The Clinical Application of Endoscopic Sphenoidotomy and Anatomical Role of the Superior Turbinate

BACKGROUND AND OBJECTIVES: Recently, endoscopic sinus surgery (ESS) is commonly performed to treat the sphenoid sinus disease. Identification of the natural ostium of sphenoid sinus (SS) according to surgeon's operating view play an important role in endoscopic sphenoid approach. This study is undertaken to investigate the role of superior turbinate (ST) as an anatomic landmark of natural ostium of SS in endoscopic sphenoidotomy. MATERIALS AND METHODS: Medical records and computed tomography (CT) images of 77 patients from March 2006 to December 2007 who underwent ESS were analyzed. We tried to investigate the location and distance of the natural ostium on the superior turbinate, skull base and nasal septum. We also measured the anterior wall thickness of the SS by using CT images. RESULTS: The natural ostium of the SS was located on the medial side of the ST in all patients who underwent endoscopic sphenoidotomy (45 cases). The level of posteroinferior end of the ST corresponded to the inferior portion of anterior wall of the SS. The lateral portion thickness of the anterior wall of the SS was thinner than the medial portion (77 cases). CONCLUSION: During an endoscopic sphenoidotomy, the superior turbinate is an important anatomic landmark for identifying the natural ostium of the SS. When widening the anterior wall of SS is performed, we sug-gest that the procedure should be directed to the lateral 1/3 portion, considering the thickness of anterior wall of SS.

Pure Isolated Sphenoid Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Isolated sphenoid sinusitis is often misdiagnosed because of its rarity and varied clinical presentation. Presenting symptom is often both subtle andsuggestive of other intracranial lesions. The purpose of this study is to present typical clinical manifestations and treatment of pure bacterial isolated sphenoid sinusitis. Materials and Method: Nine cases of isolated sphenoid sinusitis of bacterial origin were reviewed retrospectively. RESULTS: Two cases were acute and seven cases were chronic. The most common symptom was deep seated headache. Most of them were transferred via other department. Radiologic diagnosis using CT and MRI was enough to distinguish. Four cases were improved by medical treatment. Five cases were treated by endoscopic sphenoidotomy. CONCLUSION: Isolated sphenoid sinusitis should be considered as a possible cause in case of deep seated, intractable headache. And in this case, CT or thorough endoscopic examination should be recommended. Endonasal endoscopic sphenoidotomy is good and simple treatment for cases intractable to medical treatment.