Sphenoid sinus surgery

Sphenoid sinus surgery due to specific localization is placed in otolaryngologists and neurosurgeons field of interest. Surgery of this area, from one side, causes number of problems, which usually arise due to close neighbourhood of important structures, but on the other, serves as alternative approach, eliminating necessity of extended operations with craniotomies. The article summarizes results of sphenoid sinus surgery at ENT Department, University of Medical Sciences in Poznan between 1990 and 2003, as well as points out characteristic features of the surgery in this specific localization.     

Sphenoid sinus mucoceles

Mucoceles of the sphenoid or posterior ethmoid sinuses usually behave in a similar manner. Because of the thinness of surrounding bone and the proximity of vital structures, these lesions can expand aggressively at a clinically alarming rate. Presenting symptoms vary but characteristically include headache and ocular disturbance. Careful radiologic evaluation helps in the correct assessment of these lesions. The authors feel that the rhinologic approach to the sphenoid cavity, via an external ethmoidotomy, affords the best visualization possible of the diseased area without entailing possibly serious central nervous system complications. Six cases are discussed from the standpoint of presenting signs and symptoms, radiologic assessment, therapy and outcome.     

Sphenoid sinus mucocele

Sphenoid sinus mucocele is a rare entity that can occur alone or as a result of ethmoid sinusitis and polyposis. A myriad of presentations is possible due to the presence of important contiguous neurologic and vascular structures. Past surgical approaches to the sphenoid sinus have problems associated with them. The endoscopic sinus technique offers outstanding visualization and a safe, straight-forward approach to the sphenoid sinus. Four patients with documented mucocele of the sphenoid sinus were treated successfully with endoscopic sinus surgery. The technique involves partial removal of the inferior middle turbinate and direct entrance into the sphenoid sinus through the anterior sinus wall. Other sinus abnormalities can be treated simultaneously as required. Sphenoid sinus mucocele is discussed from the standpoint of cause, clinical presentation, and treatment options.     

Sphenoid sinus revisited

J. H. Maxwell, M.D., in 1959 presented a paper on, “The Diagnosis of Chronic Inflammatory Lesions of the Sphenoid Sinus.” In that paper he reviewed chronic inflammatory lesions of the sphenoid sinus and demonstrated through means of case presentations various techniques required for proper diagnosis. During the past five years at the Geisinger Medical Center some interesting noninflammatory lesions of the sphenoid sinuses have been observed and will be reviewed. The symptoms of these sphenoid sinus lesions are usually related to abnormalities of the orbit and/or nasal passages. Cerebrospinal fluid rhinorrhea and meningitis may be present. Pain, when present, is generally not as severe as that described in inflammatory lesions, but is still localized in a similar manner. The diagnosis of sphenoid sinus disease may be suspected on the history and x-rays of the paranasal sinuses. Poytomography and computerized tomography scanning have aided markedly in the identification of the sphenoid lesions. Surgery in these cases included either a transnnsal or sublabial transseptal approach to the sphenoid sinus and is recommended as a method to gain access to this rather obscure area.     

Sphenoid sinus fungal balls

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.     

真菌球型真菌性鼻-鼻窦炎55例临床分析

目的:探讨真菌球型真菌性鼻-鼻窦炎的发病原因、鼻内镜手术方法及临床疗效。方法:回顾性分析55例真菌球型真菌性鼻-鼻窦炎患者的临床资料。结果:全部患者经鼻内镜手术治疗均获临床治愈,无一例出现手术并发症。随访6个月～2年,复发2例。结论:鼻腔、鼻窦局部解剖异常和局部创伤史是真菌球型真菌性鼻-鼻窦炎患者患病的主要原因。鼻内镜手术是治疗真菌球型真菌性鼻-鼻窦炎的有效手段。术后复发与术后是否定期冲洗窦腔有关。     

Paranasal sinus fungus ball and surgery: a review of 175 cases

OBJECTIVE: To analyze the surgical results after Functional Endoscopic Sinus Surgery (FESS) in patients with paranasal sinus fungus ball. MATERIAL AND METHODS: Retrospective analysis of the results of FESS performed in 175 patients suffering from paranasal sinus fungus balls. RESULTS: All maxillary (n = 150), sphenoidal (n = 20), and ethmoidal (n = 4) locations have been treated exclusively by FESS to obtain a wide opening of the affected sinuses, allowing a careful extraction of all fungal material without removal of the inflamed mucous membrane. No major complication occurred. Postoperative care was reduced to nasal lavage with topical steroids for 3 to 6 weeks. Only 1 case of local failure have been observed (maxillary sinus, n = 1), and 6 cases of persisting of fungus ball (maxillary sinus, n = 4; frontal sinus, n = 2) with a mean follow-up of 5 years. No medical treatment (antibiotic, antifungal) was required. CONCLUSION: Surgical treatment of a fungus ball consists in opening the infected sinus cavity at the level of its ostium and removing fungal concretions while sparing the normal mucosa. No antifungal therapy is required. Finally, through this 175 patients study, FESS appears a reliable and safe surgical treatment with a low morbidity.     

