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Rossi IR, Levinson J, Kuan EC, Tajudeen BA. Chronic Sphenoiditis With Deep Neck Space Extension: Case Report With Review of the Literature and Postulated Mechanisms for Extracranial Extension. Ear Nose Throat J 2024; 103:151-155. [PMID: 33470832 DOI: 10.1177/0145561321989453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Isolated primary sphenoid sinusitis is a rare occurrence, estimated to make up less than 3% of sinus infections. The posterior anatomic location of the sphenoid makes treatment challenging when it becomes infected. Complications involving intracranial extension to surrounding structures often result in cranial nerve deficits due to their proximity. A single case of chronic sphenoiditis with direct extracranial extension into the prevertebral space is reported with a discussion on clinical presentation, diagnosis, and management. A 46-year-old female patient with diffuse headaches radiating into the neck and throat was evaluated in the office. Computed tomography demonstrated sphenoiditis with direct extension into the prevertebral space. Imaging revealed a purported route of direct extension through the clinoid and directly into the clivus to form an abscess in the longus colli muscle. The patient underwent endoscopic surgical management including drainage of the prevertebral abscess and has since made a full recovery. This is the first reported case of direct extension of sphenoiditis into the prevertebral space. The findings highlight the importance of aggressive treatment of chronic sphenoid infections to prevent detrimental complications. Computed tomography imaging proved an advantageous imaging modality to demonstrate bony erosion and sinus tracts from the skull base to the deep neck space.
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Affiliation(s)
- Isolina R Rossi
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL, USA
| | - John Levinson
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL, USA
| | - Edward C Kuan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of California Irvine, CA, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL, USA
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2
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Larin RA, Mokeeva PP. [Methods of surgical treatment for isolated lesions of the sphenoid sinus]. Vestn Otorinolaringol 2023; 88:69-75. [PMID: 37970773 DOI: 10.17116/otorino20238805169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
This article presents an analytical review of scientific publications on the topic of surgical treatment of isolated lesions of the sphenoid sinus. The publications, research data presented in the RSCI database, PubMed in the period 1985-2021 are analyzed. The selection of the material was carried out according to the keywords: sphenoid sinus, isolated sphenoiditis, phenotypes of sphenoiditis, endoscopic sphenotomy, relapses of sphenoiditis, sphenoid sinus, isolated sphenoiditis, phenotypes of sphenoiditis.
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Affiliation(s)
- R A Larin
- Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | - P P Mokeeva
- Children's City Clinical Hospital No. 1 of Prioksky District of Nizhny Novgorod, Nizhny Novgorod, Russia
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Yanagisawa K, Christmas DA, Mirante JP, Yanagisawa E. Balloon dilation of the sphenoid sinus ostium for recurrent sphenoid sinusitis. Ear Nose Throat J 2016; 95:310-312. [PMID: 27551838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Ken Yanagisawa
- Section of Otolaryngology, Yale New Haven Hospital, Saint Raphael Campus, and the Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, USA
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Bolger WE, Brown CL, Church CA, Goldberg AN, Karanfilov B, Kuhn FA, Levine HL, Sillers MJ, Vaughan WC, Weiss RL. Safety and Outcomes of Balloon Catheter Sinusotomy: A Multicenter 24-Week Analysis in 115 Patients. Otolaryngol Head Neck Surg 2016; 137:10-20. [PMID: 17599558 DOI: 10.1016/j.otohns.2007.02.006] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 02/08/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE: The aim of this study was to further evaluate the safety and effectiveness of balloon catheter devices to dilate obstructed sinus ostia/perform sinusotomy. METHODS: Through a prospective, multicenter evaluation, safety was assessed by rate of adverse events, patency was determined by endoscopic examination, and sinus symptoms were determined by the Sino-Nasal Outcome Test (SNOT 20). RESULTS: At the conclusion of the 24-week analysis, endoscopy determined that the sinusotomy was patent in 80.5% (247 of 307) sinuses and nonpatent in 1.6% (5 of 307), and could not determine ostial patency status in 17.9% (55 of 307). Of the ostia visualized on endoscopy, 98% were patent (247 of 252), while 2% (5 of 252) were considered nonpatent. SNOT 20 scores showed consistent symptomatic improvement over baseline. Revision treatment was required in 3 sinuses (3 of 307 sinuses, 0.98%) in 3 patients (3 of 109 patients, 2.75%). CONCLUSION: Balloon catheter technology appears safe and effective in relieving ostial obstruction. Patients were pleased and indicated that they experienced symptomatic improvement.
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Affiliation(s)
- Ibrahim Ketenci
- Department of Otolaryngology, School of Medicine, Erciyes University, Kayseri, Turkey.
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Lop-Gros J, Gras-Cabrerizo JR, Bothe-González C, Montserrat-Gili JR, Sumarroca-Trouboul A, Massegur-Solench H. Fungus ball of the paranasal sinuses: Analysis of our serie of patients. Acta Otorrinolaringol Esp 2015; 67:220-5. [PMID: 26708329 DOI: 10.1016/j.otorri.2015.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The fungus ball is the most frequent type of fungal rhino-sinusitis. The objective of this study is to analyze the clinical and surgical features of our patients. METHODS Retrospective analysis of 35 patients with fungus ball treated in our centre between 2006 and 2014. RESULTS Mean age was 55 years old. 49% were men and 51% women. 75% involved the maxillary sinus, whereas 25% involved the sphenoid. 69% of our patients showed microcalcifications in the CT study. All the patients were surgically treated, with no cases of recurrence. CONCLUSIONS Clinical manifestations of fungus ball are non-specific, therefore endoscopy and image study are mandatory. The definitive diagnosis is made by histopathological study of the lesion. Endoscopic sinus surgery is the treatment of choice, with opening of the diseased sinus and complete removal of the fungus ball. The frequency of complications is very low. No oral or topical antimycotic treatments are necessary.
