polyps; Rhinitis; Sinusitis; Sphenoid Sinus
PubMed: 35129538
DOI: 10.14639/0392-100X-N1545 -
European Annals of Otorhinolaryngology,... Apr 2016Nocardia sinusitis is exceptional, as a Medline search revealed only one published case. The authors report a case of sphenoid sinusitis complicated by infratemporal...
INTRODUCTION
Nocardia sinusitis is exceptional, as a Medline search revealed only one published case. The authors report a case of sphenoid sinusitis complicated by infratemporal fossa abscess, which raised several diagnostic problems.
CASE REPORT
The patient was referred with temporal headache, subacute trigeminal neuralgia and subsequent infectious syndrome. Computed tomography imaging revealed left sphenoid sinusitis with osteolysis and infratemporal fossa abscess, as well as suspicious lung nodules suggestive of the initial site of infection. Bacteriological specimens obtained by endoscopic sphenoidotomy confirmed the presence of Nocardia nova. A favourable outcome was observed in response to targeted antibiotic therapy.
DISCUSSION AND CONCLUSION
Sphenoid sinusitis with infratemporal fossa abscess is an exceptional mode of presentation of nocardiosis, illustrating the polymorphic clinical features of this disease. Bacteriological examination of samples taken directly from the organ concerned, in this case, by sphenoidotomy, is the only formal diagnostic criterion. Antibiotic therapy with intravenous imipenem/amikacin, followed by oral sulfamethoxazole/trimethoprim (Bactrim Forte(®)) for several months, is the key to successful management.
Topics: Abscess; Aged; Female; Humans; Nocardia Infections; Sphenoid Sinusitis
PubMed: 26471040
DOI: 10.1016/j.anorl.2015.09.004