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Levi L, Havazelet S, Moskovitz A, Soudry E. Long-Term Follow-Up of Post Radiation Complete Sinus Opacification in Sinonasal Cancer Patients. Laryngoscope 2024. [PMID: 38738794 DOI: 10.1002/lary.31504] [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: 12/14/2023] [Revised: 04/14/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Treatment of sinonasal malignancies most often requires primary or postoperative radiation treatment. Post radiation sinonasal morbidity has been previously described; however, none addressed post-radiation sinus obstruction. Our objective was to investigate the long-term outcomes of post radiation complete isolated sinus opacification (CISO). METHODS A retrospective analysis of sinonasal cancer patients treated with radiation therapy during the years 2002 to 2022. Clinical, imaging and treatment data were collected from patients' medical records. Only patients with at least 12 months of follow-up and available imaging for review were included. RESULTS Out of 109 patients, 37 patients were identified to meet the inclusion criteria. Mean follow-up was 58 months. 35% of patients were diagnosed with persistent post radiation CISO with a mean onset of 4 months. All these patients remained asymptomatic, and their imaging remained stable during follow-up with none developing an expanding mucocele. Ethmoid sinus tumor involvement was found to be more prevalent in the CISO group (62% vs. 25%, p-value = 0.048) as well as chemotherapy/immunotherapy (54% vs. 38%, p-value = 0.046). Multivariant analysis revealed that ethmoid sinus involvement (OR = 9.516, p-value = 0.047) and adjuvant therapy, either chemotherapy/immunotherapy (OR = 10.75, p-value = 0.036) were found to be a predictive factor for complete opacification. CONCLUSION Our study revealed that a substantial number of post-radiation patients develop a stable and persistent CISO, often in the frontal and sphenoid sinuses. These patients remained asymptomatic, and none required surgical intervention during nearly 5 years of follow-up. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Lirit Levi
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Shany Havazelet
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Anner Moskovitz
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ethan Soudry
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Janakiram TN, Karunasagar A. Sphenoid Mucocele: A Complication of Skull Base Reconstruction with Nasoseptal Flap-A Critical Review and Our Experience. Indian J Otolaryngol Head Neck Surg 2019; 71:2151-2156. [PMID: 31763313 DOI: 10.1007/s12070-019-01713-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/11/2019] [Indexed: 11/26/2022] Open
Abstract
The evolution of expanded endoscopic skull base surgery has enabled development of minimally invasive approaches for resection of large skull base tumors with the nasoseptal flap proving to be an indispensable tool in skull base reconstruction. We here present our experience of sphenoid mucocele development after skull base reconstruction with the nasoseptal flap along with a comprehensive review of the limited literature on the same. With the expanding scope of endoscopic skull base surgery, the nasoseptal flap is increasingly being used for reconstruction. Despite adherence to standard recommendations and use of meticulous technique during flap placement, the potential risk of mucocele formation under the flap should always be borne in mind. In our experience, displacement of the flap pedicle could lead to ostial obstruction and mucocele formation. Hence, in addition to meticulous technique, a close follow up of such patients via nasal endoscopy or imaging is important to further our knowledge and understanding of the long-term effects and complications of this flap.
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Affiliation(s)
- T N Janakiram
- Department of Otorhinolaryngology and Skull Base Surgery, Royal Pearl Hospital, Tiruchchirappalli, Tamil Nadu India
| | - Abhilasha Karunasagar
- 2Department of Otorhinolaryngology and Head and Neck Surgery, Sri Devaraj Urs Medical College, Kolar, Karnataka India
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3
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Jaafoura H, Tbini M, Riahi I, Harhira MR, Ben Salah M. Mucocèles nasosinusiennes post-radiques à propos de trois cas. Cancer Radiother 2019; 23:228-231. [PMID: 31126746 DOI: 10.1016/j.canrad.2018.11.006] [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: 10/05/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 10/26/2022]
Abstract
Nasosinusal mucoceles, although benign, are aggressive and sometimes destructive lesions. They may occur as a result of trauma, infection, sinus surgery and head and neck radiation. We describe three patients presenting mucocele, with the history of nasopharyngeal and temporal fossa cancers treated by radiotherapy.
