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Hafrén L, Saarinen R, Kurimo R, Viljanen M, Lundberg M. Aspergillus Sinusitis: Risk Factors and Phenotyping. J Clin Med 2024; 13:2579. [PMID: 38731108 PMCID: PMC11084900 DOI: 10.3390/jcm13092579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Aspergillus can cause fungal rhinosinusitis (FRS). We aimed to identify risk factors for sinonasal Aspergillus disease. Methods: Patients with a positive sinonasal mycological culture for Aspergillus species diagnosed in our hospital located in a continental climate were included in the 9-year retrospective study. Results: Of the 86 patients, 3 had invasive FRS (IFRS), 51 had fungal ball (FB) disease, and 32 had chronic rhinosinusitis with fungus (CFRS). In the IFRS group, all patients had a malignancy and were immunocompromised. Allergies, allergic rhinitis, asthma, nasal polyps, and the use of inhaled and nasal steroids were more common in the CFRS group, and IgE levels were greater than those in the FB and IRFS groups (p < 0.05). Conclusion: FB disease is a relatively symptom-free single-sinus disease among elderly individuals, and IFRS is dominant among immunocompromised patients. We discovered a third patient group, predominantly with nasal polyps, atopy, asthma, and elevated blood IgE and eosinophils, that did not fulfill the allergic FRS (AFRS) criteria. It is possible that a less fulminant category of underdiagnosed AFRS exists in cold climates. Treatment with local debridement is usually sufficient for FRS, apart from IFRS, and relapses are not common in cold climates.
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Affiliation(s)
- Lena Hafrén
- Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
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Chang YC, Tsao YN, Chuang CC, Li CY, Lee TJ, Fu CH, Wei KC, Huang CC. Risk Factors for Isolated Sphenoid Sinusitis after Endoscopic Endonasal Transsphenoidal Pituitary Surgery. Diagnostics (Basel) 2024; 14:758. [PMID: 38611671 PMCID: PMC11011803 DOI: 10.3390/diagnostics14070758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Transsphenoidal pituitary surgery can be conducted via microscopic or endoscopic approaches, and there has been a growing preference for the latter in recent years. However, the occurrence of rare complications such as postoperative sinusitis remains inadequately documented in the existing literature. (2) Methods: To address this gap, we conducted a comprehensive retrospective analysis of medical records spanning from 2018 to 2023, focusing on patients who underwent transsphenoidal surgery for pituitary neuroendocrine tumors (formerly called pituitary adenoma). Our study encompassed detailed evaluations of pituitary function and MRI imaging pre- and postsurgery, supplemented by transnasal endoscopic follow-up assessments at the otolaryngology outpatient department. Risk factors for sinusitis were compared using univariate and multivariate logistic regression analyses. (3) Results: Out of the 203 patients included in our analysis, a subset of 17 individuals developed isolated sphenoid sinusitis within three months postoperation. Further scrutiny of the data revealed significant associations between certain factors and the occurrence of postoperative sphenoid sinusitis. Specifically, the classification of the primary tumor emerged as a notable risk factor, with patients exhibiting nonfunctioning pituitary neuroendocrine tumors with 3.71 times the odds of developing sinusitis compared to other tumor types. Additionally, postoperative cortisol levels demonstrated a significant inverse relationship, with lower cortisol levels correlating with an increased risk of sphenoid sinusitis postsurgery. (4) Conclusions: In conclusion, our findings underscore the importance of considering tumor classification and postoperative cortisol levels as potential predictors of postoperative sinusitis in patients undergoing transsphenoidal endoscopic pituitary surgery. These insights offer valuable guidance for clinicians in identifying at-risk individuals and implementing tailored preventive and management strategies to mitigate the occurrence and impact of sinusitis complications in this patient population.
