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Stavrakas M, Khalil HS, Tsetsos N, Muquit S. Clival Mucocele: A Rare Yet not Forgotten Pathology. EAR, NOSE & THROAT JOURNAL 2023; 102:632-634. [PMID: 34112008 DOI: 10.1177/01455613211021176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary clival mucoceles are a rare clinical entity that usually represents an incidental finding on computed tomography or magnetic resonance imaging scanning. There are only a few reports in the literature of patients who presented with vague symptoms such as headaches, facial paresthesia, and numbness. Clival mucoceles can also be secondary, by extension of a sphenoid mucocele to the clivus. We present a case of primary clival mucocele, aiming to highlight the importance of a multidisciplinary approach.
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Affiliation(s)
- Marios Stavrakas
- ENT Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Hisham S Khalil
- ENT Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology, Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Samiul Muquit
- South West Neurosurgery Unit, Derriford Hospital, Plymouth, UK
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Swain S, Baliarsingh P. Sphenoid sinus mucocele: Our experiences at a tertiary care teaching hospital of Eastern India. MATRIX SCIENCE MEDICA 2023. [DOI: 10.4103/mtsm.mtsm_4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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3
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Leong WS, Mulla O. Lateral rectus muscle palsy secondary to sphenoid sinusitis. Ann R Coll Surg Engl 2022; 104:e239-e243. [PMID: 35446158 PMCID: PMC9433183 DOI: 10.1308/rcsann.2021.0338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 09/03/2023] Open
Abstract
Isolated sphenoid sinus disease is a rare, often misdiagnosed condition of the paranasal sinus. If left untreated, it can lead to complications involving pituitary gland, cavernous sinus, neurological and vascular structures nearby. Early recognition and treatment are critical to prevent the progression of the disease. We present a case of a 60-year-old woman with a history of severe left-sided headache, facial pain, diplopia and left lateral rectus palsy. She was initially referred to ophthalmology and rheumatology for possible giant cell arteritis. Magnetic resonance imaging revealed opacification in left sphenoid sinus with cavernous sinus/superior orbital fissure involvement consistent with left sphenoid sinusitis. She was then referred to the ear, nose and throat department and had endoscopic transnasal sphenoidotomy in theatre. Culture results showed Haemophilus influenza and fungal pseudohyphae. She recovered three months later after a course of antibiotics and antifungals. The onset of isolated sphenoid sinus disease is often insidious and the diagnosis of this condition remains a challenge. Magnetic resonance imaging and computed tomography remain the best diagnostic tools to recognise and manage this condition.
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Affiliation(s)
- WS Leong
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, UK
| | - O Mulla
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, UK
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Moutei H, Bennis A, Chraibi F, Zouheir Z, Abdellaoui M, Benatiya IA. Isolated sphenoid sinus mucocele: Report of a rare case. J Fr Ophtalmol 2020; 43:e307-e310. [PMID: 32928576 DOI: 10.1016/j.jfo.2020.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- H Moutei
- Service d'ophtalmologie - centre hospitalier universitaire Hassan II de Fès, Fès, Morocco.
| | - A Bennis
- Service d'ophtalmologie - centre hospitalier universitaire Hassan II de Fès, Fès, Morocco.
| | - F Chraibi
- Service d'ophtalmologie - centre hospitalier universitaire Hassan II de Fès, Fès, Morocco.
| | - Z Zouheir
- Service d'ORL - centre hospitalier universitaire Hassan II de Fès, Fès, Morocco.
| | - M Abdellaoui
- Service d'ophtalmologie - centre hospitalier universitaire Hassan II de Fès, Fès, Morocco.
| | - I A Benatiya
- Service d'ophtalmologie - centre hospitalier universitaire Hassan II de Fès, Fès, Morocco.
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Abstract
Paranasal sinus mucocele is cystic, expansile, benign masses that contain mucus surrounded by epithelium. It causes significant locally destruction of the sinus wall and present with various symptoms depending on the pressure on neighboring structures. Sphenoid sinus mucocele constitutes 1% to 2% of all paranasal sinus mucoceles. Headache is the most common symptom that leads to correct diagnosis. In addition, the close proximity of the sphenoid sinus to important structures such as the optic nerve, cavernous sinus and the pituitary gland causes various symptoms. Treatment is surgical drainage of mucocele to reduce pressure.
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Endoscopic Treatment of Huge Sinus Mucoceles Causing Orbital Symptoms. J Craniofac Surg 2020; 31:e565-e568. [PMID: 32433132 DOI: 10.1097/scs.0000000000006541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Paranasal sinus mucoceles are accumulation of mucoid secretions and desquamated epithelium within the sinus causing distension of its wall. They occur mostly in the frontal and ethmoid sinuses. Patients with giant frontal or ethmoidal sinus mucoceles suffer from orbital symptoms such as proptosis, visual disturbance, periorbital swelling, pain, or visual disturbance mostly, but they can also have rhinologic or neurologic symptoms. The purpose of this study is to evaluate the efficacy of endoscopic marsupialization for treating giant frontal and ethmoidal sinus mucoceles causing orbital symptoms. METHODS This study was a retrospective, consecutive clinical review of patients with giant frontal and ethmoidal sinus mucoceles with orbital symptoms, who were treated by endoscopic marsupialization between January 2012 and August 2019. Medical records including age, gender, nasal and orbital symptoms, imaging findings, and surgical methods were reviewed. RESULTS There were 15 patients with giant frontal and/or ethmoidal sinus mucoceles accompanied with orbital symptoms. The mean age of the patients was 50.5 years. One patient had previously undergone endoscopic sinus surgery for chronic rhinosinusitis. Within 15 patients, the main orbital symptoms were visual disturbance (6 patients), proptosis (8 patients), eyelid swelling (6 patients), and periorbital pain (1 patient). Other symptoms included nasal congestion, rhinorrhea, and headache. All patients underwent endoscopic marsupialization of the mucocele and had improvement in nasal and orbital signs and symptoms. CONCLUSION Endoscopic marsupialization is an effective treatment for giant frontal and ethmoidal mucoceles with orbital symptoms.
