Laterally attached superior turbinate is associated with opacification of the sphenoid sinus

Objective

The sphenoid sinus is situated at the most posterior part of the nasal cavity and opens at the sphenoethmoidal recess located between the nasal septum and the superior turbinate. The correlation between anatomical structures surrounding the sphenoid sinus and sphenoid sinusitis is poorly understood. This study investigated possible factors that correlate to opacification of the sphenoid sinus on computed tomography.

Methods

Review of computed tomography images of 200 patients who underwent endoscopic sinus surgery and/or septoplasty. The total lengths of the anterior sphenoid wall and the part medial to the superior turbinate were measured. The correlations were analyzed between the occurrence of sphenoiditis and these values, as well as age, sex, presence or absence of Onodi cell, opacification of the paranasal sinuses other than the sphenoid sinus, and shadow at the olfactory cleft.

Results

The length of the part medial to the superior turbinate was significantly (odds ratio = 1.36, P = 0.001) associated with sphenoiditis, but the total length of the anterior wall of the sphenoid was not. Advanced age and disease of the olfactory cleft, posterior ethmoid cells, and frontal sinus were also correlated with sphenoiditis.

Conclusions

Certain characteristics of the anatomical structures surrounding the sphenoid sinus are associated with sphenoiditis.     

Surgical anatomy of the natural ostium of the sphenoid sinus

OBJECTIVES: This study was undertaken to measure the distance and the angle between the anterior part of nasal cavity and the natural ostium of the sphenoid sinus. The anatomical location of the natural ostium according to the direction of surgeon's operating view toward the anterior wall of the sphenoid sinus was also analyzed. STUDY DESIGN: This study used careful cadaver dissection under a surgical microscope. METHODS: One hundred sagittally sectioned adult cadaveric heads were used. We measured the distances and angles for identifying the natural ostium of the sphenoid sinus using several reference points such as the limen nasi, the sill, and the posteroinferior end of the superior turbinate. In addition, we tried to identify whether the location of the natural ostium is medial or lateral to the posterior end of the superior turbinate. RESULTS: The natural ostium of the sphenoid sinus was located at an angle of 35.9 degrees with a distance of 56.5 mm from limen nasi and at an angle of 34.3 degrees with a distance of 62.7 mm from nasal sill. It was located approximately 1 cm above the posteroinferior end of the superior turbinate and at a medial aspect to the posterior end of the superior turbinate in 83% of specimens. CONCLUSIONS: We speculate that the posteroinferior end of the superior turbinate is the best landmark for identifying the natural ostium of the sphenoid sinus. Furthermore, the natural ostium should ideally be searched from a superior and medial aspect in relation to the posteroinferior end of the superior turbinate.     

The superior turbinectomy approach to isolated sphenoid sinus disease and to the sella turcica

Sphenoidotomy or sphenoidectomy are most commonly performed as part of a more extensive pansinus procedure. However, rhinologists may find themselves occasionally in a need to surgically treat an isolated sphenoid sinus disease. With the introduction of endoscopic sinus techniques and instrumentation, intranasal sphenoidotomy has become increasingly popular. The most common approach used is the intranasal, transethmoid sphenoidectomy. Alternatively, many surgeons perform middle turbinectomy to approach the sphenoid sinus transnasally. We describe our direct transnasal, nontransethmoid, nontransseptal approach to the sphenoid sinus. Superior tubinectomy is performed to enhance the exposure of the anterior sphenoid wall. Seventy patients underwent sphenoid sinus exploration for isolation sphenoid sinus disease or for pituitary lesions. Surgical goals were achieved in all patients and there were no complications related to the technique. The superior turbinectomy approach to isolated sphenoid sinus disease provides excellent exposure and avoids the sequelae of total ethmoidectomy or middle turbinectomy.     

Mucus circulation between accessory ostium and natural ostium of maxillary sinus

We report a case of one asymptomatic 28-year-old male with mucus circulation between the natural ostium and the accessory ostium of the maxillary sinus. Computerized tomography (CT) revealed a recirculating mucus ring between the two ostia of the maxillary sinus.     