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Affiliation(s)
- Yun-Chen Chang
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
| | - Yu-Ning Tsao
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan (C.-Y.L.)
| | - Cheng-Yu Li
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan (C.-Y.L.)
| | - Ta-Jen Lee
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
- Department of Otolaryngology-Head and Neck Surgery, Xiamen Chang Gung Hospital, Xiamen 361028, China
| | - Chia-Hsiang Fu
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan District, Taoyuan City 333, Taiwan
| | - Kuo-Chen Wei
- Department of Neurosurgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City 236, Taiwan;
| | - Chi-Che Huang
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan District, Taoyuan City 333, Taiwan
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3
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Götting M, Zibell R, Jungehülsing M. [Cephalgia and diplopia with an unusual cause]. HNO 2024:10.1007/s00106-023-01402-x. [PMID: 38165415 DOI: 10.1007/s00106-023-01402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Affiliation(s)
- M Götting
- Abteilung für HNO, Kopf- und Halschirurgie, Klinikum Ernst von Bergmann, Charlottenstraße 72, 14467, Potsdam, Deutschland.
| | - R Zibell
- Abteilung für HNO, Kopf- und Halschirurgie, Klinikum Ernst von Bergmann, Charlottenstraße 72, 14467, Potsdam, Deutschland
| | - M Jungehülsing
- Abteilung für HNO, Kopf- und Halschirurgie, Klinikum Ernst von Bergmann, Charlottenstraße 72, 14467, Potsdam, Deutschland
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Duan HG, Ji F, Yuan H, Wang HL, Chen M, Ma DJ. Modified sphenoidotomy for isolated sphenoid sinus disease: A series of 117 cases. Sci Prog 2023; 106:368504231189538. [PMID: 37543182 PMCID: PMC10404384 DOI: 10.1177/00368504231189538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
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.
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Affiliation(s)
- Hong-Gang Duan
- Department of Otolaryngology, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Ji
- Department of Neurology, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Yuan
- Department of Otolaryngology, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hua-Lin Wang
- Department of Otolaryngology, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ming Chen
- Department of Otolaryngology, College of Medicine, Zhejiang University, Hangzhou, China
| | - Di-Jiang Ma
- Department of Otolaryngology, Yuyao People’s Hospital of Zhejiang Province, Yuyao, China
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Kotowski M, Szydlowski J. Isolated Sphenoid Sinus Disease in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:847. [PMID: 36613169 PMCID: PMC9819992 DOI: 10.3390/ijerph20010847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/17/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
The rarity of isolated sphenoid sinus disease (ISSD) and the specificity of pediatric populations meant that a separate analysis was required in this study. This study aimed to present and discuss the results of an analysis of clinical manifestations, radiological findings and surgical methods based on a large series of exclusively pediatric patients. The study group covered 28 surgically treated children (aged 5.5-17.5 years). The medical data were retrospectively analyzed and meticulously discussed with regards to presenting signs and symptoms, radiographic findings, surgical approaches, complications, post-op care, histopathological results and follow-ups. The dominant symptom was a persistent headache (78%). Four children presented visual symptoms, diplopia in two cases, visual acuity disturbances in one case and both of these symptoms in one patient. Sixteen children presented chronic isolated rhinosinusitis without nasal polyps, six suffered from mucocele and one presented chronic sphenoiditis with sphenochoanal polyp. Four patients turned out to exhibit neoplastic lesions and developmental bony abnormality was diagnosed in one case. No fungal etiology was revealed. The transnasal approach was used in 86% of patients. A transseptal approach with concurrent septoplasty was used in four patients. The patient with visual acuity disturbances completely recovered after the surgery. All children with visual symptoms reported improvement in the vision immediately after surgery. No postoperative complications were observed. Fungal etiology was extremely rare in the pediatric population with ISSD. The surgical treatment should be a minimally invasive procedure regarding a limited range of the pathology in ISSD. Emergency surgery should be performed if ISSD produces any visual loss.