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Chen K, Cao Y, Wu J, Xiang H, Huang XF, Chen B. Clinical Analysis of Sphenoid Sinus Mucocele With Initial Neurological Symptoms. Headache 2019; 59:1270-1278. [PMID: 31342517 DOI: 10.1111/head.13605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Neurological manifestations associated with sphenoid sinus mucocele (SSM) are easily misdiagnosed due to nonspecific symptoms. The objective is to analyze and report the clinical features of SSM presenting with neurological manifestations, to allow an earlier diagnosis and more timely intervention for this disease. METHODS This was a retrospective cross-sectional study including 19 patients. The detailed clinical information of 19 patients with the initial symptom of neurological manifestations caused by SSM presenting at the Second Affiliated Hospital of Wenzhou Medical University between January 2000 and May 2018 were retrospectively analyzed. Collected data including symptoms, signs, neuroimaging, and pathologic diagnoses. RESULTS There were eleven males and 8 females, and their ages ranged from 23 to 71 years. Headache was the most frequent symptom, in 12 of the 19 patients presenting as the initial symptom. The visual disturbance included visual loss (4/19), diplopia (3/19), and another patient had both visual loss and diplopia. Neurophysical examination found that 4 patients presented with oculomotor nerve palsy, 4 patients had optic nerve or abducens nerve palsy, and 1 patient had optic neuropathy, oculomotor nerve palsy and abducens nerve palsy simultaneously. All patients underwent endoscopic surgery and had postoperative clinical symptom improvement. CONCLUSIONS Headache is the most common symptom of SSM and should be on the differential diagnosis of patients presenting with headache, even if in isolation. The results suggest that CT and MRI are the best tools in diagnosis of SSM and endoscopic sphenoidotomy is a safe and effective method in the treatment of SSM.
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Affiliation(s)
- Keyang Chen
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yungang Cao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianbin Wu
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haijie Xiang
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiu-Feng Huang
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Brisbane, Australia
| | - Bobei Chen
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Li E, Howard MA, Vining EM, Becker RD, Silbert J, Lesser RL. Visual prognosis in compressive optic neuropathy secondary to sphenoid sinus mucocele: A systematic review. Orbit 2018; 37:280-286. [PMID: 29303386 DOI: 10.1080/01676830.2017.1423087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sphenoid sinus mucoceles (SSMs) are rare, benign lesions that can expand, often presenting with ocular symptoms-decreased vision, diplopia, visual field defects, proptosis, and external ophthalmoplegia. Reported cases are few, visual compromise varies, and factors affecting visual prognosis are poorly characterized. We investigate whether prompt surgical intervention (within 2 weeks of visual symptom onset) affects best-corrected visual acuity (BCVA) regained in patients with vision loss secondary to compressive SSM. We present a retrospective review of three cases and published literature to date. Our primary outcome was BCVA regained after surgical intervention; secondary outcomes included change in visual field defect and ophthalmological symptoms other than vision loss. Our three cases of SSM varied in onset, ranging from several hours to several months with patients aged from 13 to 80 years. All patients had severe vision loss to light perception (LP) or worse. Rapid neuro-imaging and urgent surgical intervention improved vision to count fingers at best. Of the two patients who underwent prompt decompression, one improved from no LP to LP and the other did not recover any vision. The patient who had visual loss for 3 months before intervention improved from LP to 20/400. Findings from our literature search, which yielded 12 cases of urgent intervention, supported the variability in visual prognosis despite prompt surgical intervention. SSMs are rare, pathologically benign lesions which can expand to cause ocular involvement. Prompt diagnosis and surgical decompression are recommended, but visual recovery may be limited even with urgent intervention.
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Affiliation(s)
- Emily Li
- a Department of Ophthalmology and Visual Science , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Martha A Howard
- a Department of Ophthalmology and Visual Science , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Eugenia M Vining
- b Section of Otolaryngology, Department of Surgery , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Richard D Becker
- c Department of Radiology , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Jonathan Silbert
- a Department of Ophthalmology and Visual Science , Yale University School of Medicine , New Haven , Connecticut , USA.,d The Eye Care Group , Waterbury , Connecticut , USA
| | - Robert L Lesser
- a Department of Ophthalmology and Visual Science , Yale University School of Medicine , New Haven , Connecticut , USA.,d The Eye Care Group , Waterbury , Connecticut , USA.,e Department of Neurology , Yale University School of Medicine , New Haven , Connecticut , USA
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Fu CH, Chang KP, Lee TJ. The difference in anatomical and invasive characteristics between primary and secondary paranasal sinus mucoceles. Otolaryngol Head Neck Surg 2016; 136:621-5. [PMID: 17418262 DOI: 10.1016/j.otohns.2006.10.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 10/20/2006] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the difference in anatomical and invasive characteristics of primary and secondary paranasal sinus mucoceles. Study Design A retrospective chart review at a tertiary academic center. Results During a 10-year period, 57 and 109 patients with primary and secondary mucoceles were enrolled, respectively. Thirty-five (61.4%) of primary and 26 (23.9%) of secondary mucoceles had intraorbital extension (IOE), while seven (12.3%) of primary and two (1.8%) of secondary mucoceles had intracranial extension (ICE). In comparison of tendency for IOE or ICE between primary and secondary mucoceles in each sinus, only primary maxillary mucoceles were shown to have a significantly higher probability of IOE than secondary maxillary mucoceles. Among primary mucoceles, ethmoid mucoceles had a significantly greater capability to cause IOE while maxillary mucoceles had the least. Among secondary mucoceles, frontal and ethmoid mucoceles had a greater ability to cause IOE while maxillary mucoceles had the least. As for ICE, sphenoid mucoceles had a greater potential in both groups. Conclusions Primary mucoceles seem to have a greater potential to cause IOE and ICE than secondary mucoceles. In both groups, ethmoid mucoceles have a higher potential of IOE, while sphenoid mucoceles have a greater tendency to cause ICE.