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Affiliation(s)
- Joan Lop-Gros
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España.
| | - Juan R Gras-Cabrerizo
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Carolina Bothe-González
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Juan R Montserrat-Gili
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Anna Sumarroca-Trouboul
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Humbert Massegur-Solench
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
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7
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Le CP, Valenzuela AA, Rosenberg M, Allen L, Palacios E. Sphenoid sinus dehiscence as a risk for visual consequences in an immunocompromised patient. J La State Med Soc 2014; 166:70-72. [PMID: 25075599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Isolated sphenoid sinus disease is a rare entity with severe and potentially life threatening sequela. Because of the proximity of the sinus to the orbit, anatomical defects within the surrounding bony structures can facilitate communication with orbital content, predisposing the patient to substantial visual consequences. We report a case of a 51-year-old immunocompromised male who presented with headache and gradual unilateral decreases in vision. Computed tomography revealed opacification of the left sphenoid sinus accompanied by unusual bony dehiscence of the proximal optic canal. Early recognition and treatment of sphenoid sinusitis requires urgent surgical intervention with delay of treatment potentially leading to irreversible blindness or other devastating consequences. Bony dehiscence of the sphenoid sinus overlying the optic nerve has only been found in 4% of cadavers. It is associated with increased risk of orbital complications and predicts a poor prognosis. Immediate intervention is particularly important in immunocompromised individuals who are at greater risk of these severe complications.
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Affiliation(s)
| | | | | | - Laveil Allen
- Department of Radiology at Tulane University School of Medicine
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8
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Hase T, Kurita H, Matsumoto E, Kuroda H, Hashimoto M, Shinoda S. [A case of cavernous sinus aspergillosis]. No Shinkei Geka 2013; 41:901-906. [PMID: 24091462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We reported a case of cavernous sinus aspergillosis. A 62-year-old man complained of trigeminal neuralgia in the right V1 region. Neurological examination on admission showed ptosis, loss of light reflex and ophthalmoplegia externa in the right side. MRI enhanced with gadolinium demonstrated sphenoid sinusitis and mass lesion in the right cavernous sinus. MRA revealed right internal carotid artery occlusion. An open biopsy using the extradural temporopolar approach was performed. Pus discharge was observed from the cavernous sinus and histological examination showed hypha of Aspergillus. With early voriconazole treatment, the patient had improvement in headache, ptosis and ophthalmoplegia externa. Cavernous sinus aspergillosis is often found after sphenoiditis. It results in invasion to an internal carotid artery and worsens the patient's prognosis by cerebral infarction, so early diagnosis and treatment are important. We should consider aspergillosis as one of the differential diagnoses of a mass in the cavernous sinus. The epidural approach to this lesion was available to obviate aspergillus dissemination into the medullary cavity.
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Affiliation(s)
- Tomomi Hase
- Department of Neurosurgery, International University of Health and Welfare Hospital
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Marquez M, Palacios E, Nguyen J, Neitzschman HR. Progressive blindness caused by an unusual sphenoid sinus dehiscence. Ear Nose Throat J 2013; 92:416-420. [PMID: 24057899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- Mariana Marquez
- Department of Radiology, Tulane University Hospital and Clinics, New Orleans, LA, USA
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Lin J, Ye Q, Zheng H, Shen F. [The management of 53 non-pituitary lesions in sphenoidal sinus by transnasal endoscopic surgery]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012; 26:928-930. [PMID: 23272494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the diagnosis and management of non-pituitary lesions in sphenoidal sinus. METHOD All cases with non-pituitary lesions in sphenoidal sinus were confirmed by CT scan. Eight cases with localized lesions underwent operation by trans-sphenoidal approach. Two cases with juvenile nasopharyngeal angiofibroma with invasion to the sphenoid sinus were treated by trans-septal approach. The rest received operation by trans-superior meatal or trans-ethmoidal approach. RESULT Forty-five of these cases underwent complete or major resection of the lesion by endoscopic sphenoid sinus surgery, including 23 cyst and pus cyst of sphenoidal sinus, 8 fungal sphenoid sinusitis, 2 bleeding polyp of sphenoidal sinus, 1 post- hypophysectomy granulation hyperplasia of sphenoidal sinus , 5 papilloma of sphenoid sinus, 1 cerebrospinal rhinorrhea of sphenoid sinus, 2 ossified fibroma of sphenoid sinus,2 juvenile nasopharyngeal angiofibroma with invasion to the sphenoid sinus, 1 meningioma of ethmoid and sphenoid sinus. Three cases with hematoma in sphenoidal sinus and pseudoaneurysm in internal carotid artery underwent nasal endoscopic examination, and the diagnosis was established by DSA, and they received interventional therapy. Three cases with malignancy of sphenoidal sinus received major mass resection of sphenoidal sinus by trans-ethmoidal approach, and followed with radio therapy and chemotherapy. Two cases with NPC involving sphenoidal sinus were treated by radio therapy and chemotherapy after pathological examination. CONCLUSION Headache and visual loss were two common symptoms for the lesions in sphenoidal sinus. Imaging study including CT, MRI and DSA is very important for the diagnosis of the lesions in sphenoidal sinus. There are various surgical pathways to deal with sphenoidal sinus diseases under nasal endoscope. The operation will be direct, safe and minimal invasive if we choose the pathway properly.
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Affiliation(s)
- Juan Lin
- Department of Otolaryngology, the Provincial Hospital of Fujian Medical University, Fuzhou, 350001, China
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11
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Christmas DA, Mirante JP, Yanagisawa E. Endoscopic view of sphenoid sinusitis adjacent to an intracranial aneurysm. Ear Nose Throat J 2012; 91:E33-E34. [PMID: 22829045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Dewey A Christmas
- Department of Otolaryngology, Halifax Medical Center, Daytona Beach, FL, USA
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12
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[The giant fungal body in the sphenoidal sinus and the destruction of the skull base]. Vestn Otorinolaringol 2012;:96-8. [PMID: 22951699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of the present study was to estimate the efficacy of the optical systems with the variable visual field angle applied for the endoscopic interventions on the paranasal sinuses. The authors report a clinical observation of the patient presenting with the giant fungal body in the sphenoidal sinus responsible for the partial destruction of the bone canal of the optic nerve and the internal carotid artery. The patient was treated by endoscopic shenoidotomy through the paraseptal approach with the use of a sinuscope with the variable visual field angle. It was shown that the use of optical devices with the variable visual field angle makes it possible to significantly reduce the duration of the surgical intervention, facilitates orientation in the difficult-of-access regions , and ensures adequate control during the removal of neoplasms at the basis of the skull.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Lee JH. Bilateral sphenoid fungal sinusitis. Ear Nose Throat J 2011; 90:E28. [PMID: 21792789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Jae Hoon Lee
- Department of Otolaryngology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Chonbuk, South Korea
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Ai D, Huang J, Zhang H, Huang M, Chen M, Gao L. [The diagnosis and management of isolated sphenoiditis in children]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011; 25:627-629. [PMID: 22032118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Analyzing the clinical manifestation, diagnosis and management of isolated sphenoiditis in children, retrospectively, was to get more information of the disease and to supply correct treatment early. METHOD The symptoms, signs and imaging data of seventeen cases with isolated sphenoiditis hospitalized in our department from June 2001 to January 2010 were analyzed retrospectively. RESULT Nine out of seventeen patients had the chief complaint of headache, three patients had blood in nasal discharge and had a fever, and five patients had postnasal drip with headache and a slight fever. The disease lasted for three months to one year. Five patients showed nasal discharge in rhinologic examination, one patient had solitary polyps in sphenoethmoid recess, eight patients had adenoid hypertrophy and the last three patients showed no positive signs. CT scan or MRI revealed opacification in sphenoid sinus. Eight patients received normative antibiotic therapy and were cured. The rest nine patients received endoscopic sinus surgery. The complaints relieved after the surgery and there was no signs of recurrence in 1 to 5 years of follow-up. CONCLUSION Headache can be the chief and unique symptom of isolated sphenoiditis in children, which was easy to misdiagnose and miss diagnosis. CT or MRI was the evidence of diagnosis. Antibiotic therapy could be used for acute sphenoiditis. Patients with chronic sphenoiditis should receive endoscopic sinus surgery as early as better. From supraturbinal to sphenoid sinus natural ostia is the best way in sphenoidotomy.
