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Imadeddin Malek A, Hamadi I, Fakoury M, Al Salhani T. Reversal of Sudden Blindness as a Consequence of Isolated Sphenoid Sinus Mucocele: A Case Report and Literature Review. Cureus 2024; 16:e62158. [PMID: 38993406 PMCID: PMC11238662 DOI: 10.7759/cureus.62158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Mucoceles are locally invasive but benign expansive cystic lesions that can arise within paranasal sinuses. Isolated sphenoid sinus Mucoceles (SSM) are quite rare, comprising less than 1% of all paranasal sinus mucoceles. Due to the critical position and proximity of the sphenoid sinus to vital structures, SSMs can cause a multitude of symptoms and complications. We report a case of a 53-year-old man who presented with sudden vision loss and was found to have an isolated SSM. Following surgical drainage and management of the SSM, the patient had full recovery of visual acuity upon discharge.
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Affiliation(s)
| | - Iyad Hamadi
- Otolaryngology - Head and Neck Surgery, Dubai Health, Dubai, ARE
| | | | - Tarek Al Salhani
- Otolaryngology - Head and Neck Surgery, Dubai Health, Dubai, ARE
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2
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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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3
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Gokani S, Kumaresan K, Adari S, Ergisi M, Oludeye O, Jegatheeswaran L, Philpott C. The Clinical Course of Paranasal Sinus Mucocoeles-A Retrospective Case Series. J Clin Med 2024; 13:397. [PMID: 38256532 PMCID: PMC10816877 DOI: 10.3390/jcm13020397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/21/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Paranasal sinus mucocoeles can be secondary to chronic rhinosinusitis and can result in intra-orbital and intra-cranial complications requiring surgical management. The natural history of conservatively managed mucocoeles is not well established. We aimed to quantify the proportion of radiologically identified paranasal sinus mucocoeles resulting in complications over 10 years. We retrospectively reviewed anonymised data on radiologically diagnosed mucocoeles between 2011 and 2021 at two UK hospitals. We collected data on age at presentation, extent of sinus involvement, management and complications. We identified 60 patients with mucocoeles, of which 35 (58%) were incidental findings from radiological investigations. The mean age was 58 years. Fifteen patients (25%) were managed surgically and one presented with recurrence following surgery. Overall, six patients (10%) had an intra-orbital extension of their mucocoele and three (5%) had an intra-cranial extension. There was no difference in the rates of intra-cranial extension between conservative and surgical cases but surgical cases included a higher rate of intra-orbital extensions (27% vs. 4%, p = 0.01). The proportion of patients requiring surgical intervention in this study is low. Incidental and asymptomatic mucocoeles have a relatively benign disease course and selected uncomplicated cases can be considered for conservative management with serial scanning at 12 months.
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Affiliation(s)
- Shyam Gokani
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (K.K.); (M.E.); (C.P.)
| | - Kala Kumaresan
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (K.K.); (M.E.); (C.P.)
| | - Sushritha Adari
- Department of Ear, Nose and Throat Surgery, James Paget University Hospital, Great Yarmouth NR31 6LA, UK; (S.A.); (O.O.); (L.J.)
| | - Mehmet Ergisi
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (K.K.); (M.E.); (C.P.)
| | - Oladapo Oludeye
- Department of Ear, Nose and Throat Surgery, James Paget University Hospital, Great Yarmouth NR31 6LA, UK; (S.A.); (O.O.); (L.J.)
| | - Lavandan Jegatheeswaran
- Department of Ear, Nose and Throat Surgery, James Paget University Hospital, Great Yarmouth NR31 6LA, UK; (S.A.); (O.O.); (L.J.)
| | - Carl Philpott
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (K.K.); (M.E.); (C.P.)
- Department of Ear, Nose and Throat Surgery, James Paget University Hospital, Great Yarmouth NR31 6LA, UK; (S.A.); (O.O.); (L.J.)
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4
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Nasal Sinus Mucoceles Manifesting Ocular Symptoms. J Craniofac Surg 2023; 34:e141-e145. [PMID: 35946831 DOI: 10.1097/scs.0000000000008888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/05/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION To describe the ocular symptoms in a series of patients with nasal sinus mucoceles of different locations. METHODS The authors analyzed the diagnosis and treatment of patients with sinus mucoceles and ocular symptoms who presented to the hospital from February 2010 to April 2020. A total of 61 patients were included in the study. The locations of the mucoceles were the frontal sinus (8 patients), ethmoid sinus (25 patients), and sphenoid sinus (28 patients). The authors selected 1 typical mucocele case from each of the sinuses, including the frontal, ethmoid, and sphenoid sinuses, and analyzed the history, diagnosis, and treatment of mucoceles in each location. RESULTS The main clinical manifestations were ophthalmic symptoms, such as exophthalmos or displacement, eye pain, blindness or decreased vision, blepharoptosis, and diplopia; no obvious nasal symptoms were noted. Most patients with these symptoms went to an ophthalmologist first. All lesions in this study were found through imaging examinations. Most symptoms improved after surgical interventions. Only 2 of the 61 patients had no improvement in vision because of the long period of vision loss. CONCLUSIONS Although sinus mucoceles are located in the sinuses, ocular symptoms are more prevalent than nasal symptoms. The earlier the imaging examinations are performed; the sooner lesions are detected, and the patients can be treated.