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Affiliation(s)
- Chia-Hsiang Fu
- Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
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Serrano E, Klossek JM, Percodani J, Yardeni E, Dufour X. Surgical Management of Paranasal Sinus Mucoceles: A Long-Term Study of 60 Cases. Otolaryngol Head Neck Surg 2016; 131:133-40. [PMID: 15243570 DOI: 10.1016/j.otohns.2004.02.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Paranasal sinus mucocele is a benign pseudocystic lesion, which may originate from any of the sinus cavities. Although the diagnosis may be suggested by the clinical presentation, CT is necessary to accurately analyze the regional anatomy and extent of the lesion. MRI is helpful in defining the limited unusual lesions occurring in critical areas. Standard treatment is surgical marsupialization, through endonasal sinus surgery, which offers a conservative, minimally invasive approach, and respects the sinus architecture and natural drainage. Our long-term experience with the endonasal endoscopic approach for the treatment of mucoceles led us to subsequently expand our indications to include most mucoceles, either as the sole approach or associated with an external approach. Comprising the surgical experience of two collaborating universities, this paper describes the indications for the endonasal surgical approach and the long-term postoperative followup.
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Affiliation(s)
- Elie Serrano
- ENT Department, Rangueil University Hospital, Tolouse, France.
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Scangas GA, Gudis DA, Kennedy DW. The natural history and clinical characteristics of paranasal sinus mucoceles: a clinical review. Int Forum Allergy Rhinol 2013; 3:712-7. [PMID: 23696282 DOI: 10.1002/alr.21178] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/02/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND A retrospective data analysis at a university tertiary referral center was conducted to characterize the natural history, clinical characteristics, management principles, and outcomes of paranasal sinus mucoceles. METHODS A chart review was performed on 102 patients with a total of 133 paranasal sinus mucoceles who were treated between 1987 and 2011 at the Hospital of the University of Pennsylvania. RESULTS The study population included patients with a mean age of 53.1 years (range, 22-82 years). Patients were diagnosed with a mucocele on average 5.3 years following prior functional endoscopic sinus surgery (FESS), 17.7 years following prior paranasal sinus trauma, and 18.1 years following prior open sinus surgery. The most common presenting symptoms were headache (42.1%) and maxillofacial pressure (28.6%). The most common sites were the frontal, frontoethmoidal, and ethmoid sinuses. Fifty-seven mucoceles (44.9%) had intraorbital extension, intracranial extension, or both. Out of 133 mucoceles, 114 underwent ESS without complication. CONCLUSION The length of time between prior surgery or trauma and mucocele presentation highlights the importance of long-term follow-up in both patient care and in the understanding and reporting of surgical outcomes. In this study, most patients exhibited nonspecific symptomatology despite extensive mucoceles and a significant incidence of orbital and skull-base erosion. The endoscopic approach can be safely used for the management of such lesions.
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Affiliation(s)
- George A Scangas
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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12
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Kang IG, Kim ST, Jung JH, Paik JY, Woo JH, Cha HE, Chi MJ, Jin SM, Lee KC. Effect of endoscopic marsupialization of paranasal sinus mucoceles involving the orbit: a review of 27 cases. Eur Arch Otorhinolaryngol 2013; 271:293-7. [DOI: 10.1007/s00405-013-2538-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 04/25/2013] [Indexed: 11/29/2022]
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Hopf-Jensen S, Rubarth O, von D Ahe I, Riis P, Preuss H, Preiss M, Börm W, Müller-Hülsbeck S. Isolated oculomotor nerve palsy caused by a mucocele of an aerated anterior clinoid process. Clin Neuroradiol 2013; 24:161-4. [PMID: 23529563 DOI: 10.1007/s00062-013-0211-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- S Hopf-Jensen
- Department of Diagnostics and Interventional Radiology/Neuroradiology, Diakonissen Hospital Flensburg, Knuthstraße 1, 24939, Flensburg, Germany,
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Jolly K, Krishnasamy S, Buch VH, Buch HN, Mathews J. Sphenoid mucocele: an uncommon complication of a rare condition. Scott Med J 2012; 57:247. [PMID: 22917586 DOI: 10.1258/smj.2012.012080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 58-year-old white woman presented with sudden onset of diplopia, headache and vomiting with a history of tiredness and lethargy over the past four to six months. She had smooth, pale, hairless skin and on examination she was found to have left-sided third and sixth nerve palsy. Laboratory tests confirmed pan-anterior hypopituitarism. Computerized tomography scan of head and magnetic resonance imaging appearances were consistent with those of a sphenoid sinus mucocoele. Following adequate replacement with hydrocortisone and thyroxine she underwent sphenoid mucocoele drainage and endoscopic left sphenoethmoidectomy. Her symptoms were relieved over the next few days and she had a near-total recovery of ophthalmoplegia over the following three months. Pituitary function tests showed partial resolution of hypopituitarism with recovery of hypothalamic-pituitary-adrenal axis and hydrocortisone therapy was withdrawn, but she continued to require thyroxine.
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Affiliation(s)
- K Jolly
- Department of Endocrinology, New Cross Hospital, Wolverhampton, England, UK.