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Affiliation(s)
- Dongliang Ai
- Department of Otolaryngology, Chinese Medicine Hospital of Jiexi, Jieyang 515400, China.
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Kaya S, Yavuz I, Cobanoğlu U, Ural A, Yılmaz G, Köksal I. [Fatal sino-orbital aspergillosis in an immunocompetent case]. MIKROBIYOL BUL 2011; 45:546-552. [PMID: 21935789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The paranasal sinus infections caused by Aspergillus spp. are usually presented clinically with mild symptoms, however they may lead to invasive disease and mortality especially in immunocompromised individuals. In this report a fatal case of sino-orbital aspergillosis developed in an immunocompetent patient has been presented. Seventy-four years old female patient was admitted to the hospital with the complaints of fever and progressively increasing headache that continued for 15 days. Due to the development of nausea, vomiting, loss of consciousness and stiff neck in the following days, cerebrospinal fluid (CSF) sample was obtained. Direct microscopic examination of the Gram and acidfast staining of the CSF sample revealed no microorganisms, no growth was detected in CSF culture and PCR amplification was negative for Herpes simplex virus and Mycobacterium tuberculosis. Since no response was achieved by empirical ceftriaxone, ampicillin and conventional anti-tuberculosis treatment and tachypnea, proptosis and progressive respiratory failure developed in the patient, she was transferred to the intensive care unit. The radiological examination revealed soft tissue lesion filling the sphenoid sinus, extending to the nasal cavity and suprasellar cistern, destruction of bones, dilated orbital vein, cavernous sinus thrombosis and infarction on left cerebral peduncule. Patient was operated and pus and fungus ball were aspirated from the openings of both sphenoid sinuses. Gomori methenamine silver, periodic acid-Schiff and haematoxylin-eosine staining of the operational material exhibited dichotomously branching hyphae. The patient was diagnosed as invasive sino-orbital aspergillosis based on the clinical, radiological and histopathological findings. Despite antifungal therapy and surgical debridement, the patient died. It should always be kept in mind that aspergillosis can develop in immuncompetent individuals. Delay in diagnosis and treatment may lead to fatality. Thus multidiciplinary approach is necessary for early diagnosis and successful treatment of aspergillus infections.
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Affiliation(s)
- Selçuk Kaya
- Karadeniz Technical University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey.
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Farboud A, Trinidade A, Shakeel M, Rajapaksa S, Hanif J. Unilateral blindness secondary to acute sphenoid sinusitis. B-ENT 2011; 7:47-49. [PMID: 21563557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVES To highlight a rare scenario where a delay in diagnosis caused unilateral blindness. CASE REPORT A 45-year-old Aboriginal woman with a history of non-Hodgkin's lymphoma presented with a severe left-sided headache, pyrexia and positive blood cultures. Following admission, the patient rapidly developed unilateral blindness, but did not inform her physician until 21 hours after onset. High-resolution CT scanning of the sinuses showed erosion of the bony covering of the optic nerve. Sinus surgery was performed. RESULTS Despite the discovery of pus under considerable pressure, and clearing the sphenoid sinus of pus and debris, vision was not restored, even at 2-month follow-up. CONCLUSIONS Two pathological processes are postulated here: that erosion of the bony optic canal allowed the optic nerve to be exposed, allowing the ensuing sinusitis to cause irreversible nerve ischemia, and immunosuppression meant the patient's immune response was inadequate to cope with the sinusitis, with devastating effects.
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Affiliation(s)
- A Farboud
- Royal Darwin Hospital, Darwin, Australia
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Bakker NA, Hoving EW. A rare case of sudden blindness due to a pituitary adenoma coincidentally infected with methicillin-resistant Staphylococcus aureus (MRSA). Acta Neurochir (Wien) 2010; 152:1079-80. [PMID: 19915791 PMCID: PMC2872010 DOI: 10.1007/s00701-009-0551-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 10/19/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Nicolaas A. Bakker
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Eelco W. Hoving
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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19
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Righini CA, Bing F, Bessou P, Boubagra K, Reyt E. An acute ischemic stroke secondary to sphenoid sinusitis. Ear Nose Throat J 2009; 88:E23-E28. [PMID: 19924653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Acute isolated sphenoid sinusitis is a relatively uncommon entity. Because its symptoms and clinical findings are nonspecific, it can be easily misdiagnosed. Left unrecognized and untreated, it can lead to several well-known and severe complications, including meningitis, cerebral abscess, cavernous sinus thrombosis, and epidural or subdural empyema. We report the case of a 28-year-old woman with acute sphenoid sinusitis complicated by ischemic stroke in the left caudate nucleus, lentiform nucleus, and posterior part of the internal capsule. The stroke was diagnosed on magnetic resonance imaging. Also, magnetic resonance angiography showed a narrowing of the internal carotid artery and a narrowing of the first part of the left anterior and middle cerebral arteries (A1 and M1 segments). The patient was treated with medical therapy, including antibiotics, and surgical drainage of the sphenoid sinus via an endoscopic approach. Her outcome was good, and she experienced minimal neurologic sequelae. We discuss the possible explanations for this rare complication.
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Affiliation(s)
- Christian Adrien Righini
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Michallon University Hospital, Grenoble, Cedex 09, France.