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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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Gozgec E, Ogul H. A Case of Sphenoid Mucocele Causing Hypopituitarism. EAR, NOSE & THROAT JOURNAL 2022:1455613221142123. [PMID: 36427225 DOI: 10.1177/01455613221142123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Mucocele is rarely seen in the sphenoid sinus. It may cause compression of neighboring structures due to significant destruction of the bony structure and its expansile nature. Although headache is the main symptom, it may present with different symptoms. Imaging methods play an important role in the diagnosis and differential diagnosis.
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Affiliation(s)
- Elif Gozgec
- Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Hayri Ogul
- Department of Radiology, Duzce University, Duzce, Turkey
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Mishra A, patel D, Munjal VR, Patidar M. Isolated Sphenoid Sinus Mucocele with Occular Symptoms: A Case Series. Indian J Otolaryngol Head Neck Surg 2022; 74:1109-1112. [PMID: 36452687 PMCID: PMC9702297 DOI: 10.1007/s12070-020-02176-2] [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: 08/16/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022] Open
Abstract
Mucoceles are benign, encapsulated, expansible, locally invasive masses within a paranasal sinus filled with mucus and lined by epithelium. Sphenoid sinus mucoceles are relatively rare, accounting for only 1% of all paranasal sinus mucoceles. Usually presenting with headache but can rarely result in visual defect, diplopia and at times, ptosis. We present two cases of sphenoid sinus mucocele where patient presented with ophthalmoplegia, ptosis and/or sudden onset vision loss. With the help of imaging studies like CT scan and MRI of paranasal sinus diagnosis was made and immediate surgical intervention was planned which resulted in acceptable improvement of symptoms and vision.
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Affiliation(s)
- Ankit Mishra
- Department of Otorhinolaryngology and Head and Neck Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Sanwer Road, Indore, M.P 453555 India
| | - Dinesh patel
- Department of Otorhinolaryngology and Head and Neck Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Sanwer Road, Indore, M.P 453555 India
| | - Vishal R. Munjal
- Department of Otorhinolaryngology and Head and Neck Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Sanwer Road, Indore, M.P 453555 India
| | - Murli Patidar
- Department of Otorhinolaryngology and Head and Neck Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Sanwer Road, Indore, M.P 453555 India
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Nardi C, Maraghelli D, Pietragalla M, Scola E, Locatello LG, Maggiore G, Gallo O, Bartolucci M. A practical overview of CT and MRI features of developmental, inflammatory, and neoplastic lesions of the sphenoid body and clivus. Neuroradiology 2022; 64:1483-1509. [PMID: 35657394 PMCID: PMC9271108 DOI: 10.1007/s00234-022-02986-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Abstract
The sphenoid bone is an unpaired bone that contributes to the formation of the skull base. Despite the enormous progress in transnasal endoscopic visualisation, imaging techniques remain the cornerstones to characterise any pathological condition arising in this area. In the present review, we offer a bird’s-eye view of the developmental, inflammatory, and neoplastic alterations affecting the sphenoid body and clivus, with the aim to propose a practical diagnostic aid for radiologists based on clinico-epidemiological, computed tomography, and magnetic resonance imaging features.
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Affiliation(s)
- Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Michele Pietragalla
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Elisa Scola
- Department of Neuroradiology, Careggi University Hospital, Largo Piero Palagi 1, 50134, Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Maurizio Bartolucci
- Department of Radiology, Azienda USL Toscana Centro, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20/22, 59100, Prato, Italy
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Large sphenoid mucocele presenting with cranial neuropathies in a 10-year-old boy: case report and literature review. Childs Nerv Syst 2022; 38:1035-1039. [PMID: 34347143 DOI: 10.1007/s00381-021-05314-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mucoceles in the sphenoid sinus are rare, making up 1-3% of all paranasal sinus mucoceles. Sphenoid sinus mucoceles among pediatric patients are uncommon and have a range of presentations due to their proximity to other structures, in rare cases causing oculomotor and visual disturbances through expansion and mass effect. CASE REPORT We present a case of a large expansile sphenoid sinus mucocele causing cranial nerve III and VI palsies in a 10-year-old boy. Endoscopic resection of the mucocele was performed for diagnosis and decompression, leading to immediate relief of the patient's symptoms and improvement in cranial nerve function. Post-operative imaging showed complete resolution of the mucocele. CONCLUSION Our case report and review of the current literature emphasizes that prompt diagnosis and intervention can lead to a good clinical outcome and prevention of permanent cranial neuropathy.
