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Bijou W, Oukessou Y, Larhrabli I, Rouadi S, Abada R, Mahtar M. A rare case of headache in a 4-year-old child: sphenoiditis. Childs Nerv Syst 2023; 39:1357-1360. [PMID: 36705688 DOI: 10.1007/s00381-022-05820-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/28/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Isolated sphenoidal sinusitis is an uncommon cause of headaches in children and adolescents. Recognizing the condition on physical examination alone can be challenging, and delayed diagnosis often occurs. CASE PRESENTATION A 4-year-old child presented with symptoms of headache, fever, and vomiting. Nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) were used to confirm the diagnosis of isolated sphenoiditis. The patient was treated with antibiotics and steroids. However, the patient developed meningoencephalitis as a complication of the untreated isolated sphenoiditis. CONCLUSION Isolated sphenoidal sinusitis can lead to serious complications if left untreated. Adjunctive imaging and prompt treatment are essential to prevent such complications in children and adolescents. This case highlights the importance of considering isolated sphenoiditis in the differential diagnosis of pediatric headaches and the need for early diagnosis and treatment.
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Affiliation(s)
- Walid Bijou
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco.
| | - Youssef Oukessou
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Ibtissam Larhrabli
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Sami Rouadi
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Reda Abada
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Mohammed Mahtar
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
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Clement WA, Sooby P, Doherty C, Qayyum N, Irwin G. Acute isolated sphenoid sinusitis in children: A case series and systematic review of the literature. Int J Pediatr Otorhinolaryngol 2021; 140:110492. [PMID: 33234332 DOI: 10.1016/j.ijporl.2020.110492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to present a case series and systematic review of acute isolated sphenoid sinusitis (AISS) in children in order to better characterize clinical presentation, diagnosis, treatment, and outcomes of this condition. DATA SOURCES Ovid MEDLINE, Pubmed, Embase, Cochrane Library, and Google Scholar. STUDY SELECTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text, peer-reviewed journal publications from 1994 to 2020 in English; focus on acute sphenoid sinusitis; pediatric patients (<18 years of age); series with two or more children. Studies were assessed for data including demographics, presenting symptoms and signs, radiological investigations, treatment, outcomes and complications. RESULTS Ten studies identifying 71 patients were included. Average age at presentation was 12.0 years (range 5-17 years). M:F ratio 1:1. The most common presenting symptoms were headache (98.6%), fever (50.7%), nasal symptoms (22.5%) ocular symptoms (19.7%) and decreased level of consciousness (12.7%). Twenty patients (28.1%) had neurological signs. Twenty-three patients (32.4%) presented with headache in isolation. Unsuspected diagnosis at presentation was noted in 54.0%. Average time to initial presentation was 14.0 days (median = 5.5 days, range 1-90 days). The majority of children were treated with antibiotics (98.6%) with 31.0%, 2.8% and 2.8% also undergoing sinus surgery, revision sinus surgery and neurosurgery, respectively. Intracranial complications occurred in 16.9% of patients. Significant long term sequelae occurred in 2 children (2.8%) and one death (1.4%) was also reported. LIMITATIONS All studies were retrospective case note reviews. CONCLUSIONS Acute sphenoid sinusitis is a rare and difficult condition to diagnose in children. The majority of patients make a full recovery with appropriate treatment. If treatment is delayed however consequences can be life-threatening.
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Affiliation(s)
- W A Clement
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom.
| | - P Sooby
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom
| | - C Doherty
- Department of Paediatric Infectious Diseases Immunology and Allergy, Royal Hospital for Children, Glasgow, United Kingdom
| | - N Qayyum
- Department of Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
| | - G Irwin
- Department of Paediatric Radiology, Royal Hospital for Children, Glasgow, United Kingdom
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An YH, Venkatraman G, DelGaudio JM. Isolated Inflammatory Sphenoid Sinus Disease: A Revisitation of Computed Tomography Indications based on Presenting Findings. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Isolated inflammatory sphenoid sinus disease (IISSD) can be difficult to diagnose. Frequently, history and physical are inadequate in establishing a diagnosis. Computed tomography (CT) is an excellent screening tool; however, it often is obtained late in the disease process because of vague symptoms at presentation. Identifying the most common presenting symptoms of IISSD may allow earlier detection and avoidance of more severe sequelae by determining earlier indications for CT. Presently, headache is not an indication for sinus CT. Methods A retrospective chart review of IISSD presentation was performed at our institution. A literature review was performed also to quantitatively document trends in presentation of IISSD, including characterization of headache symptoms by location. Cumulative findings were then compared with current CT indications to determine if presentation patterns warrant a change in indications for CT. Results A total of 361 cases were evaluated by our inclusion criteria. Headache was the most common finding (81.7%), particularly peri/retro-orbital, vertex, and frontal headache. Ocular changes (17.5%) and cranial nerve involvement (16.1%) were common also, but headache frequently was a solitary finding (42.6%). Twenty-six IISSD cases were reviewed at our institution over 7 years, with similar results. Under current guidelines, the only IISSD findings that are indications for CT scan are the ophthalmologic and neurological complications. Conclusion Not every headache necessitates a CT scan. However, the deep-seated vertex, frontal, and, particularly, peri/ retro-orbital headaches, especially when aggravated by head movement and refractory to analgesics, as is often seen in IISSD, should be an indication for CT evaluation. (American Journal of Rhinology 19, 627–632, 2005)