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Yap HJ, Ramli RR, Yeoh ZX, Sachlin IS. Series of isolated sphenoid disease: Often neglected but perilous. SAGE Open Med Case Rep 2022; 10:2050313X221097757. [PMID: 35646372 PMCID: PMC9130846 DOI: 10.1177/2050313x221097757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/13/2022] [Indexed: 12/04/2022] Open
Abstract
Isolated sphenoid sinus disease (ISSD) is an uncommon entity and may present with
non-specific symptoms. As sphenoid sinus is located adjacent to vital structures, a
diseased sphenoid sinus can potentially lead to devastating complications such as cranial
neuropathies, cavernous sinus thrombosis and intracranial abscess. Herein, we report a
case series of three patients who presented with different localization of headache as
their main symptom. Endoscopic nasal assessment showed abnormal nasal cavity findings with
mucosal thickening and soft tissue mass occupying the sphenoid sinus revealed by computed
tomography (CT) scan. All the sphenoid sinuses were drained via endoscopic approach. Post
operatively, antibiotics or anti-fungal were given, however, these three cases displayed
the possible variation in severity of this disease. Case 1 had an uncomplicated
inflammatory disease of the sphenoid sinus, which is of bacterial origin, while the other
two cases had fungal infection. Case 2 achieved disease stability with anti-fungal
treatment, but Case 3 had a serious complication after treatment with permanent vision
loss. A patient who presents with atypical headache, not responsive to analgesia should be
investigated promptly with nasal endoscopic examination and radiological imaging for
isolated sphenoid sinus disease to avoid devastating complications.
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Affiliation(s)
- Hui Jean Yap
- Department of Otorhinolaryngology-Head and Neck Surgery, Universiti Sains Malaysia, Kampus Kesihatan, Kota Bharu, Malaysia
| | - Ramiza Ramza Ramli
- Department of Otorhinolaryngology-Head and Neck Surgery, Universiti Sains Malaysia, Kampus Kesihatan, Kota Bharu, Malaysia
| | - Zhi Xiang Yeoh
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
| | - Ida Sadja’ah Sachlin
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
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Larin RA, Krasilnikova SV, Mokeeva PP. [Clinical and diagnostic features in the phenotyping of isolated sphenoiditis]. Vestn Otorinolaringol 2022; 87:92-98. [PMID: 35818952 DOI: 10.17116/otorino20228703192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED The relevance of the issues of diagnosis and treatment of isolated sphenoiditis (IS) is increasing, due to the widespread introduction into clinical practice of radiation diagnostic methods that allow the diagnosis, including latent forms of IS. Among the chronic forms of IS, polypous-cystic and fungal lesions of the sphenoid sinus (SS) predominate. OBJECTIVE To study the age, gender and radiological features of SS in patients with IS. MATERIAL AND METHODS A retrospective observational single-center non-randomized study was conducted - an analysis of the case histories of 56 patients aged 18 to 68 years who were on inpatient treatment at the Semashko Nizhny Novgorod Regional Clinical Hospital (Department of Ear, Throat and Nose Diseases of the Privolzhsky Research Medical University) in the period 2018-2020, by age, gender composition, clinical and radiological manifestations in various forms of IS. RESULTS The duration of the disease was 59±19 days. Latent forms were detected in 40% of patients. Statistically, the polypous-cystic form of IS was diagnosed more often than the fungal one (z=4.2; p=0.001). The median age of patients with polypous-cystic and fungal IS was 46.5 [35.0; 59.0] years. Evaluation of computed tomograms on the Lund-Mackay scale showed higher values in patients with polypous-cystic IS than in patients with fungal SS lesion (p=0.07). Obstruction of the anastomosis was detected in 38 out of 50 (69.5%) patients with polypous-cystic IS and in 13 out of 50 (92.9%) patients with fungal IS. CONCLUSIONS Against the background of a significant prevalence of rhinosinusitis, the absolute values of isolated sphenoiditis, even with a relative value of 5% of the total, are very significant. Determining the phenotype of isolated sphenoiditis and their features is very important for building a consistent treatment strategy. Age, gender, clinical and radiological manifestations should form the basis of phenotyping and further construction of a therapeutic and diagnostic algorithm.