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10
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Danni multipli dei nervi cranici. Neurologia 2022. [DOI: 10.1016/s1634-7072(21)46000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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Swain S. Scuba Diver Presenting with a Giant Sphenoid Sinus Mucocele. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_32_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Kelly M, Chang L, Patel P, Weller A, Advani R, Lakhani R. Sphenoid mucopyocele causing bilateral sixth nerve palsy. J Surg Case Rep 2022; 2022:rjab607. [PMID: 35079336 PMCID: PMC8784181 DOI: 10.1093/jscr/rjab607] [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: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Sphenoid mucoceles, although rare, should be considered in patients with headache, visual disorders and eye paralysis. Due to close relationships with the orbit and neuromeningeal structures, early recognition is vital. We report the case of a patient who presented with bilateral abducens nerve palsies. At surgery, she was found to have a mucopyocele; this was drained and she required prolonged intravenous antibiotic therapy due to ongoing symptoms and persistent dural enhancement on imaging. A lesion of sufficient size in the clival area has the potential to cause bilateral abducens nerve palsies, though we believe this is the first time it has been described in relation to a sphenoid mucocele. Imaging plays a crucial role in diagnosis, and prompt surgical intervention is essential to avoid serious and permanent complications. The multi-disciplinary team approach is vital—these cases requiring input from ophthalmology, ear nose and throat, microbiology, radiology, neurology and neurosurgery.
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Affiliation(s)
- Mairead Kelly
- Correspondence address. Department of Ear Nose and Throat Surgery, St George’s University Hospitals NHS Foundation Trust, Blackshaw Rd., London, SW17 0QT, UK. Tel: 07779245551;
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Mirasoglu B, Kirmizi S, Aktas S. Sphenoid sinus mucocele as an unusual differential diagnosis in diving injuries. Diving Hyperb Med 2020; 50:168-172. [PMID: 32557420 DOI: 10.28920/dhm50.2.168-172] [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] [Received: 11/11/2019] [Accepted: 01/31/2020] [Indexed: 11/05/2022]
Abstract
Sphenoid sinus mucocele is a rare cystic lesion. It grows gradually and causes visual disturbances, ocular motility abnormalities and headache due to cavernous sinus compression. Sudden change in sinus cavity volume by a barotrauma may compress a mucocele and precipitate symptoms that may easily be confused with decompression sickness. A diver suffering from vertigo, nausea, blurry vision and hearing loss following uneventful dives is presented in this report. He underwent hyperbaric oxygen treatment for inner ear decompression sickness but later was diagnosed as sphenoid sinus mucocele. A high index of suspicion is necessary to capture rare conditions like mucocele in the differential diagnosis for divers with symptoms suggesting vestibulocochlear origin. To our knowledge, only one sphenoid sinus mucocele case presenting as a diving injury has been previously reported.
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Affiliation(s)
- Bengusu Mirasoglu
- Underwater and Hyperbaric Medicine Department, Istanbul Faculty of Medicine, Istanbul, Turkey.,Corresponding author: Dr Bengusu Mirasoglu, Istanbul Tip Fakultesi, Sualti Hekimligi ve Hiperbarik Tip Anabilim Dali, 34093 Fatih, Istanbul, Turkey,
| | - Seren Kirmizi
- Underwater and Hyperbaric Medicine Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Samil Aktas
- Underwater and Hyperbaric Medicine Department, Istanbul Faculty of Medicine, Istanbul, Turkey
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14
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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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15
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Kam J, Ahmad A, Williams A, Peterson EL, Craig JR. Postoperative epistaxis and sphenoid sinus ostial stenosis after posterior septal branch injury during sphenoidotomy. Int Forum Allergy Rhinol 2019; 9:842-849. [PMID: 31012265 DOI: 10.1002/alr.22345] [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] [Received: 12/30/2018] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Postoperative arterial epistaxis and sphenoid sinus stenosis after sphenoidotomies for endoscopic sinus surgery (ESS) and transsphenoidal approaches (TSAs) are uncommon. One potential source of epistaxis after sphenoidotomy is the sphenopalatine artery's posterior septal branch (PSB). PSB injury, in addition to other factors, could increase the risk of sphenoid stenosis. The purpose of this study was to determine incidence of, and risks factors for, the following outcomes after sphenoidotomy: PSB injury; postoperative epistaxis from the injured PSB; and sphenoid stenosis after PSB injury. METHODS A single-institution, prospective case series was conducted based on 233 sphenoidotomies performed during ESS (n = 163) and TSAs (n = 70). Outcome measures included intraoperative PSB injury, postoperative epistaxis from the PSB, and sphenoid stenosis. RESULTS The incidence of PSB injury was 17.2% during ESS-related sphenoidotomies, and 5.7% during TSA-related sphenoidotomies (p = 0.010). After PSB injury during ESS- and TSA-related sphenoidotomies (n = 32), there was 1 instance of epistaxis from the PSB (3.1%). Of the 161 ESS-related sphenoidotomies, 6 developed complete or near-complete stenosis (3.7%), which was more likely to occur with smaller anterior sphenoid face dimensions (p = 0.001). PSB injury, revision sphenoidotomy, and other factors did not increase the risk of stenosis. None of the TSA-related sphenoidotomies stenosed completely. Median follow-up was 7 months. CONCLUSION PSB injury occurred in 17.2% of ESS-related sphenoidotomies and 5.8% of TSA-related sphenoidotomies. After PSB injury, postoperative epistaxis from the PSB was rare (3.1%). After ESS-related sphenoidotomies, sphenoid stenosis was rare (3.7%), and was more likely to occur with smaller sphenoid dimensions, but not with PSB injury or other factors.