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Christmas DA, Mirante JP, Yanagisawa E. Endoscopic view of the carotid artery appearing as a sphenoid sinus mass. Ear Nose Throat J 2009; 88:1028-1029. [PMID: 19688710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Dewey A Christmas
- Department of Otolaryngology, University of South Florida College of Medicine, Tampa, FL, USA
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21
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Christmas DA, Mirante JP, Yanagisawa E. Endoscopic view of purulent sphenoid sinusitis. Ear Nose Throat J 2009; 88:766-767. [PMID: 19224473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Dewey A Christmas
- Department of Otolaryngology, University of South Florida College of Medicine, Tampa, FL, USA
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Ejdys R, Tywończuk-Szulc M, Kibiłda B, Bujnowski T. [Intracranial complications of sinusitis in patients of the otolaryngology Department of the regional hospital in Olsztyn treated between 2004-2007]. Otolaryngol Pol 2008; 62:415-21. [PMID: 18837215 DOI: 10.1016/s0030-6657(08)70283-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sinusitis is common disease. However intracranial complications of sinusitis are rare, but they are still a serious problem that results in high mortality. Diagnostic advantages of CT scanning and magnetic resonance imaging as well as therapeutic advantages of FESS prevent spread of complications. Patients with intracranial complications require surgery to remove the focus of infection from the sinuses and neurosurgical drain the abscess in some cases, with intensive antibiotic therapy. We presented three cases of intracranial complications treated by endoscopic sinus surgery connected with extranasal drain of frontal sinus. It is worth to emphasize the advantages of FESS over the external approaches as follows: the method treats the causative source of the disease, the morbidity is low, and it avoids facial cosmetic trauma.
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Affiliation(s)
- Robert Ejdys
- Oddział Otolaryngologiczny i Onkologii Laryngologicznej Wojewódzkiego Szpitala Specjalistycznego w Olsztynie
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Mark IHW, Tan HKK. Sphenoid mucocele after radiation for the treatment of nasopharyngeal carcinoma. J Otolaryngol Head Neck Surg 2008; 37:E28-E31. [PMID: 19133405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Ignatius Hon Wah Mark
- Department of Otolaryngology, Singapore General Hospital, Singapore, Republic of Singapore
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Abstract
BACKGROUND Isolated acute sphenoid sinusitis is an uncommon sinus infection, frequently misdiagnosed and not usually considered in the differential diagnosis of acute severe headache, with the potential of serious neurologic complications. OBJECTIVES To describe two patients with acute sphenoid sinusitis who presented with acute onset of severe headache and consider the role of surgical management. DESIGN Case report. SETTING Tertiary care hospital. RESULTS Patient 1 developed right cavernous sinus thrombosis and permanent visual loss in one eye, requiring sphenoidotomy following failure of medical treatment. Patient 2 experienced failure of the medical treatment. However, sphenoidotomy abated all his symptoms without any neurologic sequelae. CONCLUSION It is important to be aware of acute sphenoid sinusitis in the setting of new onset severe headache, when imaging studies are unrevealing for intracranial pathology. Considering the serious consequences of failed medical treatment vis-à-vis the safety and efficacy of sphenoidotomy we propose surgical intervention at the time of diagnosis.
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Affiliation(s)
- Markos Poulopoulos
- Department of Neurology, Hartford Hospital and University of Connecticut School of Medicine, 80 Seymour Street, Hartford, CT 06102-5037, USA
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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
OBJECTIVES We sought to examine the nature of fungal balls of the sphenoid sinus, in particular the exposure of adjacent skull base structures and the potential for surgical morbidity. METHODS We retrospectively reviewed our series of 17 cases of sphenoid sinus fungal balls seen between 1998 and 2005 with reference to their diagnosis, radiologic changes, histopathology, and surgical management. RESULTS Exposed structures included the pituitary fossa, cavernous sinus, and cavernous internal carotid artery, but this exposure did not result in an increase in perioperative complications. Sclerotic thickening of the sinus walls persisted, probably representing a chronic osteitis in response to concurrent bacterial infection. This appeared to be protective against further sinus wall erosions. Wall erosions did not heal. One patient demonstrated what appeared to be invasive fungal disease from a fungal ball. CONCLUSIONS Sphenoid sinus fungal balls can occur with minimal symptoms in a mainly elderly population and require surgical removal. Sphenoid sinus fungal balls have a low rate of operative morbidity and should be effectively managed by transnasal endoscopic sphenoidotomy alone.
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Affiliation(s)
- James Bowman
- Department of Otorhinolaryngology-Head and Neck Surgery, Greenslopes Private Hospital, Greenslopes, Australia
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28
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Wankhar B, Bapuraj JR, Gupta AK, Khandelwal N, Saxena AK, Batchala PP, Gandhi D. Chronic sphenoid sinusitis revisited: comparison of multidetector axial sections, multiplanar reconstructions, and virtual sinoscopy with endoscopic sinus surgery. ACTA ACUST UNITED AC 2007; 133:710-6. [PMID: 17638786 DOI: 10.1001/archotol.133.7.710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To assess the role of multidetector computed tomography (CT) and CT virtual sinoscopy in the evaluation of chronic sphenoid sinusitis and to compare the imaging findings with functional endoscopic sinus surgery. DESIGN Prospective study. SETTING Tertiary care teaching hospital. PATIENTS Thirty patients with chronic sphenoid sinusitis referred for preoperative CT. INTERVENTIONS Thin-section helical axial CT was performed using a multidetector CT scanner with multiplanar reformation (MPR) and volume-rendered or virtual sinoscopy images. Sixty sinuses were divided into quadrants for analysis. Extrasinus extension was labeled as the "fifth quadrant." MAIN OUTCOME MEASURES Imaging findings were compared with those of functional endoscopic sinus surgery, and accuracy of the imaging modality was determined. RESULTS Multidetector CT (axial CT and MPR) was found to be 100% sensitive, specific, and accurate in the evaluation of extent of sinusitis, status of the sinus septum, integrity of the optic nerve canal in relation to the sinus, and type of sinus pneumatization. Axial CT and MPR images showed sensitivity of 98% and specificity of 92% compared with functional endoscopic sinus surgery in evaluating the ostia. Regarding carotid canal integrity, axial CT and MPRs were 100% sensitive and 98% specific. Virtual sinoscopy showed sensitivity and specificity of 67% and 92%, respectively, for the 22 ostia that could be visualized and evaluated using this modality. CONCLUSIONS Axial multidetector CT with secondary MPRs provide the necessary preoperative information regarding extent of disease and sphenoid sinus anatomy. Virtual sinoscopy is a navigational aid, an adjunct to endoscopy, and an educational tool for surgeons-in-training.