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15
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Giant frontal mucocele complicated by subdural empyema: treatment of a rare association. Acta Neurol Belg 2012; 112:85-90. [PMID: 22427297 DOI: 10.1007/s13760-012-0030-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 04/28/2011] [Indexed: 10/14/2022]
Abstract
Giant frontal mucocele (GFM) is an extremely rare cause of frontal lobe syndrome. Subdural empyema (SDE) is an uncommon complication of paranasal sinisutis, for which craniotomy and decompressive craniotomy are the most effective surgical procedures. A 54-year-old man was brought unconscious to the emergency room where recurrent generalized seizures occurred. Heroine abuse, HCV-related hepatitis, prolonged antibiotic therapy for treatment of purulent rhinorrhea, along with recent personality changes were reported. High white blood cell count, pansinusitis, GFM, SDE and cerebritis were documented. The patient underwent bifrontal craniotomy in emergency, extensive drilling of the inner aspect of the frontal bone, surgical toilet of the enlarged frontal sinus and its "cranialization". Prevotella intermedia and Fusobacterium nucleatum were isolated and antibiotic therapy was started intravenously and then continued orally for 3 months. 2 years later the patient has recovered, though minor signs of frontal lobe syndrome persist. To the authors knowledge, this is the first case of GFM with SDE reported in the literature. Although decompressive craniectomy is advocated in extreme conditions, as in this case, "internal decompressive craniectomy", obtained with craniotomy and cranialization of the frontal sinuses, is strongly advocated in cases of SDE associated with megasinuses.
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A Case of Petrous Apex Mucocele with Unilateral Ear Fullness Treated with Endoscopic Sphenoid Marsupialization. ACTA ACUST UNITED AC 2012. [DOI: 10.3342/kjorl-hns.2012.55.7.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bhattacharjee H, Soibam R, Deori N. Sphenoethmoidal mucocele presenting with unilateral visual loss. Eye Brain 2010; 2:117-120. [PMID: 28539770 DOI: 10.2147/eb.s9719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sphenoethmoidal sinus mucocele causing uniocular progressive vision loss is a rare entity and was first described by Bery in 1985. It is generally diagnosed in its advanced stage when the patients develop subjective ophthalmic symptoms. CASE A 43-year-old male presented to our institute for further evaluation and treatment of progressive visual deterioration in his left eye. The patient complained of visual impairment in his left eye for the past three months, in the form of a dark area in his left side of the visual field. OBSERVATIONS Magnetic resonance imaging (MRI) revealed a large expansile lesion in the left sided posterior ethmoidal air cells, abutting on the left optic nerve and displacing it in the region of the orbital apex. The patient underwent an urgent endoscopic sinus surgery by an Ear-Nose-Throat surgeon which resulted in stable visual acuity in the sixth postoperative month. CONCLUSIONS Sphenoethmoidal mucocele can cause irreversible blindness. Progressive vision loss with a neurological visual field defect should raise a high index of suspicion and computed tomography and MRI are to be performed to confirm the diagnosis. Collaboration between radiologists, ENT specialists, and ophthalmologists is essential for treating such cases.
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Affiliation(s)
- Harsha Bhattacharjee
- Neuroophthalmology Department, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Ronel Soibam
- Neuroophthalmology Department, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Nilutparna Deori
- Neuroophthalmology Department, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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Abstract
Endoscopic sinus surgery is commonly performed and has a low risk of major complications. Intraoperative bleeding impairs surgical conditions and increases the risk of complications. Remifentanil appears to produce better surgical conditions than other opioid analgesics, and total intravenous anaesthesia with propofol may provide superior conditions to a volatile-based technique. Moderate hypotension with intraoperative beta blockade is associated with better operating conditions than when vasodilating agents are used. Tight control of CO(2) does not affect the surgical view. The use of a laryngeal mask may be associated with improved surgical conditions and a smoother emergence. It provides airway protection equivalent to that provided by an endotracheal tube in well-selected patients, but offers less protection from gastric regurgitation. Post-operatively, multimodal oral analgesia provides good pain relief, while long-acting local anaesthetics have been shown not to improve analgesia.
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Affiliation(s)
- A R Baker
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Prahran, Vic., Australia
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19
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Lui YW, Dasari SB, Young RJ. Sphenoid masses in children: radiologic differential diagnosis with pathologic correlation. AJNR Am J Neuroradiol 2010; 32:617-26. [PMID: 20595365 DOI: 10.3174/ajnr.a2144] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Childhood central skull base masses are rare, often difficult to diagnose, and have overlapping imaging findings. In this review, we provide an overview of the epidemiology, clinical findings, and management of pediatric sphenoid bone and sphenoid sinus masses with an emphasis on imaging findings that may help to differentiate lesions. Radiologic-pathologic correlation is provided. Finally, an imaging-based algorithm is presented as a guide to help radiologists narrow their differential diagnoses. Some of the entities discussed are virtually unique to the pediatric population; others occur rarely in this age group but should be considered in the appropriate clinical setting. Entities included in the discussion are grouped into 2 categories: those that cause nonaggressive osseous remodeling and those that are more commonly associated with aggressive bone changes. Mucocele, aneurysmal bone cyst, giant cell lesions, meningioma, and fibrous dysplasia tend to remodel bone, while entities such as chordoma, craniopharyngioma, rhabdomyosarcoma, sinonasal carcinoma, and neuroblastoma may cause more aggressive local bone changes.
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Affiliation(s)
- Y W Lui
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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20
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Morita S, Mizoguchi K, Iizuka K. Paranasal sinus mucoceles with visual disturbance. Auris Nasus Larynx 2010; 37:708-12. [PMID: 20570455 DOI: 10.1016/j.anl.2010.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 01/29/2010] [Accepted: 04/30/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Paranasal sinus mucoceles may cause visual disturbance in patients because of their close proximity to the orbit. We aimed to investigate visual prognosis to determine whether it is influenced by the interval before surgery and the severity of visual disturbance, and to heighten the physician's awareness of the occurrence of this disease. METHODS We retrospectively reviewed eight surgically treated patients with paranasal sinus mucoceles accompanied by visual disturbances between March 2005 and January 2009, and examined the visual acuity outcome of the patients. RESULTS Four patients with a mild visual acuity loss showed improvement after surgical drainage within 1 month after onset. Two patients with visual disturbances persisting for more than 1 year did not show postoperative improvements. Although two patient's preoperative visual acuity loss was worse than the ability to count fingers, they showed a remarkable improvement after surgery. CONCLUSIONS These results show the importance of diagnosing and treating paranasal sinus mucoceles with visual disturbance as soon as possible. In addition, the improvement of visual acuity can be expected if surgery is performed within 1 month after onset, and the patient's preoperative visual acuity loss is mild. However, if patients with severe visual acuity loss consult otolaryngologists at a later date, surgery may still be considered worthwhile.