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Affiliation(s)
- Joanna Kam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI
| | - Abid Ahmad
- Wayne State University School of Medicine, Wayne State Medical University, Detroit, MI
| | - Amy Williams
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI
| | - Edward L Peterson
- Department of Public Health Services, Henry Ford Health System, Detroit, MI
| | - John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI
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16
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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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Cluster-Like Headache Secondary to Sphenoid Sinus Mucocele. Case Rep Neurol Med 2018; 2018:5850286. [PMID: 30631616 PMCID: PMC6304483 DOI: 10.1155/2018/5850286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 11/25/2018] [Indexed: 01/03/2023] Open
Abstract
Background The great majority of cases of cluster headache (CH) are primary, but there are several reported cases of CH secondary to underlying structural lesions. The identification of these lesions is crucial for the achievement of an effective treatment and favorable outcome, although the determination of a cause-effect relationship between the two entities may be challenging. Case Report We present the first case of CH secondary to sphenoid sinus mucocele. Discussion This case reinforces the need to perform neuroimaging studies in CH patients in order to identify lesions that can constitute its cause, especially if atypical features are present. Activation of the trigeminovascular system due to direct contact between the lesion and the trigeminal nerve or by local edema and inflammation possibly plays a role in the pathophysiology of this CH secondary to sphenoid sinus mucocele.
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Jun YJ, Kwon KY. A middle-aged man with lying-down headache: an unusual presentation of sphenoid sinus mucocele. Acta Neurol Belg 2018; 118:315-317. [PMID: 28602007 DOI: 10.1007/s13760-017-0807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/03/2017] [Indexed: 10/19/2022]
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Li E, Howard MA, Vining EM, Becker RD, Silbert J, Lesser RL. Visual prognosis in compressive optic neuropathy secondary to sphenoid sinus mucocele: A systematic review. Orbit 2018; 37:280-286. [PMID: 29303386 DOI: 10.1080/01676830.2017.1423087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sphenoid sinus mucoceles (SSMs) are rare, benign lesions that can expand, often presenting with ocular symptoms-decreased vision, diplopia, visual field defects, proptosis, and external ophthalmoplegia. Reported cases are few, visual compromise varies, and factors affecting visual prognosis are poorly characterized. We investigate whether prompt surgical intervention (within 2 weeks of visual symptom onset) affects best-corrected visual acuity (BCVA) regained in patients with vision loss secondary to compressive SSM. We present a retrospective review of three cases and published literature to date. Our primary outcome was BCVA regained after surgical intervention; secondary outcomes included change in visual field defect and ophthalmological symptoms other than vision loss. Our three cases of SSM varied in onset, ranging from several hours to several months with patients aged from 13 to 80 years. All patients had severe vision loss to light perception (LP) or worse. Rapid neuro-imaging and urgent surgical intervention improved vision to count fingers at best. Of the two patients who underwent prompt decompression, one improved from no LP to LP and the other did not recover any vision. The patient who had visual loss for 3 months before intervention improved from LP to 20/400. Findings from our literature search, which yielded 12 cases of urgent intervention, supported the variability in visual prognosis despite prompt surgical intervention. SSMs are rare, pathologically benign lesions which can expand to cause ocular involvement. Prompt diagnosis and surgical decompression are recommended, but visual recovery may be limited even with urgent intervention.
