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Clinical Anatomy (New York, N.Y.) Sep 2022The paranasal sinuses (maxillary, frontal, ethmoid, and sphenoid sinuses) are complex anatomical structures. The development and growth of these have been investigated... (Review)
Review
The paranasal sinuses (maxillary, frontal, ethmoid, and sphenoid sinuses) are complex anatomical structures. The development and growth of these have been investigated utilizing a number of different methods ranging from cadaveric analysis to modern cross sectional imaging with 3D modeling. An understanding of normal pediatric paranasal sinus embryology and development enables us to better determine when pathology may be affecting the normal developmental process. Cystic fibrosis, chronic sinusitis, deviated nasal septum and cleft lip and palate are some of the conditions which have been shown to effect paranasal sinus development to varying degrees. Functional endoscopic sinus surgery (FESS) is becoming increasingly common and an understanding of sinus anatomy together with when periods of rapid growth occur during childhood is important clinically. Although concerns have been raised regarding the impact of FESS on facial growth, there is limited evidence of this in regards to either changes in anthropomorphic measurements or clinical assessments of symmetry post operatively.
Topics: Child; Cleft Lip; Cleft Palate; Ethmoid Bone; Humans; Paranasal Sinuses; Sphenoid Sinus
PubMed: 35437820
DOI: 10.1002/ca.23888 -
Head & Face Medicine Sep 2022This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve...
PURPOSE
This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve canal (ONC) as well as the types of attachment of the sphenoidal septa onto these structures.
METHODS
In total, 230 computed tomography (CT) scans were reviewed to study the type of sphenoid sinus pneumatization (SSP), the protrusion and dehiscence of the ICA and ONC, the relationship between the sphenoidal septa and surrounding vital structures as well as pterygoid recess pneumatization (PRP).
RESULTS
The most common SSP was sellar type (58.7%). The rates of protrusion and dehiscence of the ICA were 26.3 and 0.4%, and for the ONC, they were 13 and 1.5%, respectively. The ICA and ONC were most protruded and dehiscent in more extensive SSP. In 21.6% of patients, the intersphenoidal septa (IS) were attached to the wall of the ICA and in 8.6% they were attached to the wall of the ONC. The attachment of IS to the ICA correlated statistically significantly (p < 0.0001) with protrusion of the ICA. Accessory septa were detected in 30.4% of cases with various sites of attachment.
CONCLUSION
To reduce the risk of injury and complications during endoscopic sinus surgery (ESS), surgeons should consider using CT to identify possible bulging and dehiscence of the ICA/ONC and their relationship to the extent of SSP and also to establish the presence of deviation of the sphenoid septum, and the presence of accessory septa.
Topics: Endoscopy; Humans; Optic Nerve; Sphenoid Bone; Sphenoid Sinus; Tomography, X-Ray Computed
PubMed: 36057720
DOI: 10.1186/s13005-022-00336-z -
Neurology India 2017
Topics: Acromegaly; Cardiomyopathies; Humans; Neurosurgical Procedures; Sphenoid Bone; Sphenoid Sinus; Treatment Outcome
PubMed: 29133685
DOI: 10.4103/0028-3886.217988 -
Brazilian Journal of Otorhinolaryngology 2022Nasal polyps that originate from the sphenoid sinus and reach the nasopharynx are called sphenochoanal polyps. Reports on sphenochoanal polyps in children have thus far... (Review)
Review
OBJECTIVES
Nasal polyps that originate from the sphenoid sinus and reach the nasopharynx are called sphenochoanal polyps. Reports on sphenochoanal polyps in children have thus far been limited only to case reports. This review aims to describe and summarize clinical presentation, diagnosis, management, surgical approaches to the sphenochoanal polyps with recurrence rate after surgery in pediatric patients reported in the literature.
METHODS
A systematic literature review was performed using PubMed, MEDLINE and Cochrane Library Databases for articles published prior to December 2021 to identify all studies reporting on pediatric patients with sphenochoanal polyps. Clinical presentation, management options, surgical approaches and outcomes of applied management were extracted from included studies.
RESULTS
9 articles provided data on 11 eligible patients with an age range 3 years and 8 months-16 years. The commonest symptoms included: nasal obstruction, nasal discharge, and headache respectively. All patients were subjected to surgical treatment. No recurrences after the endoscopic sphenoidotomy were reported.