不同类型蝶窦开放治疗相关疾病

目的 提高对蝶窦开放术的认识,以选择合理术式治疗蝶窦及其相关疾病。方法 回顾分析于鼻内镜下行蝶窦开放术的患者42例的临床资料,其中行1型蝶窦开放术18例,相关疾病为细菌性蝶窦炎;2型蝶窦开放术19例,相关疾病为蝶窦真菌病、黏膜下囊肿及乳头状瘤;3型蝶窦开放术5例,相关疾病为蝶筛窦黏液囊肿、脑垂体瘤、岩尖胆脂瘤、岩尖胆固醇肉芽囊肿。结果 所有患者均治愈,随访半年至3年,无复发。其中1例脑垂体瘤患者术后出现脑脊液鼻漏,经保守治疗后治愈。结论 不同类型蝶窦开放不但可以治疗不同蝶窦疾病,还可作为经鼻内镜颅底手术的径路,均可获得良好效果。     

Sphenoid sinus barotrauma after free diving

We report 2 cases of a 29- and a 37-year-old male patient both having sphenoid sinus barotrauma associated with free diving at about 12-m depth. A unilateral occupation of the sphenoid sinus was revealed in both cases by computed tomography and magnetic resonance imaging examination of the paranasal sinuses.     

Sphenoid sinus development in choanal atresia

Objectives

To study the growth and size of the sphenoid sinuses in choanal atresia patients.

Study design

Case-control single blinded retrospective study.

Methods

Fifteen non-syndromic patients (ages 0-26 years old) were selected because they had at least one suitable CT scan (nine bilateral and 11 unilateral = total 20 scans). Twenty age-matched CT scans were used as controls. The following linear measurements were obtained: (1) fronto-zygomatic width, (2) zygomatic width, (3) width of the maxillary sinuses, (4) width of the sphenoid sinuses. Statistical analysis was performed with the exact permutation test in the framework of a parametric analysis of a randomized completed block.

Results

The width measurements of the choanal atresia CT scans did not show any statistically significant difference when compared to their control CT scans except for the zygomatic width in the bilateral choanal atresia patients. In the latter, the width was smaller (p = 0.03).

Conclusions

In unilateral and bilateral choanal atresia patients, there is normal growth of the width of the sphenoid sinuses.     

Sphenoid sinus barotrauma after scuba diving

We report the case of an 18-year-old male patient operated on for sphenoid sinus barotrauma after scuba diving. The patient attended our emergency department because of intractable headache but did not improve with conservative treatment. After computed tomography and magnetic resonance imaging examination, he was diagnosed with sphenoid sinusitis that extended to the nasal septum. He therefore underwent surgery for sinus ventilation and abscess drainage.     

Sphenoid sinus mucocele with unilateral blindness

Mucoceles of the sphenoid sinus are rare and may frequently remain undiagnosed until symptoms due to compression of surrounding structures set in. In such cases, the optic nerve, because of its close proximity to the sphenoid sinus, is at risk, and pressure exerted by the mucocele may result in visual impairment. A case of a sphenoid sinus mucocele with sudden-onset unilateral blindness as the only presenting symptom has been described. Early diagnosis and prompt surgical intervention enabled the vision to be restored completely.     

单侧上颌窦真菌球患者上颌窦解剖参数的CT研究

目的 探讨单侧上颌窦真菌球（UMFB）与上颌窦解剖参数的关系。方法 回顾性分析55例UMFB患者的鼻窦CT资料,应用Mimics 21.0软件对双侧上颌窦进行三维重建,同时测量计算患侧与健侧上颌窦的容积、表面积、气化系数、骨壁厚度及密度等解剖参数,并对得到的数据进行统计学分析。结果 ①UMFB患者的双侧上颌窦中,患侧上颌窦容积、内表面积、气化系数、上下径均较健侧小,差异具有统计学意义（P<0.05）,而左右径、前后径的差异无统计学意义（P>0.05）;患侧上颌窦骨壁厚度及密度均较健侧大,差异具有统计学意义（P<0.05）;②UMFB患侧上颌窦解剖参数与Lund-Mackay评分均无相关性（P>0.05）。结论 UMFB更好发于上颌窦容积、表面积、气化系数以及上下径较小的一侧。上颌窦骨壁厚度及密度增大对于诊断UMFB具有一定价值。     

功能性鼻内镜手术治疗真菌球性鼻窦病变

近年随着鼻内镜与CT的广泛应用，对鼻窦真菌球病变的诊断有了很大的提高。此病好发于上颌窦，其次为螺窦。1999年1月-2004年6月我们收治了32例鼻窦真菌球性病变的患者，现对此组病例进行回顾性分析。     

Sphenoid sinus paraganglioma: first reported case

Paragangliomas are uncommon tumors that present in the head and neck. Rarely, this benign tumor may occur in the nose and paranasal sinus. We report a case of paraganglioma involving the sphenoid sinus, discuss histologic characteristics, and review this tumor.     

Sphenoid sinus symmetry and differences between sexes

OBJECTIVES: To evaluate the anatomic variations of neurovascular structures adjacent to the sphenoid sinus and their agreement between right and left sides as well as differences between sexes. METHODS: Forty-five cadavers were dissected (24 men, and differences between sexes and agreement of anatomic variations of the sphenoid sinus between sides were analyzed. RESULTS: The mean distance from the sphenoid sinus ostium to the anterior nasal spine was greater in males than in females by an average of 3.0 mm (p = 0.001) while the mean difference of distances between the right and left side was -1.1 +/- 3.1 mm. Female cadavers had a greater frequency of optic-carotid recess (p = 0.04) and dehiscence over the maxillary nerve (p = 0.02), as well as greater relative risk of optic nerve protrusion (p < 0.001), and dehiscence over the internal carotid artery (ICA) (p = 0.002). In male cadavers the intersinus septum was inserted on the course of the ICA 3.5 times more often than in female (p = 0.02). Agreement of anatomic variations between sides ranged from moderate to almost perfect depending on the structures evaluated. CONCLUSIONS: There are anatomic differences of the sphenoid sinus between sexes and between right and left sides, and these differences should be taken into consideration during surgery.