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Affiliation(s)
- Emily Li
- a Department of Ophthalmology and Visual Science , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Martha A Howard
- a Department of Ophthalmology and Visual Science , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Eugenia M Vining
- b Section of Otolaryngology, Department of Surgery , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Richard D Becker
- c Department of Radiology , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Jonathan Silbert
- a Department of Ophthalmology and Visual Science , Yale University School of Medicine , New Haven , Connecticut , USA.,d The Eye Care Group , Waterbury , Connecticut , USA
| | - Robert L Lesser
- a Department of Ophthalmology and Visual Science , Yale University School of Medicine , New Haven , Connecticut , USA.,d The Eye Care Group , Waterbury , Connecticut , USA.,e Department of Neurology , Yale University School of Medicine , New Haven , Connecticut , USA
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Endoscopic-Assisted Removal of a Rare Mucocele Complicating From Alloplastic Medial Orbital Fracture Reconstruction. J Craniofac Surg 2017; 28:967-969. [PMID: 28118188 DOI: 10.1097/scs.0000000000003454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Orbital wall fracture reconstruction is usually recommended to prevent subsequent functional and esthetic complications. Mucocele development following such injuries or its management is recognized but rare sequelae. When they occur, they represent a diagnostic and management dilemma. The authors described a patient with orbital and ethmoidal mucocele. A 62-year-old female patient presented with progressive left exophthalmos 1 year following titanium mesh reconstruction of a medial orbital wall fracture. Computed tomography and magnetic resonance imaging demonstrated an encysted lesion encasing the mesh plate in the left orbit and extending into the ethmoidal sinus. The patient is treated surgically through endoscopic-assisted approach with complete removal of the lesion and lacrimal duct stenting. The patient improved immediately after surgery.
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Abstract
Chronic sphenoid rhinosinusitis is a spectrum of inflammatory diseases in isolated sphenoid sinus which may persist over a period of 12 weeks. It is a different entity from other types of rhinosinusitis because clinical presentations include headache, visual loss or diplopia, and patients may or may not have nasal obstruction or nasal discharge. Nasal endoscopic examination is useful, and computed tomography is mandatory. The disease requires comprehensive knowledge and appropriate imaging technique for diagnosis. To treat patients with chronic sphenoid rhinosinusitis, surgical treatment with endoscopic transnasal sphenoidotomy is often required. As there are no recent updated reviews of chronic sphenoid rhinosinusitis, in this article, we review the anatomy of the sphenoid sinus and its clinical relationship with the clinical signs and symptoms of the disease, the imaging findings of each diagnosis and the comprehensive surgical techniques.
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Affiliation(s)
- Natamon Charakorn
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kornkiat Snidvongs
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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22
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Mora-Horna ER, López VG, Anaya-Alaminos R, Ceriotto A, Salcedo G. Optic neuropathy secondary to a sphenoid-ethmoidal mucocele: Case report. ACTA ACUST UNITED AC 2015; 90:582-4. [PMID: 26243436 DOI: 10.1016/j.oftal.2015.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/05/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
CASE REPORT The case is presented of a 51-year old male patient with a history of blunt trauma in the frontal region and a one-year history of vision loss, proptosis and paresis of the lateral rectus muscle of the right eye. A right ethmoid and bilateral sphenoid mucocele was diagnosed. Drainage was performed using an external and endoscopic approach with improvement in symptoms without recurrence at 10 months. DISCUSSION Sphenoid mucoceles represent 1% of all mucoceles and may present with different clinical manifestations. Surgical excision is the treatment of choice, and early intervention is indicated to prevent complications.
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Affiliation(s)
- E R Mora-Horna
- Servicio de Párpados, Órbita y Vía Lagrimal, Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sánchez Bulnes, México, DF, México.
| | - V G López
- Servicio de Párpados, Órbita y Vía Lagrimal, Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sánchez Bulnes, México, DF, México
| | - R Anaya-Alaminos
- Departamento de Órbita, Oculoplástica y Vías Lagrimales, Institut Català de Retina, Barcelona, España
| | - A Ceriotto
- Servicio de Párpados, Órbita y Vía Lagrimal, Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sánchez Bulnes, México, DF, México
| | - G Salcedo
- Servicio de Párpados, Órbita y Vía Lagrimal, Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sánchez Bulnes, México, DF, México
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Lee DH, Lee JJW, Cho WS, Lim SC. Mucocele of the Nasal Septum: Case Report and Review of the Literature. JOURNAL OF RHINOLOGY 2015. [DOI: 10.18787/jr.2015.22.2.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, Korea
| | - John Jae Woon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, Korea
| | - Wan Seok Cho
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, Korea
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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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Affiliation(s)
- C Hill
- From the ENT Department, Queen's Hospital, Romford, UK
| | - G Kumar
- From the ENT Department, Queen's Hospital, Romford, UK
| | - J S Virk
- From the ENT Department, Queen's Hospital, Romford, UK
| | - A Owa
- From the ENT Department, Queen's Hospital, Romford, UK
| | - H Kaddour
- From the ENT Department, Queen's Hospital, Romford, UK
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27
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Villa A, De Angelis M, Piscevic I, Solari D, Cavallo LM, Cappabianca P. Sphenoid sinus mucocele caused by a completely thrombosed intracavernous carotid artery aneurysm: an unusual association. J Neurol Surg Rep 2014; 75:e108-12. [PMID: 25083367 PMCID: PMC4110156 DOI: 10.1055/s-0034-1373666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 02/20/2014] [Indexed: 11/29/2022] Open
Abstract
Background Mucocele is an inflammatory disease caused by the retention of mucoid secretions within a paranasal sinus. Although rare, the presence of a vascular lesion inside the sphenoid sinus could determine ostium obstruction, thus causing mucocele development. Clinical Presentation An 84-year-old woman was referred to our institution due to a lesion abutting into the sphenoid sinus; she was complaining of constrictive frontal headache, progressive worsening of visual acuity in the left eye; later, sudden homolateral ptosis and diplopia occurred. The radiologic evidence was consistent with the diagnosis of thrombosed aneurysm of the right intracavernous carotid artery, surrounded by sphenoidal mucocele. The patient underwent an endoscopic endonasal transsphenoidal approach exclusively for sphenoid mucocele drainage. Conclusion Although rare, the presence of a vascular lesion inside the sphenoid sinus has to be considered among the possible diagnostic hypotheses of masses abutting in this cavity; the association with mucocele is even more rare and, to date, has not been described.