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Affiliation(s)
- Shinya Morita
- Department of Otolaryngology, Kushiro City General Hospital, 1-12 Shunkodai, Kushiro, Hokkaido, Japan.
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21
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Abstract
Endoscopic sphenoidotomy is a common surgical procedure that often accompanies routine sinus surgery. Safe completion of a sphenoidotomy depends on a thorough understanding of the surrounding anatomy, reviewing preoperative imaging, and maintaining intraoperative orientation. Intraoperative complications include local hemorrhage, catastrophic hemorrhage caused by internal carotid injury, optic nerve injury, and CSF leak. Postoperative complications tend to be less severe and include postoperative stenosis and mucocele formation. Regarding surgery of the sphenoid sinuses, the best management of complications truly is prevention, making pre- and intraoperative vigilance vital to a successful outcome.
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Sphenoid sinus mucocele: 10 cases and literature review. The Journal of Laryngology & Otology 2009; 124:44-7. [PMID: 19825255 DOI: 10.1017/s0022215109991551] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Sphenoid sinus mucoceles represent only 1-2 per cent of all paranasal sinus mucoceles. Patients may present with a myriad of symptoms. Pre-operative investigations include nasoendoscopy, computed tomography and/or magnetic resonance imaging. Treatment is by endoscopic sinus surgery. METHODOLOGY A retrospective review of the archives of the Singapore General Hospital otolaryngology department (1999-2006) identified 10 cases of sphenoid sinus mucocele. Patient demographics, presenting symptoms, investigations and treatment were evaluated. RESULTS The 10 patients identified (three women and seven men) had a mean age of 54.5 years (range 24-70 years). Thirty per cent of patients had a history of nasopharyngeal carcinoma treated with radiotherapy. Presenting symptoms, in order of decreasing frequency, were: ocular symptoms (50 per cent), headaches (30 per cent), nasal discharge (30 per cent) and facial pain (10 per cent). All patients underwent pre-operative computed tomography or magnetic resonance imaging. Twenty per cent of patients had evidence of intracranial involvement on imaging. All patients underwent uncomplicated transnasal sphenoidotomy and drainage of the mucocele. There was no clinical or radiological evidence of recurrence at a mean follow up of 29 months (range 4-90 months). CONCLUSION Sphenoid sinus mucocele is a rare condition. In this study, radiation to the head and neck appeared to be a predisposing factor, and eye symptoms were the commonest presentation. Endoscopic sinus surgery is a safe and effective treatment modality.
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Extensive paranasal sinus mucoceles: a 15-year review of 82 cases. Am J Otolaryngol 2009; 30:234-8. [PMID: 19563933 DOI: 10.1016/j.amjoto.2008.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 05/17/2008] [Accepted: 06/05/2008] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of the study was to report the clinical characteristics, management, and outcome of patients with extensive paranasal sinus mucoceles. MATERIALS AND METHODS In a retrospective study, 82 patients with intracranial or intraorbital extension due to paranasal sinus mucoceles who were surgically treated between 1993 and 2007 were studied. In addition, clinical data, presenting symptoms, clinical features, management, and outcome were analyzed. RESULTS The study population included 42 males and 40 females, with a mean age of 52.7 years (range, 15-87 years). The most common presenting symptoms were ptosis (27/82, 32.9%) and periorbital swelling (24/82, 29.3%). The main radiologic finding on computed tomography scan was bony defect of lamina papyracea and/or medial superior orbital rim. Sixty-six patients underwent endoscopic sinus surgery; among them, 3 patients had recurrence (3/77, 3.9%) during follow-up periods. CONCLUSION In our study, a majority of patients with extensive paranasal sinus mucoceles exhibited ophthalmologic symptoms before treatment (81/82, 98.8%). Computed tomography scanning was a feasible tool for preoperative assessment. A satisfactory outcome can be achieved after surgical treatment of endoscopic sinus surgery.
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24
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Abstract
Sphenoid isolated lesions are rare; they occur in 2% to 3% out of all paranasal sinus lesions. Diagnosis is based on the endoscopic examination and computed tomography scan or magnetic resonance imaging of the maxillofacial area. In this study, we present patients with sphenoid mucocele in the Maxillo-facial Surgery Department, University of Rome La Sapienza, treated with the endoscopic technique. Moreover, a literature review is performed, dealing with the evolution of approaches to the sphenoid sinus. From January 2001 to January 2007, we treated 75 patients affected by paranasal sinus mucocele. Out of this number, 8 patients (11%) presented an isolated localization in the sphenoid sinus. These patients were divided as follows: 5 involved the right sphenoid sinus and 3 involved the left sphenoid sinus. Isolated sphenoid sinus disease is a rare entity that can result in serious sequelae if diagnosis and treatment are inappropriately delayed. In our study, we highlighted how the endoscopic approach allows the removal of even large mucocele with the use of 45-degree angle optic and if it is possible to control and remove lateral walls of the sphenoid sinus. In our experience, we shifted from a traditional approach to the endoscopic approach. At the present time, the endoscopic approach represents the gold standard for sphenoid sinus mucocele treatment because it allows the best view of the sphenoid sinus and grants a better restoring of respiratory function and a higher compliance from the patient.
