Endoscopic treatment of the isolated sphenoid sinus lesions

Acute isolated sphenoid sinusitis in children

OBJECTIVE

Acute infection of the sphenoid sinus usually affects both pre-adolescent and adolescent subjects and is associated with infections of the other paranasal sinuses. Acute isolated sphenoiditis, though uncommon, is frequently misdiagnosed as symptoms are vague and there are few clinical findings. Indeed, it is not usually diagnosed until the patient develops neurological complications. The aim of this report is to discuss our cases of acute isolated sphenoiditis and compare them with those reported in the International literature.

METHODS

We reviewed our 10-year records of paediatric patients affected by acute isolated sphenoid sinusitis, as confirmed by nasal endoscopy and/or CT scan, and compared them with paediatric cases of sphenoid sinusitis reported in literature. In particular, we focused on clinical findings, associated risk factors, diagnostic approach, and treatment.

RESULTS

As previously stated at the Brussels Consensus Meeting, patients can be separated into two groups on the basis of clinical findings: the first including patients affected by severe acute sphenoiditis presenting fever and headache, and frequently associated with neurological symptoms, with swimming and diving as possible predisposing factors. The second group includes patients with non-severe acute sphenoiditis, mainly associated with headache, allergic rhinitis being a possible predisposing factor.

CONCLUSIONS

Acute isolated sphenoid sinusitis appears to be difficult to diagnose, and there are few reports in peer-reviewed paediatric journals. We wish to alert paediatricians and ENT specialists of the importance of this rare but still potentially devastating disorder.

Bibliography. Current world literature. Nose and paranasal sinuses

PURPOSE OF REVIEW

Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed.

RECENT FINDINGS

There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death.

SUMMARY

Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.