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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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Doucet M, Farishta D, Abdulsattar J, Yim M. Sphenoid sinus cholesterol granulomas presenting with abducens nerve palsy. BMJ Case Rep 2022; 15:15/5/e243020. [PMID: 35537768 PMCID: PMC9092132 DOI: 10.1136/bcr-2021-243020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We discuss two patients who presented with sphenoid sinus cholesterol granulomas and associated unilateral abducens nerve palsies. Two case reports from our institution are reported. A literature review of available articles is presented, discussing both cholesterol granulomas of the sphenoid sinus and sphenoid sinus lesions that present with unilateral abducens palsy. A total of nine cases of sphenoid sinus cholesterol granulomas have been previously reported in the literature. A wide variety of sphenoid sinus pathologies can present with unilateral abducens nerve palsies, however no sphenoid sinus cholesterol granulomas with this presentation were found in the literature. In conclusion, cholesterol granulomas should be included in the differential when a patient presents with an expansile mass of the sphenoid sinus and associated unilateral abducens nerve palsy.
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Affiliation(s)
- Manon Doucet
- Otolaryngology, University of Louisville, Louisville, Kentucky, USA
| | - Daniel Farishta
- Otolaryngology, LSU Health Shreveport, Shreveport, Louisiana, USA
| | | | - Michael Yim
- Otolaryngology, LSU Health Shreveport, Shreveport, Louisiana, USA
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Numano Y, Nomura K, Sugawara M, Hemmi T, Suzuki J, Kakuta R, Katori Y. Sinonasal Inverted Papilloma Showing a Misleading Finding on Magnetic Resonance Imaging. EAR, NOSE & THROAT JOURNAL 2022:1455613221095614. [PMID: 35485578 DOI: 10.1177/01455613221095614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sinonasal inverted papilloma (IP) is the most common benign tumor in sinonasal cavities. Treatment involves excising the whole tumor, so it is essential to evaluate the extent of the tumor by preoperative radiographic findings. Magnetic resonance imaging (MRI) is superior to computed tomography (CT) for determining a tumor's location as MRI can discern the difference between mucus and IP. We herein report a 51-year-old man with sinonasal IP treated with endoscopic sinus surgery (ESS). Preoperative MRI showed findings resembling a convoluted cerebriform pattern on T2-weighted imaging, but this site was not enhanced by intravenous gadolinium at all. We preoperatively suspected that this site was not part of the tumor but rather the accumulation of mucus, and indeed, we found no tumor at this site when we performed the surgery. This patient is a valuable example of misleading findings of IP on T2-weighted imaging and underscores the importance of contrast-enhanced T1-weighted imaging to determine the extent of IP.
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Affiliation(s)
- Yuki Numano
- Department of Otolaryngology, 38185Tohoku Kosai Hospital, Sendai-shi, Miyagi, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, 38185Tohoku Kosai Hospital, Sendai-shi, Miyagi, Japan
| | - Mitsuru Sugawara
- Department of Otolaryngology, 38185Tohoku Kosai Hospital, Sendai-shi, Miyagi, Japan
| | - Tomotaka Hemmi
- Department of Otolaryngology, Head and Neck Surgery, 73819Tohoku University Hospital, Sendai-shi, Miyagi, Japan
| | - Jun Suzuki
- Department of Otolaryngology, Head and Neck Surgery, 73819Tohoku University Hospital, Sendai-shi, Miyagi, Japan
| | - Risako Kakuta
- Department of Otolaryngology, Head and Neck Surgery, 73819Tohoku University Hospital, Sendai-shi, Miyagi, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, 73819Tohoku University Hospital, Sendai-shi, Miyagi, Japan
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Peng Z, Wang Y, Fang Y, Wang Y, Chen X, Fan R, Zhang H, Xie Z, Jiang W. Precision Endonasal Endoscopic Surgery of the Frontal Recess Cells and Frontal Sinus Guided by the Natural Sinus Drainage Pathway. Front Surg 2022; 9:862178. [PMID: 35548182 PMCID: PMC9081679 DOI: 10.3389/fsurg.2022.862178] [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: 01/25/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background The endoscopic endonasal approach to removing lesions in the nasal cavity and sinuses has become the modern first choice. However, if endoscopic surgery is performed without proper knowledge of sinus anatomy, there is a risk of residual lesions, recurrence, and even serious complications. Therefore, this article illustrates the importance of precise sinus opening guided by the natural sinus drainage pathway, using the anatomy of the frontal sinus (FS) and the frontal recess (FR) cells as an example. Method A total of 82 sides cadaveric heads were dissected and analyzed, and the natural drainage pathways of the FR cells and FS were observed at 0°and 70°nasal endoscopic views, and the findings were summarized. The data of 79 patients who accepted endonasal endoscopic surgery (EES) guided by natural sinus drainage pathways to remove mucoceles in our department from January 2015 to January 2021 were retrospectively analyzed. Results Two natural drainage pathways of the FR cells were discovered, identified, and named the medial pathway of the FR (MPFR) and the lateral pathway of the FR (LPFR). The 79 patients who accepted EES to remove mucoceles through the natural drainage pathways of FR cells and the FS showed significant improvement in clinical symptoms, and none of them had recurrence after surgery without serious complications. Conclusion The EES of the FR cells and FS through the natural drainage pathways to remove the mucoceles facilitates exposure of the cells without residual lesions and without serious complications.