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Affiliation(s)
- R A Larin
- Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | - S V Krasilnikova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - P P Mokeeva
- Children's City Clinical Hospital No. 1 of the Prioksky district of Nizhny Novgorod, Nizhny Novgorod, Russia
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Tunç O, Yazıcı A, Aytaç İ, Tümüklü K, Akşamoğlu M. Value of Hounsfield Units in the Evaluation of Isolated Sphenoid Sinus Lesions. ALLERGY & RHINOLOGY 2021; 12:21526567211032560. [PMID: 34457372 PMCID: PMC8387604 DOI: 10.1177/21526567211032560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Radiologic findings of fungal sinus disease are generally opacification in paranasal computed tomography (CT) images. The Hounsfield unit (HU) is a standardized objective unit that is also suitable for measuring remodeling and opacifications on CT scans of bone sections of patients with chronic rhinosinusitis. We hypothesized that HU values could provide valuable information in isolated sphenoid sinus lesions before surgery. Between 2012 and 2019, 35 patients underwent functional endoscopic sinus surgery for sphenoid sinus lesions. Tissues obtained from the sphenoid sinus were divided into two groups, fungal and nonfungal, according to the findings of histopathologic examinations. HU values were measured in sphenoid sinus sections on paranasal CT scans of these two groups. Differences in mean and maximum HU values between the two groups were statistically significant (p < .05). The maximum HU values calculated from the sphenoid sinus were 435.08 and 196.23 (p ≤ .05) in the fungal group and nonfungal group, respectively. The mean HU values calculated from the sphenoid sinus were 64.31 and 29 (p ≤ .05) in the fungal and nonfungal groups, respectively. At the maximum cutoff value of 241, the sensitivity and specificity of the HU maximum were 84.6% and 77.3%, respectively. At the mean cutoff value of 41.5, the sensitivity and specificity of the HU mean were 76.9% and 86.4%, respectively. HU is an objective value used in radiographic density measurement. The HU values were higher in fungal lesions than in nonfungal inflammations, and they are useful in preoperative measurement.
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Ashida N, Maeda Y, Kitamura T, Hayama M, Tsuda T, Nakatani A, Obata S, Takeda K, Akazawa H, Inaba F, Hosomi N, Uno A, Inohara H. Isolated sphenoid sinus opacification is often asymptomatic and is not referred for otolaryngology consultation. Sci Rep 2021; 11:11902. [PMID: 34099744 PMCID: PMC8184879 DOI: 10.1038/s41598-021-89995-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/27/2021] [Indexed: 12/01/2022] Open
Abstract
Isolated sphenoid sinus opacifications (ISSOs) are clinically important because they can lead to serious complications. However, some patients with ISSOs are asymptomatic, and not all patients are properly referred to the otolaryngology department. Because past studies of ISSOs focused only on patients who received treatment, in this study we selected ISSO cases based on radiology reports, then determined whether these patients had symptoms and were appropriately referred for specialty care. We conducted a retrospective analysis of data collected from patients who underwent computed tomography or magnetic resonance imaging from January 2007 to March 2017 at Osaka General Medical Center. We searched for the terms “sphenoid” or “sphenoidal” using F-REPORT to identify patients who had a sphenoid disease. We checked all selected images and diagnosed ISSOs. Examination of 1115 cases revealed 223 cases of ISSOs, of whom 167 (74.9%) were asymptomatic. We categorized patients with ISSOs into four groups: inflammation, mucocele, fungal diseases, and unclassifiable; the final category was used when edges were irregular or complete opacity was encountered. In the unclassifiable group, the majority of cases required otolaryngology consultation, but 37 of 47 unclassifiable patients did not have an otolaryngology visit. ISSOs are often identified by chance on imaging tests performed by non-otolaryngologists. However, our study revealed that many patients with ISSOs who should be treated by otolaryngologists were not referred to the otolaryngology department. Accordingly, it is important to promote awareness of the disease among other types of clinicians.