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Affiliation(s)
- Alessandro Villa
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Michelangelo De Angelis
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Ivan Piscevic
- Clinical Centre of Serbia, Clinic of Neurosurgery, Belgrade, Serbia
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
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Mohebbi A, Jahandideh H, Harandi AA. Sphenoid Sinus Mucocele as a Cause of Isolated Pupil-Sparing Oculomotor Nerve Palsy Mimicking Diabetic Ophthalmoplegia. EAR, NOSE & THROAT JOURNAL 2013. [DOI: 10.1177/014556131309201210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alireza Mohebbi
- From the Department of Otolaryngology–Head and Neck Surgery, Hazrat-e-Rasool Akram Hospital, Iran University of Medical Sciences, Tehran
| | - Hesam Jahandideh
- From the Department of Otolaryngology–Head and Neck Surgery, Hazrat-e-Rasool Akram Hospital, Iran University of Medical Sciences, Tehran
| | - Ali Amini Harandi
- Department of Neurology, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran
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29
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Bag AK, Chapman PR. Neuroimaging: Intrinsic Lesions of the Central Skull Base Region. Semin Ultrasound CT MR 2013; 34:412-35. [DOI: 10.1053/j.sult.2013.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Mowatt L, Foster T. Sphenoidal sinus mucocele presenting with acute visual loss in a scuba diver. BMJ Case Rep 2013; 2013:bcr-2013-010309. [PMID: 23964041 DOI: 10.1136/bcr-2013-010309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old male scuba diver presented with an acute history of painful unilateral visual loss after scuba diving. He had right-sided retrobulbar pain and headache. He was known to have sinusitis and had transient visual loss in two previous episodes after scuba diving. His visual acuity was hand motions and 20/20 in the right and left eye, respectively. There was no proptosis. He had a right relative afferent pupillary defect. Colour vision was normal in the left eye and absent in the right eye. Fundal examination revealed healthy discs and macula bilaterally. He was assessed as a right optic neuropathy, possibly secondary to compression. An MRI of the brain revealed a large sphenoidal mucocele extending into the right optic foramen. He was treated with oral steroids, antibiotics and nasal decongestants. He underwent endoscopic intranasal sphenoidectomy and marsupialisation with return of his visual acuity to 20/25 in that eye.
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31
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Wang AC, Than KD, Ramnath S, Pandey AS. Anterior clinoid mucocele presenting with orbital apex syndrome. Surg Neurol Int 2013; 4:63. [PMID: 23772333 PMCID: PMC3680997 DOI: 10.4103/2152-7806.111583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/04/2013] [Indexed: 11/12/2022] Open
Abstract
Background: Pneumatized anterior clinoid process is a common anatomic variant. Mucocele formation is a known complication of clinoid drilling during certain intracranial operations; however, mucoceles of pneumatized anterior clinoid processes have been found to spontaneously occur. Case Description: A 44-year-old male presented with complaints of left-sided retro-orbital pain, double vision, and numbness over the upper face and scalp on the left side of 1-week duration. On examination, he was found to develop cranial nerve III, IV, and VI palsies with pupillary sparing, ophthalmic division cranial nerve V dysfunction, and eventually, the onset of vision loss. Conclusions: We report a case of spontaneous anterior clinoid process mucocele presenting with orbital apex syndrome. This was treated successfully with anterior clinoidectomy for decompression.
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Affiliation(s)
- Anthony C Wang
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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Choudhri AF, Parmar HA, Morales RE, Gandhi D. Lesions of the skull base: imaging for diagnosis and treatment. Otolaryngol Clin North Am 2013; 45:1385-404. [PMID: 23153754 DOI: 10.1016/j.otc.2012.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article provides a summary of how to approach the imaging analysis of lesions of the anterior, central, and posterior skull base. The primary focus is tumors and tumor-mimickers, and representative examples are shown to differentiate the features of lesions that can occur in the same location.
