Sphenoid Sinus

Endoscopic view of sphenoid sinusitis adjacent to an intracranial aneurysm

July 5, 2012     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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Cases of isolated sphenoid sinusitis unresponsive to medical therapy can be treated endoscopically using sinus balloon dilation.

Spectrum of paranasal sinus mycoses in coastal India

June 4, 2012     Jyoti R. Kini, MD; Spoorthy S. Shetty, MBBS; Hema Kini, MD
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Abstract

Fungal infections of the nose and paranasal sinuses are uncommon, and the disease they cause can be identified from their histopathologic appearance. The aim of this study was to assess the incidence of fungal infection and histopathologic changes in specimens sent for evaluation of chronic sinusitis and correlate with culture findings wherever possible. The records of 200 consecutive cases coded as paranasal sinuses over a period of 3 years were retrieved from the Department of Pathology, Kasturba Medical College, Mangalore, India. Twenty nine out of a total of 200 specimens (14.5%) were positive for fungal elements on histopathologic examination. The most common etiologic agents in our study were Aspergillus spp (37.9%); only 1 culture (3.4%) was positive for a Candida species. Eight of 29 patients with fungal sinusitis (27.6%) had diabetes, and 1 patient was being treated for rheumatoid arthritis. Eight of the 29 patients had allergic fungal sinusitis, 8 had chronic granulomatous sinusitis, and 1 had acute fulminant invasive sinusitis. Fungi have been increasingly recognized as an important pathogen in chronic sinusitis. It is imperative for patient management not only that paranasal sinus mycoses be diagnosed but also that the specific histologic category be identified.

Inflammatory myofibroblastic tumor of the nose and paranasal sinuses masquerading as a malignancy

April 30, 2012     Mohamed Amin, MD, FRCSI; Rohana Ali, AFRCS; Susan Kennedy, MD; Conrad Timon, MD, FRCSI
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Abstract

Inflammatory myofibroblastic tumor (IMT) of the nose and paranasal sinuses is a rare entity that exhibits a diverse histologic pattern that can mimic malignant tumors clinically and radiologically. We present a case of IMT in an 88-year-old man who presented with an aggressive tumor-like lesion in the nose and paranasal sinuses that had a malignant appearance on radiology. We discuss this tumor's clinicoradiologic resemblance to a malignancy, and we review the treatment options following careful histologic and immunohistochemical analysis.

Sphenopalatine artery pseudoaneurysm after endoscopic sinus surgery: A case report and literature review

February 18, 2012     Raewyn G. Campbell, BMed(Hons), BApplSci(Physio)
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Abstract

Previously reported cases of iatrogenic sphenopalatine artery (SPA) pseudoaneurysm have occurred only after trans-sphenoidal surgery for pituitary tumors or maxillofacial surgery. In this article, the author presents what to the best of her knowledge is the first reported case of an SPA pseudoaneurysm that developed following endoscopic sinus surgery (ESS). The patient was a 76-year-old woman with myelodysplastic syndrome who presented with a 6-month history of unilateral sinus symptoms. She underwent septoplasty and unilateral ESS, which included frontal recess clearance and sphenoidotomy. However, during surgery, severe generalized bleeding was encountered. The bleeding was arrested only after anterior and posterior nasal packing. After two attempts to remove the packing failed, angiography was obtained. It revealed an SPA pseudoaneurysm, which was immediately and successfully embolized. SPA pseudoaneurysm is a rare but significant complication of ESS, and it should be considered in patients with posterior epistaxis after ESS or prolonged posterior nasal packing. The pathogenesis may include intraoperative trauma, infection, pressure necrosis from packing, or a combination of these factors. Optimal management includes either ligation or embolization, depending on anatomic, patient, staff, and resource factors. The author reviews the pertinent anatomy and the pathophysiology, diagnosis, management, and prevention of this rare complication.

Report of a sphenoid sinus lipoma

February 18, 2012     Greg Eldon Davis, MD, MPH, Lauren Elaine Kernochan, MD, and Lawrence D. True, MD
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Abstract

Sphenoid sinus opacification on computed tomography can represent a multitude of etiologies. Such a finding can signify an infectious, inflammatory, congenital, neuronal, vascular, or neoplastic mass. In this article, we describe a case of a lipoma of the sphenoid sinus, and we discuss the differential diagnosis and management of this finding.