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25
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Current management of isolated sphenoiditis. Eur Arch Otorhinolaryngol 2008; 266:987-92. [PMID: 19052765 DOI: 10.1007/s00405-008-0873-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 11/10/2008] [Indexed: 10/21/2022]
Abstract
Isolated sphenoiditis (IS) is a relatively rare clinical entity which might present with serious complications. The clinical records of ten patients with IS were reviewed. The presenting symptoms, the findings, and the treatments given were noted. Eight patients were female and two were male, and their age varied between 9 and 65 years (mean 31 years). The main presenting symptom was headache in five patients, diplopia in four patients, and postnasal drainage in one patient. The duration of the symptoms ranged between 48 h and 1 year. The diagnosis was accomplished by history, nasal endoscopy and radiological examination (computed tomography and/or magnetic resonance imaging). Two patients had fungus ball. One patient was a scuba diver as a possible predisposing factor. All of the patients underwent medical treatment consisting of intravenous antibiotics or oral antibiotics, and endoscopic sinusotomy was performed in nine patients additionally. Complete resolution was obtained for all patients except one who had diplopia for one year. IS may present with headache and orbital symptoms. Timely diagnosis and treatment are substantial in order to avoid serious complications, and to obtain a complete recovery. Medical treatment does not avoid surgery in majority of cases. Surgery is indicated from the very beginning specifically for the cases starting with diplopia which might be suggestive of a progression of the infection. Currently the most frequently used approach is endoscopic transnasal sphenoidotomy. This technique seems to be effective and less traumatic compared to other approaches.
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26
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Kim JL, Yang JW. Clinical Characteristics of Paranasal Sinus Mucoceles Which Invade the Orbit. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.4.562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Lim Kim
- Department of Ophthalmology, College of Medicine, Inje University, Pusan, Korea
- Ophthalmology Research Foundation, Inje University, Pusan, Korea
| | - Jae Wook Yang
- Department of Ophthalmology, College of Medicine, Inje University, Pusan, Korea
- Ophthalmology Research Foundation, Inje University, Pusan, Korea
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27
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Levy J, Monos T, Puterman M. Bilateral consecutive blindness due to sphenoid sinus mucocele with unilateral partial recovery. Can J Ophthalmol 2005; 40:506-8. [PMID: 16116519 DOI: 10.1016/s0008-4182(05)80015-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We present an interventional case report of a rare occurrence of sphenoid sinus mucocele causing bilateral consecutive blindness with unilateral partial recovery after endoscopic surgery. METHODS A 64-year-old woman with known sphenoid sinus mucocele and right blindness was referred because of an acute drop of vision to hand motion in her only-seeing left eye over 5 days. Imaging revealed a large mucocele enlarging the sphenoid sinus, eroding the base of the skull, protruding into the cranial cavity, and compressing the left optic nerve. RESULTS Urgent endoscopic sphenoidotomy was performed. Several hours after the procedure, visual acuity was partially recovered in the left eye. INTERPRETATION Sphenoid sinus mucoceles can cause bilateral blindness. A high index of suspicion and urgent imaging studies are necessary. Because visual recovery depends on prompt diagnosis and surgical intervention, a close collaboration between otolaryngologists and ophthalmologists is crucial.
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Affiliation(s)
- Jaime Levy
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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28
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Ada M, Kaytaz A, Tuskan K, Güvenç MG, Selçuk H. Isolated sphenoid sinusitis presenting with unilateral VIth nerve palsy. Int J Pediatr Otorhinolaryngol 2004; 68:507-10. [PMID: 15013621 DOI: 10.1016/j.ijporl.2003.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2003] [Revised: 11/12/2003] [Accepted: 11/19/2003] [Indexed: 11/17/2022]
Abstract
Isolated sphenoid sinusitis is a rare disorder. There are some difficulties in its diagnosis and the first presentation of this disorder might be with complications. These complications are essentially due to the anatomical location of the sinus and its proximity to the intra-cranial and orbital contents, to which infection may easily spread. In this paper, we report a case of isolated sphenoid sinusitis in a 12-year-old girl who was presented with unilateral VIth nerve palsy. She was initially treated with parenteral antibiotherapy, the abducens nerve palsy recovered but as sphenoiditis persisted she underwent an endoscopic sphenoidotomy. We discuss the clinical features, the diagnostic tools, and the treatment options for this entity.
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Affiliation(s)
- Mehmet Ada
- Ear Nose and Throat-Head & Neck Surgery Department, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
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29
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Sugiura N, Ochi K, Komatsuzaki Y, Koizuka I. Powered endoscopic marsupialization for recurrent sphenoid sinus mucocele: a case report. Auris Nasus Larynx 2003; 30 Suppl:S107-10. [PMID: 12543173 DOI: 10.1016/s0385-8146(02)00141-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of recurrent sphenoid mucocele successfully treated by using a powered instrument under endoscopic control. A 59-year-old male came to our clinic complaining of severe headache, right-side facial numbness (in the areas of the first and second branches of the trigeminal nerve), diplopia, and right blepharoptosis. Computed tomography (CT) imaging revealed opacification and expansion of the sphenoid sinus lesion. The lesion was diagnosed as right-side sphenoid mucocele affecting the functions of the trigeminal (first and second branches), oculomotor, and abducent nerves. Endoscopic drainage of the right-side sphenoid mucocele leads to gradual improvement of these symptoms. Approximately 1 year after the drainage procedure, the size of the enlarged sphenoid sinus ostium had decreased. The patient underwent endoscopic right-side total marsupialization of the sphenoid sinus using a powered instrument. Subsequently, the patient has presented no evidence of recurrent disease after 1 year of follow-up.
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Affiliation(s)
- Natsuki Sugiura
- Department of Otolaryngology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, 216-8511, Kawasaki, Japan.