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Affiliation(s)
- Naoki Ashida
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.,Department of Otolaryngology-Head and Neck Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.,Department of Otolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Yohei Maeda
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Takahiro Kitamura
- Department of Otolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Osaka, Japan.,Department of Otolaryngology, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Masaki Hayama
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Takeshi Tsuda
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ayaka Nakatani
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Sho Obata
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kazuya Takeda
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hitoshi Akazawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Fumitaka Inaba
- Department of Diagnostic Imaging, Osaka General Medical Center, Osaka, Osaka, Japan.,Department of Radiology, Rinku General Medical Center, Izumisano, Osaka, Japan
| | - Naohiro Hosomi
- Department of Diagnostic Imaging, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
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Chai A, Soon AYQ, Manish B, Tan JL. Ectopic sphenoid sinus pituitary adenoma masquerading as metastatic head and neck cancer. BMJ Case Rep 2021; 14:14/3/e240411. [PMID: 33692064 PMCID: PMC7949438 DOI: 10.1136/bcr-2020-240411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 68-year-old Chinese man was found to have a lobular mass in the sphenoid sinus which extended to the clivus and the roof of the nasopharynx on a staging MRI scan performed for his high-grade parotid salivary duct carcinoma. Further positron emission tomography scan showed that this lesion was fluorodeoxyglucose (FDG) avid. This proved to be a diagnostic dilemma. The patient underwent a total parotidectomy, left selective neck dissection and a transphenoidal biopsy of his nasal lesion. Final histology revealed that this lesion was a synchronous ectopic sphenoid sinus pituitary adenoma (ESSPA). Initial differential diagnoses that were considered included a chordoma, metastatic carcinoma and nasopharyngeal carcinoma. However, an important differential with a neoplastic appearance and a tendency for positive FDG uptake is an ESSPA. It requires dedicated immunohistochemical staining to diagnose, and its mainstay of treatment is surgical excision.
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Affiliation(s)
| | | | - Bundele Manish
- Department of Pathology, Tan Tock Seng Hospital, Singapore
| | - Jian Li Tan
- Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
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11
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Villemure-Poliquin N, Nadeau S. Surgical treatment of isolated sphenoid sinusitis - A case series and review of literature. Int J Surg Case Rep 2021; 79:18-23. [PMID: 33422847 PMCID: PMC7808905 DOI: 10.1016/j.ijscr.2020.12.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 11/06/2022] Open
Abstract
Isolated sphenoid opacification is a rare pathology that is increasingly being described and it represents 1–2% of sinus infections. The most frequent symptom associated with isolated sphenoid sinusitis is intractable headache. Isolated sphenoid sinusitis is usually treated surgically and endoscopic transnasal sphenoidectomy is the preferred surgical technique. Highly inflammatory diseases such as fungal infections may be associated with an increased risk of re-ossification of the sphenoid ostium following sphenoidectomy.
Introduction Isolated sphenoid opacification is a rare pathology. Unlike other sinusitis, the treatment is most often surgical. Only few studies reporting the recurrence rates with long-term follow-ups are available in the literature. In our experience, isolated sphenoid sinusitis tends to have a significant recurrence rate after a first surgical intervention. This study aims to describe our experience with patients operated for isolated sphenoid sinusitis and to compare our reoperation and complication rates with those reported in the literature. Methods We conducted an electronic chart review of patients operated at the CHU de Québec between 2007 and 2018 for isolated sphenoid sinusitis. Results 29 patients were analyzed. All patients had a sphenoidectomy with a transnasal approach. The reoperation rate was 103% (3/29) and the mean recurrence time was 15 (9–26) months. Among the patients reoperated, 2 patients had a fungus ball and one had a mucocele. Both patients with fungal balls had reossification of their sphenoidal ostium whereas the patient with the mucocele rather had a mucosal closure. No patient encountered any serious post-operative complication. Median duration of follow-up was 44 months (IQR: 25–68) for the 29 patients analyzed in our study. Conclusion Reoperation rates reported in the literature are probably underestimated. Our series emphasizes the importance of long-term follow-up for these pathologies. Highly inflammatory and chronic conditions such as fungal diseases could be linked to an increase in the occurrence of relapses.
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Affiliation(s)
- Noémie Villemure-Poliquin
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada.
| | - Sylvie Nadeau
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada.