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Affiliation(s)
- Baphiralyne Wankhar
- Division of Neuroradiology, Department of Radio-diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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29
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Fang KH, Chen CK, Hao SP. Acute visual loss in a head and neck cancer patient with ocular metastasis and sphenoid pyocele. Auris Nasus Larynx 2007; 34:569-71. [PMID: 17490836 DOI: 10.1016/j.anl.2007.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 12/25/2006] [Accepted: 02/10/2007] [Indexed: 11/16/2022]
Abstract
We report an extremely rare case of head and neck cancer patient with right acute visual loss by ocular metastasis after excluding compressive optic neuropathy by endoscopic decompression of the sphenoid pyocele. The ocular metastasis from head and neck cancer had been reported only once in English literatures. Besides, the patient combined with sphenoid pyocele increases the difficulty in differentiating the etiologies. In this article, we describe the history of this patient and discuss the possible cause of acute visual loss and the treatment strategy. Although to differentiate the etiology of acute visual loss between metastatic malignancy and compressive optic neuropathy remain difficult, treatment strategy should focus on rescuing visual acuity. Ocular metastases should always keep in mind when acute visual loss is encountered in patients with previously treated head and neck squamous cell carcinoma.
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MESH Headings
- Abscess/diagnosis
- Abscess/etiology
- Abscess/surgery
- Blindness/etiology
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/secondary
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Verrucous/diagnosis
- Carcinoma, Verrucous/radiotherapy
- Carcinoma, Verrucous/secondary
- Carcinoma, Verrucous/surgery
- Choroid Neoplasms/diagnosis
- Choroid Neoplasms/radiotherapy
- Choroid Neoplasms/secondary
- Decompression, Surgical
- Diagnosis, Differential
- Endoscopy
- Humans
- Laryngeal Neoplasms/diagnosis
- Laryngeal Neoplasms/surgery
- Laryngectomy
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Mouth Neoplasms/diagnosis
- Mouth Neoplasms/surgery
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/surgery
- Nerve Compression Syndromes/diagnosis
- Nerve Compression Syndromes/etiology
- Nerve Compression Syndromes/surgery
- Ophthalmoscopy
- Optic Nerve Diseases/diagnosis
- Optic Nerve Diseases/etiology
- Optic Nerve Diseases/surgery
- Otorhinolaryngologic Neoplasms/diagnosis
- Otorhinolaryngologic Neoplasms/surgery
- Palliative Care
- Postoperative Complications/diagnosis
- Postoperative Complications/etiology
- Postoperative Complications/radiotherapy
- Reoperation
- Sphenoid Sinusitis/diagnosis
- Sphenoid Sinusitis/etiology
- Sphenoid Sinusitis/surgery
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Affiliation(s)
- Ku-Hao Fang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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30
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Tomaç S, Turgut S. Orbital cellulitis and irreversible visual loss owing to acute sinusitis. ACTA ACUST UNITED AC 2007; 38:131-3. [PMID: 17416943 DOI: 10.1385/ao:38:2:131] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2002] [Revised: 11/30/1999] [Accepted: 07/15/2002] [Indexed: 11/11/2022]
Abstract
We report a case with orbital cellulitis and irreversible visual loss caused by asymptomatic acute sinusitis in a patient without symptoms or history of sinusitis. The prompt use of intravenous antibiotics in combination with early surgical drainage may prevent irreversible visual loss in the affected eye, and threatened visual loss in the fellow eye can be reduced.
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Affiliation(s)
- Sühan Tomaç
- Zonguldak Karaelmas University Faculty of Medicine, Department of Ophthalmology, Zonguldak, Turkey.
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Abstract
INTRODUCTION Computer-assisted surgery (CAS) has found widespread use in functional endonasal sinus surgery (FESS) over the past few years. The present study investigates if CAS leads to a better outcome in FESS. MATERIAL AND METHODS All patients who underwent endonasal sphenoethmoidectomy were enrolled in a prospective, non-randomized study. The procedures were done without CAS (group A) in 2003 and in 2004 with CAS (group B), using a Stryker navigation unit. 62 patients (113 sphenoidectomies) were included in group A and 61 patients (109 sphenoidectomies) in group B. The underlying disease was recurrent chronic sinusitis or polyposis nasi in all patients except for inverted papilloma in one patient of group A and in two patients of group B. The follow-up period was 6 months. Preoperatively and at 6 months postoperatively, a CT-scan was obtained and symptom scores were assessed using a questionnaire. RESULTS No significant difference was found between group A and B with respect to symptom scores, and CT-scans preoperatively and at 6 months postoperatively. The operation strategy did not change by the introduction of CAS. The frontal sinus was entered in group A and B in 59% and 64%, respectively. All parameters significantly improved postoperatively, compared to the preoperative values. As far as complications are concerned, two anterior orbital injuries and one retrobulbar haematoma occurred in group A and one postoperative lacrimal stenosis in group B. CONCLUSIONS CAS does not lead to a better clinical outcome in FESS. Our data suggest that the rate of complications may be reduced using CAS. However, studies with a much larger number of patients would be necessary for a definite answer to this issue.
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Affiliation(s)
- E G Thomaser
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Hals- und Gesichtschirurgie Kantonsspital Liestal, Schweiz.
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32
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Erylmaz A, Dursun E, Saylam G, Göçer C, Dağli M, Korkmaz H. Endoscopic transnasal sphenoidotomy with or without ethmoidectomy. Kulak Burun Bogaz Ihtis Derg 2007; 17:90-5. [PMID: 17527060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES We evaluated endoscopic transnasal sphenoidotomy (ETNS) with or without ethmoidectomy in patients with inflammatory sphenoid sinus disease (ISSD). PATIENTS AND METHODS A retrospective review was conducted in 42 patients (17 males, 25 females; mean age 41 years; range 17 to 67 years) who underwent ETNS with (n=37) or without (n=5) ethmoidectomy for ISSD. The disase was staged according to our staging system based on computed tomography findings. RESULTS Postnasal drainage was the most common symptom (n=37, 88.1%). Chronic rhinosinusitis was accompanied by sinonasal polyps in 25 patients (59.5%). Five patients (11.9%) had isolated sphenoid disease and 16 patients (38.1%) had unilateral disease. Five patients (11.9%) had stage 1, 15 patients (35.7%) had stage 2, and 22 patients (52.4%) had stage 3 disease. Surgery involved 68 sides. Ethmoidectomy was used in 63 sides of 37 patients, eight of whom required a supplementary procedure. At least one complication was seen in eight patients (19%), including severe perioperative hemorrhage (n=2), early postoperative hemorrhage (n=2), minor injuries to the lamina papyracea (n=4), and synechiae (n=5). CONCLUSION In patients with isolated ISSD, the direct approach to the sphenoid sinus by ETNS without ethmoidectomy is a favorable technique, whereas ETNS with ethmoidectomy is necessary for patients with concurrent disease in other paranasal sinuses.