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Affiliation(s)
- Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
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Hopf-Jensen S, Rubarth O, von D Ahe I, Riis P, Preuss H, Preiss M, Börm W, Müller-Hülsbeck S. Isolated oculomotor nerve palsy caused by a mucocele of an aerated anterior clinoid process. Clin Neuroradiol 2013; 24:161-4. [PMID: 23529563 DOI: 10.1007/s00062-013-0211-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- S Hopf-Jensen
- Department of Diagnostics and Interventional Radiology/Neuroradiology, Diakonissen Hospital Flensburg, Knuthstraße 1, 24939, Flensburg, Germany,
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Mucocele formation under pedicled nasoseptal flap. Am J Otolaryngol 2012; 33:634-6. [PMID: 22771247 DOI: 10.1016/j.amjoto.2012.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/19/2012] [Indexed: 11/24/2022]
Abstract
The pedicled nasoseptal flap has become an indispensible tool for the reconstruction of skull base defects. This flap is easily harvested, provides a large surface area of vascularized tissue, and has few reported complications. We describe the case of a 60-year-old man who underwent endoscopic, endonasal transsphenoidal surgery with septal flap reconstruction who developed a sphenoid sinus mucocele postoperatively. We also have reviewed the literature for similar findings and discuss this complication in the setting of pituitary surgery and endoscopic skull base repair. Although likely a rare occurrence, mucocele formation after septal flap reconstruction should be recognized and monitored with postoperative nasal endoscopy and radiologic imaging. Reoperation or mucocele drainage may be necessary if symptomatic or in cases of rapid enlargement.
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Chahed H, Romdhane N, Zainine R, Abid W, Sahtout S, Besbes G. [Pediatric mucoceles: clinical aspects and therapeutic approaches]. ACTA ACUST UNITED AC 2012; 113:437-41. [PMID: 22818665 DOI: 10.1016/j.stomax.2012.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 02/13/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Paranasal sinuses mucoceles are extremely rare in children and adolescents. The objective of this study was to assess their clinical presentations and the contribution of endoscopic surgery in their management. MATERIAL AND METHODS we retrospectively reviewed 11 children with paranasal sinus mucoceles who were managed during a period of 15 years (1995-2009). RESULTS The mean age was 11.8 years with a sex ratio of 2.66. One patient had a history of nasal polyposis surgery. The symptomatology was dominated by ophthalmological complains. The ethmoïd sinus was the main localization. Orbital extension was found in eight cases, pyomucocele in one case. The surgical management was endoscopic (nine cases), and by an external approach (two cases). Two cases of recurrence were assessed. The mean follow-up was 22.3 months. DISCUSSION Paranasal sinuses mucocele is exceptional in children. Cystic fibrosis is the main etiologic factor. The symptoms depend on the location and size of the mucocele. The treatment is surgical and most authors prefer the endoscopic approach.
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Affiliation(s)
- H Chahed
- Service ORL et chirurgie maxillo-faciale de la Rabta, CHU La Rabta, 1007 Bab-Saadoun, Tunis, Tunisie.
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Paradowska-Opałka B, Kawczyński M, Jaworowska E. [Ethmoid sinus mucocele penetrating to the orbit and anterior cranial fossa - case report]. Otolaryngol Pol 2012; 67:261-4. [PMID: 24021830 DOI: 10.1016/j.otpol.2012.05.018] [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: 12/09/2011] [Revised: 02/16/2012] [Accepted: 05/21/2012] [Indexed: 10/28/2022]
Abstract
Paranasal sinus mucocele is the cystic formation lined by inflammatory changed mucoperiosteum. This is slow-growing pathology with a tendency to bone erosion. The symptoms are dependent on the direction of the penetration, and are as follows: increasing headaches, deformations of frontal or orbital region, ophthalmic manifestations such as lacrimation, decreased visual acuity, exophthalmos, ocular movement limitation, diplopia. The most common location of the mucocele is fronto-ethmoid region. The most useful diagnostic tests are a magnetic resonance imaging (MRI) and a computed tomography (CT) which show the progress of the disease and bone destructions. Surgery is the only method of treatment (external approach or FESS). This paper reports the case of a 74-year-old woman with ethmoid mucocele penetrating into the orbit, frontal sinus and anterior cranial fossa with compression of frontal lobe of the brain. The patient underwent CT and MRI and was treated with endoscopic intranasal marsupialization of the cyst. There are no clinical signs of disease recurrence 7 months after surgery. The endoscopic surgical management in treatment of sinus mucocele is a good alternative to the operation from external approach because of its low invasiveness, low complication risk, rapid healing and good therapeutic effects.