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Affiliation(s)
- Young H. An
- Department of Otolaryngology–Head and Neck Surgery, Emory Clinic, Atlanta, Georgia
| | - Giridhar Venkatraman
- Department of Otolaryngology–Head and Neck Surgery, Emory Clinic, Atlanta, Georgia
| | - John M. DelGaudio
- Department of Otolaryngology–Head and Neck Surgery, Emory Clinic, Atlanta, Georgia
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Caimmi D, Caimmi S, Labò E, Marseglia A, Pagella F, Castellazzi AM, Marseglia GL. Acute isolated sphenoid sinusitis in children. Am J Rhinol Allergy 2012; 25:e200-2. [PMID: 22185724 DOI: 10.2500/ajra.2011.25.3690] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Isolated pediatric sphenoidal sinusitis is an uncommon disorder with sphenoiditis more commonly found as part of pansinusitis. Recognizing the condition on history and examination alone is difficult and delayed diagnosis many occur in many cases. Nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) are essential adjuncts to confirm diagnosis. This study was designed to confirm the clinical features and diagnostic difficulties associated with isolated sphenoidal sinusitis in children. METHODS A 16-year review was performed of cases diagnosed and treated in a tertiary teaching hospital. RESULTS Two different groups of patients were identified. One group presented with fever and headache, frequently associated with neurological complications. Swimming and/or diving could be identified as possible causative agents. The second group presented with headache alone and a less severe clinical presentation. CONCLUSION Isolated pediatric sphenoidal sinusitis may be more prevalent than was previously thought with CT/MRI helping establish the diagnosis in many cases. Pediatricians should be aware of this unusual but still potentially devastating condition. A nasal endoscopy is a useful diagnostic tool in this patient group, being noninvasive and well tolerated in children and adolescents.
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Affiliation(s)
- Davide Caimmi
- Department of Pediatrics, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Parikh SR, Cuellar H, Sadoughi B, Aroniadis O, Fried MP. Indications for image-guidance in pediatric sinonasal surgery. Int J Pediatr Otorhinolaryngol 2009; 73:351-6. [PMID: 19157578 DOI: 10.1016/j.ijporl.2008.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 10/03/2008] [Accepted: 10/07/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the indications and safety of image-guidance for pediatric sinonasal surgery. METHODS A retrospective review was carried out of all patients undergoing image-guided sinus surgery using a single electromagnetic navigation system. All patients less than 18 years who underwent image-guided endoscopic sinus surgery over a 5-year period at a tertiary children's hospital were included. The means and ranges of age, preoperative setup time, gender distribution, and indications for surgery were determined. Operative time, anatomic regions explored, and intraoperative complications were also analyzed. RESULTS Thirty-three patients underwent image-guided surgery over a 5-year period. The mean age was 12 years, with 23 males and 10 females. Mean operative time and preoperative setup time was 128 and 43 min, respectively. Indications for surgery included chronic (30.3%) and acute (12.1%) rhinosinusitis, nasopharyngeal angiofibroma (9.1%), allergic rhinosinusitis (9.1%) and allergic fungal sinusitis (9.1%). CONCLUSIONS This series represents the largest collection of pediatric image-guided sinus surgery. In our population, image-guidance was only used for advanced sinonasal procedures where there was an anatomic abnormality or disease that extended to the sphenoid sinus, frontal sinus, orbit, or skull base. No complications were noted.
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Affiliation(s)
- Sanjay R Parikh
- Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, NY, USA.
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Laurens MB, Becker RM, Johnson JK, Wolf JS, Kotloff KL. MRSA with progression from otitis media and sphenoid sinusitis to clival osteomyelitis, pachymeningitis and abducens nerve palsy in an immunocompetent 10-year-old patient. Int J Pediatr Otorhinolaryngol 2008; 72:945-51. [PMID: 18472169 DOI: 10.1016/j.ijporl.2008.02.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 02/25/2008] [Accepted: 02/28/2008] [Indexed: 11/19/2022]
Abstract
A previously healthy 10-year-old patient with headache, otalgia, and hearing loss was diagnosed with pachymeningitis and methicillin-resistant Staphylococcus aureus otitis media and bacteremia. Despite antimicrobial therapy, intracranial extension progressed, including clival osteomyelitis, sphenoid sinusitis, cavernous sinus inflammation and cranial nerve palsies, until the sphenoid sinus was drained. This case exemplifies an aggressive MRSA intracranial infection that advanced despite antibiotic therapy.