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30
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Kieff DA, Busaba N. Treatment of isolated sphenoid sinus inflammatory disease by endoscopic sphenoidotomy without ethmoidectomy. Laryngoscope 2002; 112:2186-8. [PMID: 12461338 DOI: 10.1097/00005537-200212000-00011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Isolated chronic sphenoid sinusitis is a rare entity. The study was conducted to determine the efficacy of endoscopic sinus surgery with partial middle turbinectomy and without ethmoidectomy in treating isolated sphenoid opacification from inflammatory and infectious disease. STUDY DESIGN Case series of 20 patients generated by retrospective review of 307 consecutive patients who underwent surgical treatment for chronic rhinosinusitis. METHODS The medical records were reviewed for pertinent demographic, symptom, radiographic, and endoscopic data preoperatively, interoperatively, and postoperatively. All patients in the series underwent computed tomographic image-guided endoscopic sphenoid sinus surgery with partial middle turbinectomy. RESULTS The study population consisted of 12 male and 8 female patients between 28 and 75 years of age. Headache (15 patients) and/or postnasal drip (14 patients) were the presenting symptoms in 17 of the patients. Three patients were asymptomatic. Surgical findings included inspissated secretions (15 patients), fungal debris (2 patients), and mucopyoceles (3 patients). The 17 patients with preoperative symptoms were symptom free by 12 weeks postoperatively and have remained so with follow-up ranging from 12 months to 3.25 years (mean follow-up, 23.1 mo). There were no operative complications in the series. CONCLUSIONS Endoscopic sphenoid sinus surgery without ethmoidectomy is effective for treating isolated sphenoid sinus opacification associated with inflammatory or infectious sinus disease. Partial middle turbinectomy at the time of surgery facilitates the approach, as well as postoperative cleaning and surveillance.
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Affiliation(s)
- David A Kieff
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston 02114, USA.
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31
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Abstract
OBJECTIVES/BACKGROUND Traditional teaching has emphasized the need for complete removal of sinus mucoceles to achieve a cure. However, with the introduction of endoscopic sinus surgical instruments and techniques, there has been a trend toward transnasal endoscopic management of sinus mucoceles. The aim of this study is to establish the efficacy of endoscopic management of sinus mucoceles. STUDY DESIGN Retrospective review. PATIENTS AND METHODS Between 1988 and 2000, 103 patients with 108 paranasal sinus mucoceles were treated endoscopically. This series includes 66 frontal and frontoethmoid, 17 ethmoid, 7 sphenoethmoid, 12 sphenoid, and 6 maxillary mucoceles. Ninety patients (83.3%) had intraorbital extension and 85 of them presented with some degree of proptosis or eye displacement. Sixty patients (55.5%) had erosion of the skull base with varying degrees of intracranial extension of the mucocele. Follow- up ranged from 1 to 131/2 years with a median of 4.6 years. INTERVENTION All patients underwent endoscopic-wide marsupialization of the mucocele cavity. Stents were used in frontal mucoceles only. RESULTS Recurrence of a frontal mucocele was seen in 1 patient (0.9%). In 5 patients, out of 23 patients who presented with massive pansinus polyposis in addition to the mucocele, recurrent polyposis required revision surgery. However, the mucoceles did not recur in those patients. CONCLUSIONS There is increasing evidence in the literature that endoscopic management of sinus mucoceles results in long-term control with recurrence rates at or close to 0%. Rhinologic surgeons should consider the endoscopic technique as the surgical treatment of choice.
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Affiliation(s)
- G Har-El
- Department of Otolaryngology, State University of New York, Health Science Center at Brooklyn, New York 11203, USA
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32
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Ikeda K, Takahashi C, Oshima T, Suzuki H, Satake M, Hidaka H, Takasaka T. Endonasal endoscopic marsupialization of paranasal sinus mucoceles. AMERICAN JOURNAL OF RHINOLOGY 2000; 14:107-11. [PMID: 10793914 DOI: 10.2500/105065800781692886] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Paranasal sinus mucoceles are relatively common in Japan, especially after prior Caldwell-Luc surgery. Recently developed endonasal endoscopic approaches were used for the drainage and marsupialization of mucoceles. We present the surgical treatment of 97 patients with mucoceles, including 68 maxillary, 13 ethmoid, nine frontal, seven sphenoid, eight frontoethmoid, and one sphenoethmoid sinuses. Six patients with maxillary mucoceles were operated via a sublabial incision. For frontal mucoceles, four patients were treated by a combined external and endonasal endoscopic approach. The other mucoceles underwent complete marsupialization under endonasal endoscopic control. There were no intraoperative or postoperative complications. No evidence of recurrence was observed in any patients during follow-up periods ranging from 36 to 84 months.
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Affiliation(s)
- K Ikeda
- Department of Otorhinolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, Sendai, Japan
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33
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Abstract
OBJECTIVES To assess the outcome of functional endoscopic sphenoid sinus surgery, and to determine the predictors of outcome. STUDY DESIGN Retrospective chart review of 651 consecutive endoscopic sinus procedures performed between 1992 and 1997. SETTING USC University Hospital, University of Southern California, Los Angeles. MATERIALS AND METHODS Seventy-four patients (11.4% of all endoscopic procedures) with sphenoid sinus disease were selected. All 74 patients were mailed a sinusitis-specific questionnaire, and 46 of them (62.2%) responded. Outcome measures derived from clinician ratings were applied to all 74 patients, and those derived from self-report were applied to 46. Outcome measures were determined from patient questionnaires at a minimum of 6-month postoperative follow-up, operative complications, and clinician perceptual ratings. Patient questionnaires addressed general patient satisfaction, symptom score, and medication usage. A statistical analysis was performed using chi2 test, linear regression, and one-way nonparametric ANOVA. RESULTS Favorable surgical outcomes based on general patient satisfaction (84.8%, n = 39) and clinician perceptual rating (78.4%, n = 58) were noted. Minor postoperative complications were noted in 10 patients (13.5%) and 8 patients (10.8%) needed revision endoscopic procedures during follow-up. Of the complications, eight (80%) occurred in revision endoscopic procedures. The use of an expanded, sinus-specific symptom score revealed far fewer favorable outcomes (56.5%, n = 26). Seven outcome predictors were established, although none of the predictors held for more than one of the six outcome measures used. CONCLUSION Endoscopic sphenoid sinus surgery is safe and effective. An expanded symptom score is recommended to assess the outcome of this procedure.