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12
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Zhu J, Wang Z, Zhang Y, Li X, Liu J, Deng K, Lu L, Pan H, Wang R, Yao Y, Zhu H. Ectopic pituitary adenomas: clinical features, diagnostic challenges and management. Pituitary 2020; 23:648-664. [PMID: 32757141 DOI: 10.1007/s11102-020-01071-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Ectopic pituitary adenomas (EPAs) are extremely rare pituitary adenomas located outside the sella turcica without any connection with intrasellar components. This study aims to review all the reported cases to date and describe the clinical characteristics of EPAs. METHODS In a retrospective chart review, 14 patients were identified with EPAs in our hospital. A literature review was performed, and 166 cases in the literature met the criteria. Clinical data were analyzed. RESULTS Of 180 patients with EPAs, the mean age at diagnosis was 45.4 years, and 66.5% of the patients were females. EPAs were mainly located in the sphenoid sinus (34.4%) and suprasellar region (25.6%), followed by the clivus (15.6%), cavernous sinus (13.3%) and nasopharynx (5.6%). Adrenocorticotropic hormone (ACTH)-secreting (38.9%) and nonfunctioning (27.2%) adenomas were predominant. Patients with suprasellar EPAs were more likely to present menstrual disorders and visual changes, while patients with clival EPAs were more likely to suffer from headaches. EPAs in the cavernous sinus and suprasellar space were more likely to be initially misdiagnosed as a suspicious intrasellar mass on imaging examination. The complete tumor resection rates for EPAs in the sphenoid sinus, suprasellar region, clivus, cavernous sinus and nasopharynx were 72.3%, 88.6%, 45.0%, 73.3% and 88.9%, respectively. CONCLUSIONS EPA clinical characteristics varied across different tumor locations and hormone-secreting types. In addition to comprehensive hormone evaluation and careful review of imaging data, nuclear medicine and surgical biopsy should also be considered when facing differential difficulty. EPA management should be individualized.
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Affiliation(s)
- Jianyu Zhu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Zhicheng Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yi Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xiaoxu Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Jie Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Lin Lu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
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13
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Chao CC, Lin YT, Lin CF, Chiang CW, Lin HC, Yeh TH. The clinical features of endoscopic treated isolated sphenoid sinus diseases. J Formos Med Assoc 2020; 120:1554-1562. [PMID: 33246742 DOI: 10.1016/j.jfma.2020.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/27/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Isolated sphenoid sinus disease (ISSD) is a rare clinical entity with potentially serious complications. The etiological distribution of ISSD varies among different areas and ethnicities. We aimed to investigate the clinical features of patients with endoscopic treated ISSD. METHODS We retrospectively reviewed all patients with ISSD who had undergone endoscopic surgery between April 2013 and May 2019. The patient records were reviewed for demographic data, clinical presentations, endoscopic and imaging study findings, surgical outcomes and complications. RESULTS A total of 37 patients with ISSD who underwent surgery were recruited. We divided patients into three groups according to etiology, including inflammatory diseases (78.4%), neoplasms (13.5%) and spontaneous cerebrospinal fluid (CSF) leaks (8.1%); fungal ball (62.2%) constituted the major cause of ISSD. Overall, the most common presenting symptom was headache or facial pain (65.5%). The endoscopic findings of bloody discharge and tumor lesions were mainly from the neoplasm group. Bony defects were more obvious on computed tomography in the neoplasm and CSF leak groups. Magnetic resonance imaging revealed a higher rate of involvement of the cavernous sinus (40.0%) and intracranial extensions (40.0%) in the neoplasm group. To summarize the surgical outcomes, the success rate was 97.1%, and the major complication rate was 5.4%. CONCLUSION ISSD represents a variety of etiologies, mostly comprising fungal ball in our area, while there is still a considerable proportion of ISSDs attributed to neoplasm and CSF leak. Untreated ISSD can result in serious complications. We recommend early surgical intervention for all patients with ISSD.