Hepatocellular carcinoma presenting as an isolated sphenoid sinus lesion: A case report

January 25, 2012     Shantanu Tandon, MS, DNB, Arun Nair, DNB, DLO, MBA, Anisha Sawkar, DNB, DMRD, A.M. Balasubramanya, MS, and Diganta Hazarika, MD
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Abstract

We report a rare case of a metastatic sphenoid sinus lesion originating from an undiagnosed hepatocellular carcinoma (HCC) in a 53-year-old man who presented with gradually progressive external ophthalmoplegia. Imaging showed a right sphenoid sinus lesion infiltrating the parasellar region. Although a primary sphenoid biopsy was inconclusive, positive hepatitis B surface antigen and CT-guided fine-needle aspiration cytology suggested an HCC. A repeat endoscopic biopsy from the sphenoid with immunohistochemistry confirmed the lesion to be metastatic HCC. Metastasis to the paranasal sinuses is extremely rare, and metastasis from a liver primary even more rare. Because of clinical and radiologic similarity between the primary and metastatic lesions, metastasis to the sphenoid sinus is often undiagnosed. Patients with features suggestive of sphenoid sinus malignancy should also be evaluated for the possibility of a metastatic tumor. In this article, we emphasize the rarity of the tumor, the unusual presenting symptoms, and problems with early diagnosis.

Petrous apex cholesterol granuloma involving the sphenoid sinus

November 22, 2011     Dirk Korbmacher, MD, Martin Lehmann, MS, Hans-Björn Gehl, MD, Jörg Ebmeyer, MD, and Holger Sudhoff, MD, PhD
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Abstract

Petrous apex cholesterol granulomas are slowly expanding lesions that clinically present with a variety of cranial nerve deficits. We present a case of a 40-year-old man with a right-sided, sudden-onset hearing loss. Apart from a 60-dB high-frequency sensorineural hearing loss in the right ear, all other neurotologic examinations were normal. Computed tomography revealed partial destruction of the right carotid canal, petrous apex, and clivus. Surgical treatment was performed via an endoscopic transnasal, trans-sphenoid approach using an image-guidance system. Postoperative magnetic resonance imaging showed a significant reduction in the size of the cholesterol granuloma and a stable hearing threshold.

Maxillary sinus nonodontogenic myxoma extending into the sphenoid sinus and pterygopalatine fossa: Case report

September 20, 2011     Süleyman Yilmaz, MD, Deniz Tuna Edizer, MD, Cengiz Yagiz, MD, Mehmet Sar, MD, and Harun Cansiz, MD
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Abstract

Myxomas are benign mesenchymal tumors of uncertain etiology. They can arise from odontogenic tissue, as well as from the sinonasal tract and from the facial and temporal bones, apparently from nonodontogenic mesenchyme. Although histologically benign, myxomas are locally invasive. Histopathology demonstrates a characteristically hypocellular lesion with loose stellate cells. We describe the case of a 48-year-old woman with a nonodontogenic maxillary sinus myxoma that invaded the sphenoid sinus and pterygopalatine fossa. We removed the mass via a combined endoscopic and gingivobuccal approach. The rarity of a nonodontogenic sinonasal myxoma extending into the sphenoid sinus and pterygopalatine fossa is the basis for our presentation of this case.

Bilateral sphenoid fungal sinusitis

July 13, 2011     Jae Hoon Lee, MD
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Sphenochoanal polyp: Current diagnosis and management

June 30, 2010     Mohannad Ahmad Al-Qudah, MD, FICS, FAAOHNS
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Abstract

Choanal polyps arise from inflamed, edematous mucosa in the paranasal sinuses. They extend into the choana and cause nasal obstruction and mouth breathing. In most cases, these polyps arise in the maxillary sinus, but rare cases of origin in the sphenoid sinus and other nasal structures have been reported. The presence of a choanal polyp in an atypical location can lead to diagnostic confusion and exploration of the wrong sinus at surgery. The author reports the case of a 15-year-old girl who was diagnosed with a sphenochoanal polyp. The patient was successfully treated via an endoscopic surgical approach.

Squamous cell carcinoma arising in an inverted papilloma

April 30, 2010     Jiovani M. Visaya, BA, Julie M. Wu, MD, Eugene A. Chu, MD, and Marc G. Dubin, MD
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New approach to the endoscopic repair of a CSF leak originating from the lateral recess of the sphenoid sinus

March 31, 2010     Ausama Alaani, FRCS(ORL-HNS), Patrick Jassar, FRCS(ORL-HNS), Eleanor Mein, MRCS, and Alan Phillip Johnson, FRCS
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Abstract

Difficult access can make identification of a cerebrospinal fluid leak from the lateral wall of the sphenoid sinus very difficult, especially in a well-pneumatized sinus. Access to the sphenoid sinus has become easier with the advancement of minimally invasive endoscopic technology. In this article we describe our approach to a cerebrospinal fluid leak originating from this location, which has not been described previously in the literature.

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