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Affiliation(s)
- Beata Paradowska-Opałka
- Katedra i Klinika Laryngologii i Onkologii Laryngologicznej Pomorskiego Uniwersytetu Medycznego w Szczecinie, Kierownik p.o. dr med. E. Jaworowska, Poland
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A Case of Petrous Apex Mucocele with Unilateral Ear Fullness Treated with Endoscopic Sphenoid Marsupialization. ACTA ACUST UNITED AC 2012. [DOI: 10.3342/kjorl-hns.2012.55.7.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Elden LM, Reinders ME, Kazahaya K, Tom LWC. Management of isolated sphenoid sinus disease in children: a surgical perspective. Int J Pediatr Otorhinolaryngol 2011; 75:1594-8. [PMID: 22005666 DOI: 10.1016/j.ijporl.2011.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 09/15/2011] [Accepted: 09/19/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the spectrum of diseases and optimal timing of surgical drainage for the opacified sphenoid sinus in children. METHODS Ten year retrospective chart review of children with isolated sphenoid sinus disease. RESULTS Fourteen patients (mean age 11 ± 2.8 years, range 6.5-15.1 years) were diagnosed with isolated sphenoid sinus disease. Five patients had acute, severe bacterial sphenoiditis, four had sphenoid mucoceles, three had suspected tumors involving the sphenoid bone, clivus or sella, and two were identified incidentally when imaging studies were obtained for unrelated reasons. Headache was the most common symptom. Cranial nerve or other intracranial complications were present in all of those referred because of infection, but in none of the other patients. Computed tomography (CT) revealed the presence of disease in all cases. Compared with CT, magnetic tomography (MRI) was more helpful in identifying the extent of disease spread in two patients with acute bacterial sphenoiditis and in three patients with suspected tumors. All improved with surgical drainage or biopsy of the suspected tumor. In two cases, children were treated conservatively with antibiotics and the primary symptoms resolved. CONCLUSIONS Isolated sphenoid sinus disease is rare in children. Those with clinically significant disease presented with progressive, severe headaches and minimal sinus symptoms. MRI studies were important to identify the source of headache and evolving complications in several of these patients.
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Affiliation(s)
- Lisa M Elden
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States.
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Ethmoidal mucocele presenting as oculomotor nerve paralysis. Clin Exp Otorhinolaryngol 2011; 6:103-6. [PMID: 23799169 PMCID: PMC3687058 DOI: 10.3342/ceo.2013.6.2.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 05/31/2010] [Accepted: 06/24/2010] [Indexed: 11/29/2022] Open
Abstract
A 56-year-old male was admitted with an acute headache and sudden ptosis on the right side. No ophthalmological or neurological etiologies were apparent. A mucocele of the right posterior ethmoid sinus was observed with radiology. After the marsupialization of the mucocele via a transnasal endoscopic approach, the patient's symptoms (oculomotor nerve paralysis and headache) resolved in 4 weeks. Oculomotor paralysis is a rare symptom of an ethmoidal mucocele. In this article, we report this rare case along with a literature review.
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Siu A, Singh A, Roberti F. Rapid improvement of cranial neuropathies after endoscopic resection of sphenoid sinus mucocele. SKULL BASE REPORTS 2011; 1:23-6. [PMID: 23984198 PMCID: PMC3743591 DOI: 10.1055/s-0031-1275249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 09/15/2010] [Indexed: 11/04/2022]
Abstract
Sinus mucoceles are benign, slowly enlarging, mucous-secreting, cystic lesions whose expansile growth may lead to compressive neuropathies. We present the case of a 70-year-old woman with a long-standing history of headaches and progressive ocular neuropathy who underwent an endoscopic resection of a large sphenoid sinus mucocele resulting in immediate improvement of her neurological symptoms. The endoscopic endonasal transsphenoidal approach offers a minimally invasive method to manage and treat symptomatic sinus mucoceles.
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Affiliation(s)
- Alan Siu
- Department of Neurological Surgery, George Washington University, Washington, District of Columbia
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Isolated sphenoid sinus disease: differential diagnosis and management. Curr Opin Otolaryngol Head Neck Surg 2011; 19:16-20. [PMID: 21178620 DOI: 10.1097/moo.0b013e32834251d6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the current literature on isolated disease of sphenoid sinus, and to describe the various approaches to the sphenoid sinus. RECENT FINDINGS Due to its posterior location and subtle presenting symptoms, sphenoid lesions, in the past, have often been missed and were reported as rare occurrences. However, with the availability of current diagnostic modalities such as endoscopy and imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), diseases of the sphenoid sinus are now more frequently diagnosed. Since the introduction of endoscopic techniques in the mid 1980s, various endoscopic approaches to the sphenoid sinus, depending on the extent and type of disease, have been described. These approaches were subsequently 'extended' to remove pituitary tumours, and certain diseases of the parasellar region and the petrous apex. More recently, further extension of these approaches has led to the development of endoscopic skull base surgery, using the sphenoid sinus as the 'gateway' to the anterior, middle and the posterior cranial fossa. These approaches require a clear understanding of the anatomy of the sphenoid sinus and its surrounding regions. SUMMARY This paper presents a review of the various diseases of the sphenoid sinus and describes the approaches to the sinus with special emphasis on the transpterygoid approach to the lateral recess of the sphenoid sinus.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2011; 19:58-65. [PMID: 21233627 DOI: 10.1097/moo.0b013e32834344aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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