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Affiliation(s)
- Adil Erylmaz
- Department of Otolaryngology, Ankara Numune Hospital, Ankara, Turkey
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33
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Strek P, Zagólski O, Składzień J, Oleś K, Hydzik-Sobocińska K, Najdzionek D, Głowacki R. Endoskopowe leczenie chorych z wewnątrzczaszkowymi powikłaniami zapalenia zatok. Otolaryngol Pol 2007; 61:131-6. [PMID: 17668797 DOI: 10.1016/s0030-6657(07)70400-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Intracranial complications of sinusitis (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and current topic. Although they are nowadays relatively rare, prompt recognition of these disease states is important to prevent permanent neurological deficit or fatality. Infection may spread hematogenously or by direct extension. Patients with complications require surgery to remove the focus of infection from the sinuses and drain the abscess. Recently, endoscopic frontal and sphenoid sinus surgery has emerged as the preferred technique for the treatment of the most advanced and complicated chronic sinusitis. MATERIAL AND METHODS Records of 7 patients aged from 13 to 65 (mean 30.6) years treated in our department for intracranial complications between January 2002 and September 2006 were analysed retrospectively. The diagnosis of meningitis was established in 2 patients, in one case with accompanying bilateral oculomotor nerve palsy. Cavernous sinus thrombosis, frontal abscess with hemiplegia, cerebral oedema, bilateral oculomotor nerve palsy and retrobulbar optic nerve neuritis with blindness was diagnosed each in one individual. 5 endoscopic bilateral frontosphenoethmoidectomies and 2 endoscopic sphenoethmoidectomies were performed. In one case a frontosphenoethmoidectomy was combined with craniotomy. RESULTS All preoperative symptoms subsided in 4 operated individuals. Vision improved in the patient with bilateral retrobulbar optic nerve neuritis. In patients with hemiplegia and bilateral oculomotor nerve palsy the symptoms persisted. No complications of the surgery were observed. CONCLUSIONS Surgical treatment of the focus of infection in the sinuses can be accomplished endoscopically via an intranasal approach with less morbidity, easy identification of anatomical structures, physiological drainage of the sinuses and superior cosmetic effects.
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Affiliation(s)
- Paweł Strek
- Katedra i Klinika Otolaryngologii, Collegium Medicum UJ w Krakowie
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34
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Ma YX, Wang M, Yuan XP. [Diagnosis and endoscopic treatment of sphenoid mycetoma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2007; 42:11-3. [PMID: 17432349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To investigate the presenting symptoms and signs, endoscopic findings, imaging changes and the clinical outcomes of endoscopic surgery in 23 patients with sphenoid mycetoma. METHODS The clinical data and the follow-up results of endoscopic surgery in 23 patients with sphenoid mycetoma, between April 2001 and January 2006, were retrospectively analysed. RESULTS The study population included 15 women and 8 men with a median age of 52.7 years. Presenting symptoms included headache (13 cases, 57%) and bloody discharge (9 cases, 48%). The computed tomography scans showed high density shadow in all 23 cases, with 17 cases (74%) had plaque or cord shaped calcification. All patients were treated by endoscopic transnasal approach. No surgical complications were found. Follow-up ranged 3-18 months, all symptoms disappeared, except strabismus in one case after 7 months of operation. The mucosa in surgical cavity is good. CONCLUSIONS The most common clinical symptoms of sphenoid mycetoma are headache and bloody discharge. Computed tomography scan has great value for the diagnosis of sphenoid mycetoma. The minimal invasion and the good outcome are the main advantages of the endoscopic surgery.
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Affiliation(s)
- You-xiang Ma
- Department of Otorhinolaryngology, Beijing University People's Hospital, Beijing 100044, China.
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35
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Baumann A, Zimmerli S, Hausler R, Caversaccio M. Invasive sphenoidal aspergillosis: successful treatment with sphenoidotomy and voriconazole. ORL J Otorhinolaryngol Relat Spec 2006; 69:121-6. [PMID: 17159376 DOI: 10.1159/000097858] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 04/12/2006] [Indexed: 12/23/2022]
Abstract
Treatment of invasive sphenoidal aspergillosis is surgical, followed by antifungal therapy, mostly amphotericin B. To optimize the adjuvant antifungal treatment, which is often limited by severe side effects, the new triazole antifungal agent voriconazole with broad coverage of fungal pathogens including Aspergillus was investigated in a study of 4 patients with clinical, radiological and histological signs of invasive sphenoidal aspergillosis. They first underwent endoscopic sphenoidotomy with drainage and extraction of the fungal mass. Postoperatively, 2 patients were immediately treated with voriconazole. Two patients initially received amphotericin B; but this treatment had to be stopped because of acute renal toxicity. Finally, all patients were treated orally with 200 mg voriconazole twice a day for 12-14 weeks. After this combined treatment all patients were asymptomatic and there were no endoscopic or radiological signs of residual fungal disease. The only side effects were nausea in one and transient visual disturbances in 2 other patients. In the 4 patients presented and treated, voriconazole was shown to be effective and less toxic than amphotericin B in adjuvant treatment of invasive sphenoidal aspergillosis.
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Affiliation(s)
- Ariane Baumann
- Department of ENT, Head and Neck Surgery, University Hospital, Inselspital, Berne, Switzerland
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36
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Li J, Zhang X, Tang H, Bai Y. [Operation of chronic sphenoid sinusitis with endoscopic sinus surgery]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2006; 20:1070-1. [PMID: 17285970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To evaluate the method and treatment effect of endoscopic sinus surgery for chronic sphenoid sinusitis. METHOD Fifty cases, 84 sides of chronic sphenoid sinusitis patients were treated with endoscopic sinus surgery. RESULT In the follow-up of 6-12 months, 61 sides (72.62%) were cured; 13 sides (15.48%) were mended; 10 sides (11.90%) were ineffective; 74 sides were effective, the effectiveness rate were 88.10%. CONCLUSION Treatment with endoscopic sinus surgery is a safe, effective method with little pain for chronic sphenoid sinusitis.
