Abstract
Objective
To evaluate the etiology, symptoms, signs, imaging, surgical findings and outcomes of isolated sphenoid sinus disease (ISSD).
Design
Retrospective study.
Settings
Tertiary university based referral center.
Materials and methods
All 8 patients aged 17–63, managed surgically in the department of ENT and Head and Neck Surgery at St. John’s Medical College and Hospital, Bangalore from 2006 to 2008 for ISSD. Demographic data, presenting signs and symptoms endoscopic and imaging findings, surgical management, surgical pathology and clinical outcomes were investigated in the above patients.
Results
Of the 8 cases of ISSD, 5 were male; 3 were female, with an age range of 17–63 years. The most common presenting symptom was headache (7 patients [87.5%]), followed by nasal obstruction and recurrent URTI (5 cases [62.5%]). Imaging included CT and/or MRI studies in all cases. Sphenoid sinus pathology was varied and included 5 (62.5%) inflammatory cases, 1 (11.1%) cerebrospinal fluid fistula and 2 (22.2%) cases of sphenoid sinus neop;asms. Of the inflammatory cases 2 (40%) had isolated polyps in the sphenoid sinus [sphenochoanal polyps] and 3 (60%) had fungal sinusitis. Treatment was surgical, endoscopic transnasal sphenoidotomy under general anesthesia in all 5 patients with inflammatory ISSD Two patients with sphenoid sinus tumors underwent endoscopic biopsy.
Conclusion
ISSD is rare. A high index of suspicion is required for diagnosis, which should be an active process and not one of exclusion. Both diagnostic nasal endoscopy and CT imaging are essential for diagnosis. The direct approach to the sphenoid sinus, transnasal endoscopic sphenoidotomy without ethmoidectomy is safe and effective. With early and adequate surgery we were able to avoid the morbidity associated with ISSD.
Keywords: Sphenoid sinus, Sphenochoanal polyp, Sinusitis, Headache, Sphenoidotomy
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References
- 1.Alyea O.E. Sphenoid sinus: anatomic study, with consideration of the clinical significance of the structural characteristics of the sphenoid sinus. Arch Otolaryngol. 1941;34:225–253. [Google Scholar]
- 2.Lew D., Southwick F.S., Montgomery W.M., et al. Sphenoid sinusitis: a review of 30 cases. N Engl J Med. 1983;309:1149–1154. doi: 10.1056/NEJM198311103091904. [DOI] [PubMed] [Google Scholar]
- 3.Hadar T., Yaniv E., Shvero J. Isolated sphenoid sinus changes — history, CT and endoscopic finding. J Laryngol Otol. 1996;110:850–853. doi: 10.1017/S0022215100135145. [DOI] [PubMed] [Google Scholar]
- 4.Metson R., Gliklich R.E. Endoscopic treatment of sphenoid sinusitis. Otolaryngol Head Neck Surg. 1996;114:736–744. doi: 10.1016/S0194-5998(96)70095-5. [DOI] [PubMed] [Google Scholar]
- 5.Pearlman S.J., Lawson W., Biller H.F., et al. Isolated sphenoid sinus disease. Laryngoscope. 1989;99:716–720. doi: 10.1288/00005537-198907000-00010. [DOI] [PubMed] [Google Scholar]
- 6.Levine H. The sphenoid sinus, the neglected nasal sinus. Arch Otolaryngol. 1978;104:585–587. doi: 10.1001/archotol.1978.00790100039008. [DOI] [PubMed] [Google Scholar]
- 7.Kron T.K., Johnson C.M. Diagnosis and management of the opacified sphenoid sinus. Laryngoscope. 1983;93:1319–1327. doi: 10.1002/lary.1983.93.10.1319. [DOI] [PubMed] [Google Scholar]
- 8.Lawson W., Reino A.J. Isolated sphenoid sinus disease: an analysis of 132 cases. Laryngoscope. 1997;107:1590–1595. doi: 10.1097/00005537-199712000-00003. [DOI] [PubMed] [Google Scholar]
- 9.Cakmak O., Shohet M.K., Kern E.B. Isolated sphenoid sinus lesions. Am J Rhinol. 2000;14:13–19. doi: 10.2500/105065800781602993. [DOI] [PubMed] [Google Scholar]
- 10.Wang Z., Kanoh N., Dai C., et al. Isolated sphenoid sinus disease: An analysis of 122 cases. Ann Otol Rhinol. 2002;111:323–327. doi: 10.1177/000348940211100407. [DOI] [PubMed] [Google Scholar]
- 11.Harbison J.W., Lessell S., Selhorst J.B. Neuropthalmology of sphenoid sinus carcinoma. Brain. 1984;107:855–870. doi: 10.1093/brain/107.3.855. [DOI] [PubMed] [Google Scholar]
- 12.Sethi D.S. Isolated sphenoid sinus lesions: diagnosis and management. Otolaryngol Head Neck Surg. 1999;120:730–736. doi: 10.1053/hn.1999.v120.a89436. [DOI] [PubMed] [Google Scholar]
- 13.Kieff, David A., Busaba, Nicholas Treatment of isolated sphenoid sinus inflammatory discase by endoscopic sphenoidotomy without ethmoidectomy. Laryngoscope. 2002;112(12):2186–2188. doi: 10.1097/00005537-200212000-00011. [DOI] [PubMed] [Google Scholar]