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Affiliation(s)
- H Jaafoura
- Service ORL et chirurgie cervicofaciale, hôpital Charles-Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie.
| | - M Tbini
- Service ORL et chirurgie cervicofaciale, hôpital Charles-Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie
| | - I Riahi
- Service ORL et chirurgie cervicofaciale, hôpital Charles-Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie
| | - M R Harhira
- Service ORL et chirurgie cervicofaciale, hôpital Charles-Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie
| | - M Ben Salah
- Service ORL et chirurgie cervicofaciale, hôpital Charles-Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie
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4
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Brunet-Garcia A, Costa-Climent MD, Pujol-Rodríguez M, Brunet-Garcia L, Faubel-Serra M. Sphenoid sinus mucocele: an unusual complication of head and neck irradiation in a North African woman. J Clin Exp Dent 2019; 11:e208-e212. [PMID: 30805127 PMCID: PMC6383900 DOI: 10.4317/jced.55161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/17/2018] [Indexed: 11/05/2022] Open
Abstract
Mucocele is a common benign lesion otherwise rarely located in the sphenoid sinus. Some complications after head and neck irradiation have been described in the literature until now. To our knowledge, this is the first report of a sphenoid sinus mucocele in a North African patient treated some years before with radiotherapy for a nasopharyngeal carcinoma (NPC). We extend the literature review about this infrequent finding, of which head and neck surgeons should be aware. Key words:Mucocele, sphenoid sinus mucocele, nasopharyngeal carcinoma, radiotherapy, North African.
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Affiliation(s)
- Aina Brunet-Garcia
- MD, Department of Otorhinolaryngology, Hospital Universitar Parc Taulí. Sabadell, Barcelona. Universitat Autònoma de Barcelona. Universitat de València. Spain
| | - Mª Dolores Costa-Climent
- MD, Department of Otorhinolaryngology, Hospital General Universitari de Castelló. Castelló de la Plana, Castelló, Spain
| | - Maria Pujol-Rodríguez
- MD, Department of Otorhinolaryngology, Hospital Universitari Vall d'Hebron. Barcelona. Spain
| | - Laia Brunet-Garcia
- MD, Department of Paediatric Cardiology, Hospital de Mataró. Department of Pediatrics, Hospital Sant Joan de Déu, Barcelona. Universitat de Barcelona. Spain
| | - Marta Faubel-Serra
- MD, PhD. Head of Otorhinolaryngology department, Hospital General Universitari de Castelló. Castelló de la Plana, Castelló, Spain
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5
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Prado-Ribeiro AC, Santos-Silva AR, Faria KM, Silva WG, Simonato LE, Moutinho K, Brandão TB. Radiation-related superficial oral mucoceles: An under-recognized acute toxicity in head and neck cancer patients. Med Oral Patol Oral Cir Bucal 2018; 23:e518-e523. [PMID: 30148465 PMCID: PMC6167097 DOI: 10.4317/medoral.22470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/19/2018] [Indexed: 02/07/2023] Open
Abstract
Background Acute toxicity is usually defined as adverse changes occurring immediately or a short time after the start of oncological treatment. Material and Methods Cross-sectional retrospective study performed with head and neck cancer patients who underwent radiotherapy from 2013 to 2016. Results Ten (1.2%) patients developed SOMs during radiotherapy, most (80%) of which were men with a mean age of 59.5 years at diagnosis. SOMs mainly affected the floor of the mouth (60%) between the fourth and the sixth weeks of radiation therapy. All lesions were asymptomatic and spontaneously ruptured approximately 9 days after diagnosis. Conclusions Although rare, SOMs may be regarded as an acute oral toxicity of head and neck radiotherapy. Key words:Superficial oral mucoceles; head and neck cancer; radiation toxicity, acute toxicity.
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Affiliation(s)
- A-C Prado-Ribeiro
- Instituto do Câncer do Estado de São Paulo [ICESP], Faculdade de Medicina da Universidade de São Paulo, Dental Oncology Service, São Paulo, Brazil, Avenida Doutor Arnaldo, 251, São Paulo - SP, Brasil, CEP: 01246-000,
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Sharouny H, Narayanan P. Maxillary Sinus Mucopyocele in a Fifty-eight-year-old man: A Possible Late Complication of Irradiation to Head and Neck. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e17133. [PMID: 25237579 PMCID: PMC4166098 DOI: 10.5812/ircmj.17133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/04/2014] [Accepted: 03/23/2014] [Indexed: 11/16/2022]
Abstract
Introduction: A mucocele is an epithelial-lined, mucus-containing sac that can fill the sinus completely and expand gradually. Mucopyocele is an infected mucocele. Case Report: We presented a case of left maxillary mucopyocele in a 58-year-old man that developed after radiotherapy for nasopharyngeal carcinoma. Computed tomography scan showed opacification of the left maxillary sinus expanding through the medial wall of the antrum with thinning and destruction of the adjacent structures. Endoscopic marsupialization of the lesion and left partial maxillectomy were performed. The cystic mass had yellowish thick mucopurulent fluid that was completely drained. Conclusions: A few cases of sphenoid sinus mucocele as a late complication of radiation therapy have been reported. Maxillary mucocele and mucopyocele can be considered as one of the late complications of radiotherapy to head and neck as a result of occlusion of sinus ostia by scarred mucosa.