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Affiliation(s)
- Zhouying Peng
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Yumin Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Yan Fang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Yaxuan Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Ruohao Fan
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Hua Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Zhihai Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
- Zhihai Xie
| | - Weihong Jiang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Weihong Jiang
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Costa AF, Martínez A P, Peláez V N, Peral Q A, Estévez JC. Sphenoid sinus mucocele causing ptosis with pupil-spared ophthalmoplegia: a hint on carotid artery doppler ultrasound. Int J Neurosci 2021:1-3. [PMID: 34623197 DOI: 10.1080/00207454.2021.1990915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Sphenoid sinuses mucocele (SSM) is an uncommon cause of orbital apex syndrome (OAS). Diagnosis of neurological complications in SSM might be delayed when the expansion of mucocele beyond the sinuses is not evident in conventional sinuses imaging. METHODS We present a case of a 76-years old man with spared-pupil ophthalmoplegia associated with ptosis caused by a unilateral left SSM in which internal carotid artery Doppler ultrasound showed distal sub-occlusion waves pattern. RESULTS Sinus occupation was noted in the magnetic resonance imaging (MRI) and was further evaluated in computed tomography (CT) scan and MR angiography. Nor CT or MR angiography showed clear evidence of neighboring structures compression. Doppler ultrasound of internal carotid showed high-resistance waveforms and decreased wave velocities helping diagnosis. Structures compression was confirmed intra-operatively and the patient was discharged asymptomatic after sphenoid sinus drainage. CONCLUSION In this first report of carotid Doppler ultrasound findings in a patient with a neurological presentation of a sphenoid sinus mucocele, a high-resistance waveform of the internal carotid may help differentiate uncomplicated sinusitis from invasive mucocele.
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Affiliation(s)
- Aldo F Costa
- Department of Neurology, Universitary Hospital Reina Sofía, Córdoba, Spain
| | - Paula Martínez A
- Department of Neurology, Universitary Hospital Reina Sofía, Córdoba, Spain
| | - Nazaret Peláez V
- Department of Neurology, Universitary Hospital Reina Sofía, Córdoba, Spain
| | - Alejandro Peral Q
- Department of Neurology, Universitary Hospital Reina Sofía, Córdoba, Spain
| | - José C Estévez
- Department of Neurology, Universitary Hospital Reina Sofía, Córdoba, Spain
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Fieux M, Zaouche S, Pialat JB, Tringali S. Giant Sphenoidal Mucocele Revealed by Orbital Pain. Ann Neurol 2020; 89:619-620. [PMID: 33274498 DOI: 10.1002/ana.25984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Maxime Fieux
- Department of Otology, Oto-Neurosurgery, Head and Neck Surgery, Lyon Sud University Hospital, Lyon, France
| | - Sandra Zaouche
- Department of Otology, Oto-Neurosurgery, Head and Neck Surgery, Lyon Sud University Hospital, Lyon, France
| | - Jean-Baptiste Pialat
- Department of Medical Imaging, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Stephane Tringali
- Department of Otology, Oto-Neurosurgery, Head and Neck Surgery, Lyon Sud University Hospital, Lyon, France
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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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