CONCLUSION
Sphenochoanal polyps should be kept in mind in the differential diagnosis of unilateral nasal cavity or paranasal sinuses masses. Misdiagnosis can result in recurrences in patients with sphenochoanal polyp, who can be mistakenly diagnosed with antrochoanal polyp and underwent inadequate treatment not involving sphenoidotomy and exact identification of the site of implantation. The symptoms of sphenochoanal polyps are nonspecific.
Topics: Humans; Child; Infant; Tomography, X-Ray Computed; Sphenoid Sinus; Nasal Polyps; Nasal Obstruction; Endoscopy
PubMed: 36127268
DOI: 10.1016/j.bjorl.2022.02.006 -
Romanian Journal of Morphology and... 2020The anterior extent of the sphenoidal sinus in the posterior ethmoid was less investigated. Our purpose was to study whether, or not, the occurrence of a sphenoethmoidal...
The anterior extent of the sphenoidal sinus in the posterior ethmoid was less investigated. Our purpose was to study whether, or not, the occurrence of a sphenoethmoidal sinus (SES) relates to a sagitally-shortened ethmoid. A retrospective cone-beam computed tomography (CBCT) was performed on 36 patient files. In six patients were found SES extended anteriorly above the posterior third of the middle turbinate (MT). Two of these patients had bilateral SES with ethmoidal chambers included in the lateral and superior nasal walls and draining in the sphenoethmoidal recesses. The correlation between the nasion-to-concha sphenoidalis distance and the presence of SES was statistically significant (less than 40 mm in SES cases and more than 40 mm in non-SES cases). We also found: (i) superior turbinates (STs) with ethmoidal and sphenoidal insertions on one side and ethmoidal and maxillary insertions on the opposite side (the maxillary insertion of ST modifies surgical landmarks and was not previously reported), (ii) MT perforation and (iii) pterygoid recess of the maxillary sinus located beneath the pterygopalatine ganglion fossa. The SES thus shortens sagitally the lateral nasal wall but does not modify its morphology. The MT perforation, ST maxillary insertion and the pterygoid recess are rare anatomic variants not reported previously in our knowledge.
Topics: Ethmoid Sinus; Female; Humans; Male; Retrospective Studies; Sphenoid Sinus
PubMed: 32747905
DOI: 10.47162/RJME.61.1.16 -
Medicina (Kaunas, Lithuania) Oct 2022: Understanding the anatomical variation in the sphenoid sinus is important to fully expose the sellar floor and clivus. : The Onodi cell and intersphenoid sinus...
: Understanding the anatomical variation in the sphenoid sinus is important to fully expose the sellar floor and clivus. : The Onodi cell and intersphenoid sinus septation based on preoperative paranasal sinus computed tomography (PNS CT) and the surgical records of 877 patients who underwent the endoscopic endonasal transsphenoidal approach (EETSA) were retrospectively reviewed. : An intersphenoid sinus septum (ISS) blocking the clivus was defined as a pseudoclivus. Complete and incomplete pseudoclivuses were found in 2.97% and 10.5% of patients, respectively. Intraoperative and PNS CT ISS findings differed in 17.1% of patients. Misconceptions regarding a ridge or vertical ISS and confusion between an incomplete pseudoclivus and a vertical ISS were common. : Because intraoperative and PNS CT findings may differ, anatomical variation in the paraclival area should be evaluated carefully. A pseudoclivus mimicking the clivus is important to attain a fully exposed EETSA surgical view.
Topics: Humans; Sella Turcica; Retrospective Studies; Prevalence; Sphenoid Sinus; Endoscopy
PubMed: 36295639
DOI: 10.3390/medicina58101479 -
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 -
PloS One 2022We explored the clinical significances of the relationships among sphenoid sinus aeration, intersphenoid sinus septum (ISS), and internal carotid artery (ICA).
OBJECTIVE
We explored the clinical significances of the relationships among sphenoid sinus aeration, intersphenoid sinus septum (ISS), and internal carotid artery (ICA).
METHODS
We retrospectively reviewed the preoperative paranasal sinus computed tomography scans and the medical charts of 490 patients who were treated by the endoscopic endonasal transsphenoidal approach. We analyzed sphenoid sinus pneumatization, number of ISS, and positional relationships between the ICA and ISS (including ICA prominence and the thickness of surrounding bone).