根治性鼻窦手术自然窦口处理的临床分析

目的探讨根治性鼻窦手术中更为完善的上颌窦自然孔开窗术.方法为慢性鼻窦炎伴多发性鼻息肉66例行根治性鼻窦手术自然窦口扩大术,术后随访10～42个月,对慢性鼻窦炎伴多发性鼻息肉手术疗效与相关因素进行临床分析.结果患者均未发生并发症.结论根治性鼻窦手术中自然窦口的处理是治疗慢性鼻窦病变伴多发性鼻息肉的有效方法.     

蝶窦气化程度与蝶窦周围相关结构关系的影像分析

目的研究成年人和青少年蝶窦气化及其与蝶窦周围相关结构的关系,为临床开展鼻内镜下经蝶窦颅底手术提供影像学基础。方法 100例成年人、50例青少年（10～18岁）行高分辨率CT冠状位和轴位扫描。结果蝶窦气化分蝶骨体气化和其他相关结构气化,成年人与青少年比较无显著性差异。300侧蝶窦,半鞍型和全鞍型258侧（86%）,甲介型和鞍前型42侧（14%）。蝶骨大翼、蝶骨小翼、翼突、鞍背、枕骨的气化率分别为7.3%、8.0%、28.7%、9.3%、4.0%。颈内动脉半管型和全管型共139侧（46.3%）,视神经半管型和全管型共174侧（58.0%）,部分血管神经完全突入到蝶窦腔内,骨壁菲薄甚至缺如。颈内动脉、视神经管、圆管、翼管突入蝶窦的程度与蝶窦气化类型有关。结论蝶窦气化程度及颈内动脉、视神经管、圆管、翼管突入蝶窦的程度个体差异较大。与成年人相比,青少年蝶窦及蝶窦周围相关结构已发育成熟。     

Metastatic tumors to the sphenoid sinus.

Patients with cranial nerve palsies and roentgenographic evidence of sphenoid sinus destruction present diagnostic problems. Although the presence of local primary neoplasms may be considered first, metastatic disease from distant sites also should be considered. We report on eight patients with metastatic tumors to the sphenoid sinus seen at the Mayo Clinic from 1950 through 1976. Primary sites of the lesions included the breast, thyroid gland, lung, kidney, and prostate (two patients). Metastatic myeloma was seen in two patients. Symptoms resulted from involvement of the structures adjacent to the sphenoid sinus and in all patients included diplopia or decreased visual acuity. In four patients, these ocular symptoms were the first sign of disease, after which a complete general examination disclosed the occult primary sites.     

Metastasis of prostatic adenocarcinoma to the sphenoid sinus

The presentation, diagnosis, and management of prostatic adenocarcinoma metastatic to the sphenoid sinus are reviewed. We present a case report with a review of the literature. A 67-year-old man with a history of prostatic adenocarcinoma presented with gradual left visual loss. Magnetic resonance imaging revealed a lesion of the left orbital apex with extension into the ipsilateral sphenoid sinus. Operative biopsy of the lesion was significant for adenocarcinoma of the prostate. When an otolaryngologist encounters a mass in the sphenoid sinus, he or she needs to consider a diverse differential diagnosis. In evaluating possible causes, a history of malignancies should be elicited. Furthermore, the pathophysiology and potential routes of metastatic disease should be assessed for these primary neoplasms. Having a high level of suspicion for metastatic disease from specific primary sites will help guide the pathological evaluation. As in this clinical scenario of a patient with a history of prostatic adenocarcinoma, appropriate analysis would entail sending specimens for immunohistochemical staining, such as prostate-specific antigen and prostate-specific acid phosphatase. Correct diagnosis is crucial, as these patients may achieve remission and prolonged survival with irradiation and/or hormonal therapy.     

Myxofibrosarcoma of the sphenoid sinus

Myxofibrosarcoma was originally described as the myxoid variant of malignant fibrous histiocytoma (MFH). It is uncommon in the head and neck region. We hereby report a case of myxofibrosarcoma in the sphenoid sinuses. The diagnostic and management difficulties are discussed. Close collaboration between surgeon, radiologist, histopathologist and clinical oncologist in makng accurate diagnosis and appropriate management of this rare tumour are emphasized.