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Affiliation(s)
- Hadi Sharouny
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Hadi Sharouny, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7116291478, Fax: +98-7116291478, E-mail:
| | - Prepageran Narayanan
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Mnejja M, Hammami B, Achour I, Chakroun A, Charfeddine I, Frikha M, Daoud J, Ghorbel A. [Post-radiation mucocele in two patients treated for nasopharyngeal cancer]. Cancer Radiother 2011; 15:254-6. [PMID: 21419685 DOI: 10.1016/j.canrad.2010.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 12/12/2010] [Accepted: 12/20/2010] [Indexed: 11/17/2022]
Abstract
A 30-year-old woman, with a history of nasopharyngeal carcinoma, which was treated by radiotherapy nine years previously, presented with occasional diplopia and recent headaches. A nasopharyngeal biopsy showed no recurrence. The imaging revealed a sphenoidal sinus mucocele. Endoscopic marsupialization of the mucocele allowed clinical improvement. A 56-year-old woman presented, five years after radiotherapy for nasopharyngeal carcinoma, with a fronto-orbital mass. CT-scan revealed a fronto-ethmoidal mucocele. Nasopharyngeal biopsy showed tumour recurrence. Marsupialization of mucocele was performed. Recurrence of the carcinoma was treated by radiotherapy and chemotherapy. Sphenoidal sinus mucocele developing after radiotherapy for nasopharyngeal carcinoma has rarely been reported. CT scan and MRI are useful tools in making the diagnosis. Biopsy is required to diagnose recurrence or associated radio-induced tumor. Endoscopic approach gives good results.
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Affiliation(s)
- M Mnejja
- Service ORL et chirurgie cervico-faciale, CHU Habib-Bourguiba, Sfax, Tunisie.
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Sphenoid sinus mucocele: 10 cases and literature review. The Journal of Laryngology & Otology 2009; 124:44-7. [PMID: 19825255 DOI: 10.1017/s0022215109991551] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Sphenoid sinus mucoceles represent only 1-2 per cent of all paranasal sinus mucoceles. Patients may present with a myriad of symptoms. Pre-operative investigations include nasoendoscopy, computed tomography and/or magnetic resonance imaging. Treatment is by endoscopic sinus surgery. METHODOLOGY A retrospective review of the archives of the Singapore General Hospital otolaryngology department (1999-2006) identified 10 cases of sphenoid sinus mucocele. Patient demographics, presenting symptoms, investigations and treatment were evaluated. RESULTS The 10 patients identified (three women and seven men) had a mean age of 54.5 years (range 24-70 years). Thirty per cent of patients had a history of nasopharyngeal carcinoma treated with radiotherapy. Presenting symptoms, in order of decreasing frequency, were: ocular symptoms (50 per cent), headaches (30 per cent), nasal discharge (30 per cent) and facial pain (10 per cent). All patients underwent pre-operative computed tomography or magnetic resonance imaging. Twenty per cent of patients had evidence of intracranial involvement on imaging. All patients underwent uncomplicated transnasal sphenoidotomy and drainage of the mucocele. There was no clinical or radiological evidence of recurrence at a mean follow up of 29 months (range 4-90 months). CONCLUSION Sphenoid sinus mucocele is a rare condition. In this study, radiation to the head and neck appeared to be a predisposing factor, and eye symptoms were the commonest presentation. Endoscopic sinus surgery is a safe and effective treatment modality.
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King AD, Ahuja AT, Leung SF, Abrigo J, Wong JKT, Poon WS, Woo KS, Chan HS, Tse GMK. MR imaging of nonmalignant polyps and masses of the nasopharynx and sphenoid sinus after radiotherapy for nasopharyngeal carcinoma. AJNR Am J Neuroradiol 2008; 29:1209-14. [PMID: 18467517 DOI: 10.3174/ajnr.a1043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The development of a new polyp or mass in the radiation field of a previously treated carcinoma is usually an ominous sign of a recurrent cancer, but rarely may it be caused instead by a nonmalignant process. The purpose of this study was to document the MR appearance of unusual nonmalignant polyps or masses (NMPMs) in the nasopharynx and sphenoid sinus arising after radiation treatment of nasopharyngeal carcinoma. MATERIALS AND METHODS The MR imaging reports of patients undergoing imaging after radiation therapy for nasopharyngeal carcinoma were reviewed retrospectively to identify patients with unusual polyps and masses in the nasopharynx. The MR images of those patients with no evidence of malignancy on biopsy or follow-up were reviewed. RESULTS The MR imaging reports of 1282 patients were reviewed, and 11 patients (1%) with NMPMs in the nasopharynx or sphenoid sinus were identified. Two patterns were identified: contrast enhancing nasopharyngeal polyps ranging in size from 1 to 5 cm (n = 5) and sphenoid sinus masses consisting of a nonenhancing mass filling a nonexpanded sinus (n = 4) and a heterogeneous enhancing mass expanding the sinus (n = 2). Osteoradionecrosis produced a large defect in the roof of the nasopharynx causing direct communication with the sphenoid sinus (n = 6). Histology revealed granulation tissue in all of the patients with variable amounts of fibrin and inflammatory cells. A direct infective etiology was not proved in any patient. CONCLUSION NMPMs in the nasopharynx and sphenoid sinus are rare complications after radiation therapy to the skull base, but the radiologist needs to be aware of their appearance so that they can be considered in the differential diagnosis of suspected tumor recurrence.