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Affiliation(s)
- Jun Li
- Department of Otolaryngdogy-Head and Neck Surgery, Pepole's Hospital of Changzhi, Changzhin 046000, China.
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37
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Abstract
Streptococcus pneumonia and Haemophilus influenzae account for more than 50% of bacterial acute sinusitis. Isolated sphenoid sinusitis is a rare disease with potentially devastating complications such as cranial nerve involvement, brain abscess, and meningitis. It occurs at an incidence of about 2.7% of all sinus infections. There have been no previous reported cases of unilateral sphenoid sinusitis presenting as septicaemia in an otherwise healthy young immunocompetent adult.
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Affiliation(s)
- D Rimal
- James Paget Healthcare NHS Trust, Great Yarmouth, Norfolk, UK .
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38
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Shukla S, Keh SM, Andrews P, Saleh H. Isolated inflammatory sphenoiditis with multiple unilateral cranial nerve palsies. J Laryngol Otol 2006; 121:186-8. [PMID: 17078896 DOI: 10.1017/s0022215106003926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2006] [Indexed: 11/07/2022]
Abstract
Isolated sphenoidits is a rare entity that often presents with vague, non-specific symptoms. We present the case of a 36-year-old Middle Eastern man, who developed headache and a painful right eye. A diagnosis of acute sphenoiditis was made. Shortly afterwards, he developed diplopia due to isolated abducent nerve involvement. Within two months, the extent of cranial nerve involvement had increased to include cranial nerves II, III, and V. Subsequently, this was treated by functional endoscopic sinus surgical drainage and biopsy. Histology revealed inflammatory changes. The patient made a dramatic recovery post-operatively, with resolution in all symptoms.
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Affiliation(s)
- S Shukla
- Otorhinolaryngology Department, Charing Cross Hospital, London, UK.
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39
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Herrmann BW, White FV, Forsen JW. Visual loss in a child due to allergic fungal sinusitis of the sphenoid. Otolaryngol Head Neck Surg 2006; 135:328-9. [PMID: 16890093 DOI: 10.1016/j.otohns.2005.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Accepted: 04/13/2005] [Indexed: 10/24/2022]
Affiliation(s)
- Brian W Herrmann
- Departments of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Atlanta, GA, USA.
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40
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Chen YL, Lee LA, Lim KE. Surgical consideration to optic nerve protrusion according to sinus computed tomography. Otolaryngol Head Neck Surg 2006; 134:499-505. [PMID: 16500453 DOI: 10.1016/j.otohns.2005.10.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence of optic nerve protrusion (ONP) and its clinical indicators by using sinus computed tomography (CT) scan. STUDY DESIGN Sinus CT scans of 260 consecutive patients with chronic inflammatory sinus disease were reviewed. RESULTS The prevalence of ONP in our study population was 28%. Nineteen percent of the optic nerves protruded into the sphenoid sinuses including indentation of the sinus wall (12%) and coursing through the sphenoid sinus (8%). In the presence of contralateral ONP and/or ipsilateral anterior clinoid process pneumatization, the chance of ONP occurrence was significantly higher (both P < 0.01). They were reliable indicators of ONP (R(2) = 0.47, P < 0.01). CONCLUSIONS ONP is a common anatomic variation observed in patients with chronic inflammatory sinus disease. To reduce optic nerve damage in surgeries, the presence of ONP according to sinus CT scans and the intraoperative findings should be carefully evaluated. EBM RATING C-4.
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Affiliation(s)
- Ying-Lin Chen
- Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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41
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Limanskiĭ SS. [Cure of epilepsy after sanation of the paranasal sinuses]. Vestn Otorinolaringol 2006:74-5. [PMID: 17419514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Abstract
The rhinoplastic surgeon when faced with nasal sinusitis has traditionally delayed aesthetic treatment of the nose, referring the patient to the ear, nose, and throat consultant until complete resolution of the inflammatory condition. Often, under such a scenario, the patient found the ear, nose, and throat procedure to be a traumatic experience that discouraged further surgery of an aesthetic nature. The advent of functional endoscopic sinus surgery has significantly modified the management of paranasal sinus disorders. This minimally invasive, sophisticated procedure can easily be combined with rhinoplasty. More recently, an endoscopic approach has been advocated for management of the septum and lower/middle turbinates. The authors call this functional endoscopic nasal surgery. Functional endoscopic nasal surgery allows a clearer view of the operative field (septum and turbinates), a more accurate correction of nasal obstruction, and better control of bleeding. Thus, endoscopic techniques permit the treatment of functional and inflammatory nasal disorders in a single stage, along with aesthetic improvement. Only the patient with severe sinusitis is unsuitable for combined therapy. The authors present their experience based on 72 consecutive cases of combined functional endoscopic sinus surgery/functional endoscopic nasal surgery with aesthetic rhinoplasty. Complications were minimal and functional failures were limited to 4 percent, whereas aesthetic outcomes remained uncompromised.
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Affiliation(s)
- Ricardo F Mazzola
- Ear, Nose, and Throat Department, Section of Plastic Surgery, Policlinic Hospital, University of Milan, Milan, Italy.
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43
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Abstract
Extensive functional endoscopic sinus surgery (FESS) was assessed retrospectively from the viewpoint of out-patients on the basis of their responses to a postal questionnaire, particularly in the Tokyo metropolitan area. Seventeen patients were included in this study (six females and 11 males) with an age range of 22-70 years. All the patients had at least ethmoid sinusitis. Additionally, some patients had maxillary or sphenoid sinusitis or polyps obstructing the nasal cavities. The average operation time and blood loss were 36 minutes and 31 ml, respectively. Four patients had to travel more than one hour to reach home. All of them used the train for travelling to and from the hospital. 'Doctors' advice' was the most common reason for the decision to undergo this ambulatory surgery. Nine (53 per cent) had some unexpected problems post-operatively. The establishment of a care pathway may improve the outcome of extensive FESS on an out-patient basis.
