Sospecha clínica y tratamiento quirúrgico de los mucoceles esfenoidales / Diagnosis and surgical treatment of sphenoid mucoceles

Introducción: Los mucoceles son formaciones benignas de lento crecimiento que pueden aparecer en cualquier seno paranasal, representando el seno esfenoidal menos del 10%. Objetivo: Presentamos nuestra experiencia de mucoceles en el seno esfenoidal. Material y método: Se obtuvieron los datos a partir de nuestra base de datos que recoge prospectivamente los casos de tumores de cabeza y cuello. Entre enero 1989 y enero 2013 se registraron 58 mucoceles en 54 pacientes, de los cuales 4 (7%) eran de seno esfenoidal. Tres pacientes eran mujeres y uno varón, con edades comprendidas entre 42 y 61 años. Todas las lesiones fueron estudiadas con endoscopia nasal, tomo-grafía computarizada y resonancia magnética. Resultados: Tres pacientes presentaron un antecedente quirúrgico de seno paranasal. El síntoma más frecuente fue la cefalea (3 pacientes de 4). Dos pacientes presentaron diplopia y uno pérdida progresiva de agudeza visual, requiriendo manejo quirúrgico urgente. Todos fueron tratados con esfenoidotomía por abordaje endoscópico endonasal. Fueron dados de alta a las 48 h posteriores con antibioticoterapia. Ninguno presentó recidiva. Conclusión: Los mucoceles esfenoidales representan menos del 10% de los mucoceles nasosinusales. La pérdida de agudeza visual requiere un rápido diagnóstico y manejo terapéutico quirúrgico urgente. El tratamiento de elección es la marsupialización.

Introduction: Sinus mucoceles are benign cysts that may appear in any sinus, but only 1%-10% occur in the sphenoid sinus. Aim: We describe the cases of sphenoid sinus mucoceles seen at our centre over the last 25 years. Material and method: In a prospective review of all mucoceles diagnosed between 1989 and 2013, we identified 58 mucocels in 54 patients. Four of the 58 (7%) were sphenoid mucoceles. There were three female patients and one male, and ages ranged from 42 to 61 years. We performed an endoscopy, CT and MR in all patients to confirm diagnosis. Results: Three patients had had endoscopic endonasal surgery in the past. The presenting symptoms were headache in 3 patients, diplopia in two, and visual loss, causing blindness, in one. The patient with amaurosis requiered urgent surgery. All four patients underwent sphenoidotomy with marsupialisation by the endonasal endoscopic approach. They were discharged 48 hours later on oral antibiotics. No recurrences have been observed to date. Conclusions: Sphenoid mucocele is a rare disease, requiring prompt treatment in cases of amaurosis. Good results can be achieved with endonasal endoscopic marsupialisation.

New Treatment for Isolated Invasive Aspergillosis of Sphenoid Sinus in Immunocompetent Subjects: Sphenoid Nasalization Combined with Voriconazole / 대한이비인후과학회지

Isolated invasive fungal sinusitis of sphenoid sinus in a healthy immunocompetent person is extremely rare. Classical treatment of invasive fungal sinusitis is wide sphenoidotomy and surgical debridement combined with antifungal agents, mostly amphotericin B. We describe a case of a 72-year-old immunocompetent woman who presented with deep-seated orbital pain and was diagnosed as isolated invasive aspergillosis in sphenoid sinus invading orbital apex and cavernous sinus. This case was treated successfully with a new combination treatment of sphenoid nasalization and voriconazole, a new antifungal agent. There was no evidence of postoperative recurrence and side effects during the usage of voriconazole.

A Rare Complication of Corneal Abrasion in Otorhinolaryngology Procedure: Lessons Learnt.

Despite their close anatomical relationship, orbital complications rarely occur during otorhinolaryngology operations. The well-known complication is the orbital injury during endoscopic sinus surgery. Procedures such as tonsillectomy or sinus surgery limited to the ostium widening rarely induce such an injury. We report two cases of corneal abrasion after otorhinolaryngological operative procedures.

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.

A Case of Rathke's Cleft Cyst in the Sphenoid Sinus / 대한이비인후과학회지

Isolated sphenoid sinus disease is difficult to diagnose because of the obscure and nonspecific initial findings of the disease. Because of the complex anatomic relations of the sphenoid, the disease often manifests itself through the neuroophthalmologic complications. We have recently experienced a case of intrasphenoidal symptomatic Rathke's cleft cyst, which was managed by endoscopic transnasal sphenoidotomy approach with good results. The endoscopic approach affords excellent visualization and sufficient exposure of the sinus cavity, and allows easy postoperative inspection of the sphenoid sinus.