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Affiliation(s)
- A D King
- Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
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10
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King AD, Ahuja AT, Yeung DK, Wong JKT, Lee YYP, Lam WWM, Ho SSM, Yu SCH, Leung SF. Delayed complications of radiotherapy treatment for nasopharyngeal carcinoma: imaging findings. Clin Radiol 2007; 62:195-203. [PMID: 17293211 DOI: 10.1016/j.crad.2006.10.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 09/29/2006] [Accepted: 10/03/2006] [Indexed: 11/20/2022]
Abstract
Radiotherapy is used to treat a wide variety of head and neck tumours that arise in and around the skull base. The delayed effects of radiation damages a range of structures, including the nervous system, bone, major vessels, mucus membranes, pituitary and salivary glands, as well as increasing the risk of radiation-induced neoplasms. In this review the complications resulting from radiation treatment for nasopharyngeal carcinoma (NPC), a cancer treated with a high dose of radiation to a fairly large region, are illustrated. Many patients with NPC have a long-term survival, so are at risk of developing delayed radiation effects, and hence may demonstrate a wide range of complications on imaging. Other tumours around the skull base treated with radiotherapy include meningiomas, chordomas, chondrosarcomas, pituitary adenomas, paranasal sinus and nasal cavity tumours. In these cases similar complications may be encountered on imaging, although the severity, incidence and location will vary.
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Affiliation(s)
- A D King
- Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, S.A.R., China.
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Lin JYS, Lin SL, Chang YL, Lo SH, Chuang FS, Lin SY. Sphenoid sinus mucocoele presenting with optic neuropathy and abducens palsy: a late complication of radiotherapy to the head and neck. Eye (Lond) 2005; 19:697-9. [PMID: 15332102 DOI: 10.1038/sj.eye.6701581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Wong CS, Luk SH, Leung TW, Yuen KK, Sze WK, Tung SY. Sphenoid sinus mucocoele and cranial nerve palsies in a patient with a history of nasopharyngeal carcinoma: may mimic local recurrence. Clin Oncol (R Coll Radiol) 2002; 13:353-5. [PMID: 11716228 DOI: 10.1053/clon.2001.9288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report the case history of a patient with a sphenoid sinus mucocoele detected by computed tomography and medical resonance imaging. The patient had a history of nasopharyngeal carcinoma, which was treated by radiotherapy more than 10 years previously. He presented with bilateral twelfth and sixth cranial nerve palsies. Local tumour recurrence was suspected. Further investigations showed that the cranial nerve palsies were caused by radiation damage and the sphenoid sinus mucocoele was an incidental finding. Sphenoid sinus mucocoele is a possible rare late complication of radiotherapy in patients with nasopharyngeal carcinoma.
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Affiliation(s)
- C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
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Finsterer J, Hess B, Kielhauser R, Seelmann O, Grisold W. Bilateral visual loss and ipsilateral ophthalmoplegia due to unilateral sphenoid sinus mucocele. Neuroophthalmology 1999. [DOI: 10.1076/noph.22.4.221.3721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Wong KY, Ngan KC, Sin VC, Lau WH. Sphenoidal sinus mucocoele and yawning after radiation treatment for nasopharyngeal carcinoma. Clin Oncol (R Coll Radiol) 1998; 9:415-7. [PMID: 9448973 DOI: 10.1016/s0936-6555(97)80144-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The long term complications of radiotherapy in treating patients with nasopharyngeal carcinoma (NPC) are well recognized. Among these, neurological and endocrinological complications are usually considered to be more clinically important. On the other hand, postirradiation sinusitis is often neglected or overlooked because symptoms are usually non-specific or not clinically disturbing. This leads to the under-reporting of this complication. We report the case history of a patient with NPC who developed recurrent and debilitating bouts of yawning attacks 13 years after radiotherapy. The attacks were thought to be due to the compression of the hypothalamus by a large mucocoele in the sphenoidal sinus, which was successfully managed by surgical drainage.
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Affiliation(s)
- K Y Wong
- Radiotherapy and Oncology Department, Queen Elizabeth Hospital, Hong Kong
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Affiliation(s)
- L M Tartaglino
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107
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