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Affiliation(s)
- Yoh-Ichiro Maeda
- Department of Otolaryngology-Head and Neck Surgery, Toshiba Hospital, Tokyo 140-8522, Japan
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Kazkayasi M, Karadeniz Y, Arikan OK. Anatomic variations of the sphenoid sinus on computed tomography. Rhinology 2005; 43:109-14. [PMID: 16008065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Anatomic variations of the vital structures adjacent to the sphenoid sinus can be jeopardized during functional endoscopic sinus surgery (FESS). The knowledge of the size and extent of pneumatization of the sphenoid sinus (SS) is an important condition for adequate surgical treatment of its disease. The bony anatomic variations of SS as well as its relationship with adjacent vital structures were reviewed in this paper. The study was performed on 267 patients with a complaint of chronic or recurrent sinusitis. Computed tomographic (CT) scans were obtained upon completion of therapy. The evaluations of the sphenoid sinuses were regarded separately, so as 534 sides were examined. Especially bony anatomic variations as well as mucosal abnormalities of the sphenoid sinuses were examined. Pneumatization of the pterygoid process and anterior clinoid process were found in 39.7% and 17.2% of the patients respectively. Vidian canal protrusion was found in a total of 158 sides of which 60 were bilateral. These entities were encountered usually when pneumatization of the pterygoid process occurred. Carotid canal and optic canal protrusions were found in 5.2% and 4.1% of the patients respectively. Mucosal thickening, and polyps or cysts of sphenoid sinuses were detected in 20.6% and 4.5% of the patients respectively. There was a statistically significant correlation between pterygoid pneumatization and vidian canal protrusion (p < 0.001), and vs. foramen rotundum protusion (p = 0.004). While the optic canal protrusion was found significantly associated with the anterior clinoid pneumatization (p < 0.001), there was no statistically significant correlation between a carotid canal protrusion and anterior clinoid pneumatization (p = 0.250). Sphenoid sinus surgery is very risky, because of changing variations of the cavity. We are in the opinion that detailed data from CT scans of SS will enable the surgeon to interpret any anatomic variations and pathological conditions before initiation of the surgical therapy.
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Affiliation(s)
- Mustafa Kazkayasi
- Department of ORL & HNS, School of Medicine, University of Kirikkale, Turkey.
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Dinis PB, Martins ML, Subtil J. Does Helicobacter pylori play a role in upper respiratory tract inflammation? A case report. Ear Nose Throat J 2005; 84:238-40. [PMID: 15929324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Persistent isolated inflammation of the sphenoid sinus, an entity that is not diagnosed very often, poses a challenge to clinicians and researchers alike. Its features tend to suggest that its etiopathogenesis is different from that of more common forms of chronic rhinosinusitis. We report the case of a 54-year-old woman who had a history of distressing chronic postnasal drip and a globus sensation with opacification of the sphenoid sinus. She was diagnosed with gastroesophageal reflux, and Helicobacter pylori was detected in her gastric contents and in the inflamed mucosa of the sphenoid sinus, as well. Complete symptom relief was achieved only after she had undergone surgical sphenoidotomy and treatment with anti-H pylori medication. We discuss the potential for this ubiquitous gastric bacterium to play a role in at least some forms of chronic sinonasal inflammation.
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47
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Abstract
Fulminant-invasive sinus aspergillosis affects immunocompromised patients and is usually lethal because of intracranial complications. Chronic-invasive and non-invasive types occur in non-immunocompromised patients. In these cases, intracranial extension is possible and life-threatening. The effective management of sinus aspergillosis requires early diagnosis by CT and histological classification, surgery, and if necessary, chemotherapy or steroids in case of allergy. Here we report a successfully treated case in a 29-year-old non-immunocompromised patient with chronic-invasive sinus aspergillosis. He presented a recurrent sphenoid sinus aspergillosis with destruction of the clivus and ophthalmoplegia. Diagnostic and therapeutic procedures are described.
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Affiliation(s)
- S Wenzel
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde des Universitätsklinikum Hamburg-Eppendorf.
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48
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Abstract
Recurrent meningitis due to Escherichia coli is an extremely rare infection in adult patients. Most cases have been complications of neurosurgery. We report on the case of a 43-y-old man with 4 recurrent spontaneous episodes of E. coli meningitis related to aspergillar sphenoidal sinusitis. Surgical treatment of sinusitis cured the patient.
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Affiliation(s)
- Amelie Passeron
- Department de Médecine Interne, Hôpital Européen Georges Pompidou, Paris, France.
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Wan B, Ma W, Zhang W, Shi B, Wang G, Ma H, Xie W. [Endoscopic transnasal approach in surgical treatment of ethmoid sphenoid diseases]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2004; 18:611-2. [PMID: 15620143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To study the surgical experience of endoscopic sinus surgery for the patients with sphenoid sinus disease. METHOD Twenty-one patients of sphenoid sinus diseases were treated with endoscopy by nasal cavity and sphenoid sinus. RESULT During 3 months to four years following up, 20 patients were free from disease postoperatively, 1 patient underwent reoperation because of recurrence. CONCLUSION Nasal endoscope provide the clear visual field, and operation under nasal endoscope could less pain and minimize injury to normal tissue. Transnasal-sphenoidal endoscopic sinus surgery under local anesthesia seems to be a safe and valuable way.
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Affiliation(s)
- Baoluo Wan
- Department of Otolaryngology, People's Hospital of Henan Province, Zhengzhou, 450003, China
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50
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Tan HKK, Ong YK. Acute isolated sphenoid sinusitis. Ann Acad Med Singap 2004; 33:656-9. [PMID: 15531965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Acute isolated sphenoid sinusitis is seen in fewer than 3% of all cases of sinusitis. It is frequently misdiagnosed because of its vague symptoms and the paucity of clinical findings. We report 2 cases of isolated acute isolated sphenoid sinusitis with unusual presentations. CLINICAL PICTURE Both patients presented with acute headache, eye pain and fever, and were provisionally diagnosed as meningitis. In 1 case, the symptoms were on the contralateral side of the sphenoid infection. Intracranial complications were also present. TREATMENT Treatment included intravenous antibiotics and endoscopic sphenoidotomy. OUTCOME Both patients recovered with no residual neurological disability. CONCLUSION Acute sphenoiditis usually presents with subtle symptoms and elusive physical findings and hence a high index of suspicion is necessary. Complications may arise due to the close proximity of important structures to the sphenoid sinus. Uncomplicated cases can resolve with optimal antibiotic therapy if diagnosed and treated early. Persistence or progression of disease with development of intracranial complications are indications for immediate surgical drainage.
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Affiliation(s)
- H K K Tan
- Otolaryngology Service, Division of Pediatric Surgery, KK Women and Children's Hospital, Singapore.
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