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Affiliation(s)
- Matthew B Laurens
- Department of Pediatrics, Division of Infectious Disease and Tropical Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Strek P, Zagólski O, Składzień J, Oleś K, Konior M, Hydzik-Sobocińska K, Głowacki R. [Endoscopic surgical treatment of patients with isolated sphenoid sinus disease]. Otolaryngol Pol 2007; 61:254-9. [PMID: 17847777 DOI: 10.1016/s0030-6657(07)70422-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Cases of isolated lesions of the sphenoid sinus are rare. For descriptive purposes, clinicians divide them into inflammatory and non-inflammatory with prevalence of the former. Symptoms of the sphenoid sinus disease are difficult to characterise, the most common of them being vague headache and visual disturbances. Thorough preoperative evaluation of the lesion is essential - nasal endoscopy must be performed and computerised tomography or magnetic resonance imaging results analysed. The purpose of the study is to present the assessment of endoscopic surgery outcome in the own group of patients with isolated sphenoid disease. MATERIAL AND METHODS Clinical data of 22 subjects were analysed retrospectively. There were 5 patients with bacterial sinusitis, 6 with fungal sinusitis, 4 with allergic thickening of the mucous membrane with no evidence of bacterial or fungal infection, 2 with mucocele, 1 with sphenoid osteoma, 1 with inverted papilloma, 1 with a foreign body and 2 with cerebral fluid fistula. Each patient had preoperative nasal endoscopy and CT/MRI imaging performed. Then they underwent endoscopic transnasal sphenoethmoidectomy with removal of the lesion or closure of the fistula. The sphenoid sinus was approached through its front wall. RESULTS The patients' postoperative course was uneventful. They noted improvement in all preoperative symptoms, except for bilateral oculomotor nerve paralysis in one individual, and were asymptomatic to ophthalmological examination. CONCLUSIONS Isolated lesions of the sphenoid sinus, even very rare tumours like those presented here, can be in most cases safely approached and removed endoscopically. All risks of the method must be considered prior to the operation. High frequency of fungal sinusitis should be noted.
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Affiliation(s)
- Pawel Strek
- Katedra i Klinika Otolaryngologii Collegium Medicum UJ w Krakowie
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Preś K, Bochnia M, Rostkowska-Nadolska B, Jaworska M, Kubacka M, Jankowska-Konsur A, Fraczek M, Steinmetz-Beck A, Mazur M. [Sepsis in the sphenoiditis patient]. Otolaryngol Pol 2007; 61:192-4. [PMID: 17668809 DOI: 10.1016/s0030-6657(07)70412-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We present a case of sepsis caused by isolated sphenoiditis. MATERIAL AND METHOD The case being described concerns 61-year-old woman treated at the Department of Occupational Diseases of Wroclaw Medical University due to body temperature maintaining for 2 months at above 38 degrees C, leucocytosis reaching 14-16 thousand and weight loss of about 4 kg. Detailed diagnostics did not confirm the preliminary diagnosis of system or neoplastic disease. Bacteriological blood examination revealed the presence of staphylococcus aureus susceptible to Vancomycin and Tienam. The attempt of pharmacological treatment did not produced the expected effect. NMR examination of the facial skeleton proved partial shadowing of the Sphenoidal sinus. The patient was admitted for surgical treatment. After the sphenoidal sinus was cut open, mucopurulent contents was found inside. During microbiological examination, staphylococcus aureus with identical susceptibility was cultured from the mucopurulent contents. After 3-week guided antibiotic therapy, permanent temperature regression and permanent improvement of the patient's condition were achieved. RESULTS Surgical treatment combined with intensive antibiotic therapy caused the complete regression of symptoms. CONCLUSION Isolated sphenoiditis occurs rarely but it still is a serious diagnostic and therapeutic problem. Diagnosis delay and disease progress may lead to life-threatening complications.
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Babiński D, Brzoznowski W, Skorek A, Ostrowska A, Stankiewicz C. Zapalenie zatoki klinowej. Otolaryngol Pol 2007; 61:452-7. [DOI: 10.1016/s0030-6657(07)70460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Haloi AK, Ditchfield M, Maixner W. Mucocele of the sphenoid sinus. Pediatr Radiol 2006; 36:987-90. [PMID: 16802142 DOI: 10.1007/s00247-006-0243-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Revised: 04/21/2006] [Accepted: 05/04/2006] [Indexed: 11/26/2022]
Abstract
The sphenoid sinus is the least common site of mucocele of all paranasal sinuses. It is very rare in children, especially in those younger than 12 years when pneumatization of the sphenoid sinus is completed. We report a case of histologically proven sphenoidal mucocele in a 5-year-old child. The child presented with an acute onset of significant visual impairment and headache. His vision gradually improved after trans-nasal sphenoidotomy and drainage of the sinus content with return of complete normal baseline vision after 2 months.
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Affiliation(s)
- Achyut K Haloi
- Department of Medical Imaging, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, VIC 3052, Australia
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