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Affiliation(s)
- Chih-Chen Chao
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Lo-Hsu Medical Foundation Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Yi-Tsen Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Feng Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Wen Chiang
- Department of Otolaryngology, Lo-Hsu Medical Foundation Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Hsuan-Chih Lin
- Department of Otolaryngology, Lo-Hsu Medical Foundation Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
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14
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Finegersh A, Moss WJ, Saddawi-Konefka R, Faraji F, Coffey CS, Califano JA, Brumund KT, Orosco RK. Meta-analysis of risk of occult lymph node metastasis in the irradiated, clinically N0 neck. Head Neck 2020; 42:2355-2363. [PMID: 32432819 DOI: 10.1002/hed.26248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 04/07/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recurrent head and neck squamous cell carcinoma (HNSCC) after radiation is associated with poor survival, and management of the clinically negative (N0) neck during salvage surgery is controversial. METHODS Studies were selected according to preferred reporting items for systematic reviews and meta-analyses guidelines. Inclusion criteria were patients with HNSCC, prior radiation to the lateral neck nodal basin, undergoing salvage surgery for local recurrence, persistence or second primary, and N0 at time of salvage. Eleven studies with a total of 382 patients met inclusion criteria. RESULTS The rate of occult metastasis was 15.4%. The pooled rate of occult nodal metastasis was 16.2% for oral cavity, 12.9% for oropharynx, 23.7% for hypopharynx, and 27.3% for supraglottic or transglottic tumors. There was a significantly higher relative risk of occult metastasis for locally advanced tumors. CONCLUSION Elective neck dissection at time of salvage surgery should be considered based on subsite, T classification, and prior history of nodal metastasis.
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Affiliation(s)
- Andrey Finegersh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA
| | - William J Moss
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Commonwealth Health Center, Saipan, Northern Mariana Islands
| | - Robert Saddawi-Konefka
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA
| | - Farhoud Faraji
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA
| | - Charles S Coffey
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, VA San Diego Healthcare System, La Jolla, California, USA
| | - Joseph A Califano
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA
| | - Kevin T Brumund
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, VA San Diego Healthcare System, La Jolla, California, USA
| | - Ryan K Orosco
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA
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15
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Fadda GL, D'Eramo A, Gned D, Succo G, Galizia A, Cavallo G. An unusual case of complicated rhinosinusitis of the sphenoid sinus involving the cavernous sinus and skull base: Endoscopic sinus surgery and medical therapy. SAGE Open Med Case Rep 2019; 7:2050313X19852885. [PMID: 31205718 PMCID: PMC6537237 DOI: 10.1177/2050313x19852885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022] Open
Abstract
Isolated sphenoid sinus diseases are generally asymptomatic and relatively uncommon with the potential for serious complications. Patients with this condition should be monitored closely and treated aggressively and either diagnostic or therapeutic intent is often indicated. In the management of a complex, life-threatening condition that involves many different fields of expertise, the otolaryngologist plays a key role in orchestrating different specialists and gaining direct access to the affected area, thus taking the first and essential step towards diagnosis and therapy. Because of the superiority of computed tomography in defining the bony margins and the superior soft tissue resolution of magnetic resonance imaging, these two techniques should be used in a complementary manner in the evaluation of isolated sphenoid sinus disease in addition to mapping the lesion better and identifying intracranial and intraorbital extent. We report an unusual case of isolated rhinosinusitis of the sphenoid sinus involving the cavernous sinus, pterygoid fossae and masticatory space in an immunocompetent patient.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy.,ENT Department, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Anna D'Eramo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Dario Gned
- Department of Radiology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Turin, Italy
| | - Andrea Galizia
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
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16
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Densky J, Patel T, Halderman A, Malhotra P. Extramedullary hematopoiesis of the sphenoid sinus associated with hereditary spherocytosis: A case report. Int J Pediatr Otorhinolaryngol 2018; 114:1-4. [PMID: 30262344 DOI: 10.1016/j.ijporl.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 11/19/2022]
Abstract
Extramedullary hematopoiesis is a rare cause of a sinonasal mass that presents unique diagnostic and treatment challenges. While there are numerous reports of patients with hereditary spherocytosis developing extramedullary hematopoiesis in the posterior mediastinum, involvement in the paranasal sinuses has not previously been described. Here, we present the first case of a patient with hereditary spherocytosis developing extramedullary hematopoiesis in the sphenoid sinus.
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Affiliation(s)
- Jaron Densky
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road Suite 4000, Columbus, OH, 43212, USA
| | - Tirth Patel
- College of Medicine, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - Ashleigh Halderman
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Prashant Malhotra
- Department of Otolaryngology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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