RESULTS
ISS were often present in the ICAs of patients with presellar pneumatization (36.2%; p = 0.042). Sphenoid sinus pneumatization status significantly differed according to number of ISS (p < 0.001), ICA prominence (p < 0.001), ISS insertion into the ICA (p = 0.042), and distance from ISS to ICA (p = 0.004). When sphenoid sinus aeration was poor, the ICA was not prominent, and the ISS were attached to or lay close to the paraclival ICA.
CONCLUSIONS
Patients with presellar pneumatization exhibited less prominent ICAs, and more ISS attached to or near the paraclival ICA, than did other patients. Therefore, particular caution is required when using the endoscopic endonasal transsphenoidal approach to treat patients with poor sphenoid sinus aeration.
Topics: Carotid Artery, Internal; Endoscopy; Humans; Paranasal Sinuses; Retrospective Studies; Sphenoid Bone; Sphenoid Sinus
PubMed: 36006952
DOI: 10.1371/journal.pone.0273545 -
European Annals of Otorhinolaryngology,... Jun 2016The purpose of this review was to look at the success rate of transnasal endoscopic repair of CSF rhinorrhoea and the impact of patient factors, repair techniques and... (Review)
Review
GOAL
The purpose of this review was to look at the success rate of transnasal endoscopic repair of CSF rhinorrhoea and the impact of patient factors, repair techniques and adjuvant treatment.
MATERIAL AND METHODS
A literature search was performed on PubMed, Medline and Cochrane Central databases, independently by two of the authors, of all studies reporting the outcomes of CSF rhinorrhoea repair, published until the 1st June 2014, using keywords Cerebrospinal fluid leak, CSF leak, CSF fistula, CSF leak or fistula repair, endoscopic sinus surgery or ESS complications. Sixty-seven papers were included for the review.
RESULT
The repair of CSF rhinorrhoea has rapidly evolved over the past 30 years. Prior to the advent of the endoscopic approach, craniotomy was used for repairs, which carried a variable success rate and morbidity. More recently, there have been several case series and reports that describe various endoscopic methods and materials for repair, with mean success rate of 90% (range: 60-100%). The most common site of CSF leak is the ethmoid roof/cribriform plate region. Traumatic CSF leak, in particular iatrogenic, is still the most common cause. Imaging with CT and MRI remains the gold standard for localisation of CSF leaks. The sphenoid sinus is the most common location for CSF leak repair failure. Lumbar drains and antibiotics are used as adjuvant therapy to endoscopic repair, but their benefits are not clear; intrathecal fluorescein can be used to aid location of CSF leak, but should be reserved for more complex cases. Further work into graft materials used and adjuvant treatment is needed to make any meaningful conclusions about their efficacy.
CONCLUSION
The literature demonstrates that endoscopic repair of CSF rhinorrhoea is safe and effective, with a very low complication rate. It has almost completely replaced the older open techniques.
Topics: Cerebrospinal Fluid Rhinorrhea; Drainage; Endoscopy; Ethmoid Sinus; Humans; Sphenoid Sinus
PubMed: 26776882
DOI: 10.1016/j.anorl.2015.05.010 -
Journal of Neurosurgical Sciences Jun 2018The endoscopic transnasal trans-sphenoidal transtubercular approach has become a standard alternative approach to neurosurgical transcranial routes for lesions of the... (Review)
Review
INTRODUCTION
The endoscopic transnasal trans-sphenoidal transtubercular approach has become a standard alternative approach to neurosurgical transcranial routes for lesions of the anterior skull base in particular pathologies of the anterior tubercle, sphenoid plane, and midline lesions up to the interpeduncular cistern. For both the endoscopic and the transcranial approach indications must strictly be evaluated and tailored to the patients' morphology and condition. The purpose of this review was to evaluate the evidence in literature of the limitations of the endoscopic transtubercular approach.
EVIDENCE ACQUISITION
A PubMed/Medline search was conducted in January 2018 entering following keywords. Upon initial screening 7 papers were included in this review. There are several other papers describing the endoscopic transtubercular approach (ETTA). We tried to list the limitation factors according to the actual existing literature as cited.
EVIDENCE SYNTHESIS
The main limiting factors are laterally extending lesions in relation to the optic canal and vascular encasement and/or unfavorable tumor tissue consistency.
CONCLUSIONS
The ETTA is considered as a high level transnasal endoscopic extended skull base approach and requires excellent training, skills and experience.
Topics: Brain Neoplasms; Humans; Neuroendoscopy; Pituitary Neoplasms; Sphenoid Sinus
PubMed: 29444557
DOI: 10.23736/S0390-5616.18.04347-3