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Affiliation(s)
- F S Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, USA
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34
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Voegels RL, Luxemberger W, Stammberger H. Transnasal endoscopic removal of an extensive immature teratoma in a three-month-old child. Ann Otol Rhinol Laryngol 1998; 107:654-7. [PMID: 9716865 DOI: 10.1177/000348949810700804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of endoscopy in the paranasal sinuses has grown and diversified in the past few years. We present a case of an immature malignant teratoma originating from the sinuses, with intracranial extension to the middle and posterior fossae, that was managed and removed endoscopically. At the age of 2 months, the patient was hospitalized for respiratory instability. Diagnosis was made with biopsy, and chemotherapy was introduced. After 4 weeks, an endonasal endoscopic approach was performed, and a complete macroscopic removal of the tumor was achieved without complications. Follow-up for 10 months with magnetic resonance imaging and endoscopic examination has not revealed recurrence. In selected cases, the endonasal endoscopic technique may be a good alternative to the external approach, reducing the operative trauma and mortality.
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Affiliation(s)
- R L Voegels
- Department of Otolaryngology, University of Graz Medical School, Austria
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35
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Abstract
Traditional teaching in the United States has emphasized the need for complete removal of sinus mucoceles to achieve a cure. In Europe, however, many rhinologic surgeons have been treating sinus mucoceles by draining and marsupializing them. We present our experience with the treatment of 16 patients with sinus mucoceles. This series includes nine frontal, two ethmoid, two sphenoid, one sphenoethmoid, and two maxillary sinus mucoceles. All patients were treated transnasally under telescopic control. All mucoceles were marsupialized, and 11 were stented. Intraoperative transillumination as well as intraoperative lateral x rays (for sphenoethmoid lesions) and anteroposterior x rays (for frontal mucoceles) were used to ensure complete marsupialization of the lesion and to confirm proper placement of the stent. There were no complications associated with the procedure. Follow-up periods ranged from 8 to 62 months (median, 32 months). No evidence of recurrent mucocele has been seen in any of the patients.
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Affiliation(s)
- G Har-El
- Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, 11201, USA
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36
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Yanagisawa E, Joe JK, Pastrano JA. Mucocele of the Pterygoid Recess of the Sphenoid Sinus: Endoscopic Microdebrider Excision via a Transnasal Sphenoidotomy Approach. EAR, NOSE & THROAT JOURNAL 1997. [DOI: 10.1177/014556139707601105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Eiji Yanagisawa
- Southern New England Ear, Nose, Throat and Facial Plastic Surgery Group, New Haven, CT
- Section of Otolaryngology, Yale University School of Medicine, New Haven, CT
| | - John K. Joe
- Section of Otolaryngology, Yale University School of Medicine, New Haven, CT
| | - Joe A. Pastrano
- Section of Otolaryngology, Yale University School of Medicine, New Haven, CT
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37
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Yumoto E, Hyodo M, Kawakita S, Aibara R. Effect of sinus surgery on visual disturbance caused by spheno-ethmoid mucoceles. AMERICAN JOURNAL OF RHINOLOGY 1997; 11:337-43. [PMID: 9768314 DOI: 10.2500/105065897781286025] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fifteen patients suffering from visual disturbance of varying degrees caused by a mucocele of the posterior ethmoid and/or sphenoid sinuses underwent marsupialization of a mucocele into the nasal cavity. Five of the eight patients with severe visual loss worse than 20/200 showed recovery of measurable vision. Two of these five were operated on within 24 hours after the onset of visual loss and showed marked recovery to 20/25 and 20/15. The other seven patients who had relatively mild visual disturbance experienced improvement of visual acuity or remission of subjective complaints such as blurred vision post-operatively. During operation partial bony defect was found in the optic canal in 12 patients and in the skull base in 12 patients. A good understanding of this disease by ophthalmologists and otolaryngologists is essential for early diagnosis and prompt surgical treatment to avoid permanent visual dysfunction and operative sequelae.
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Affiliation(s)
- E Yumoto
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Ehime University, Japan
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38
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Esteban F, Ruiz-Avila I, Vilchez R, Gamero C, Gomez M, Mochon A. Ectopic pituitary adenoma in the sphenoid causing Nelson's syndrome. J Laryngol Otol 1997; 111:565-7. [PMID: 9231094 DOI: 10.1017/s0022215100137922] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
An ectopic functioning pituitary in the sphenoid is an extremely rare occurrence, and even rarer is pituitary adenoma causing symptoms of Nelson's syndrome. A case is presented of a young female diagnosed and treated in our clinic. The only functioning hypophyseal tissue was detected inside the sphenoid, as the pituitary gland had been radiated because of Cushing's syndrome 10 years before and imaging studies revealed an empty sella.
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Affiliation(s)
- F Esteban
- Servicio de Otorrinolaringología, Hospital Universitario, Virgen de Valme, Sevilla
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39
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40
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Abstract
OBJECTIVE AND IMPORTANCE There are increasing reports of nasal sinus mucopyoceles eroding the base of the cranium and causing the rapid onset of neurological complications. Uncommon presentations can mimic tumors, but the infectious nature mandates an urgent surgical decompression. It is important to document these uncommon presentations. CLINICIAL PRESENTATION: A mucopyocele of the clivus is reported in a patient with a frequent history of sinusitis. Diplopia caused by an acute sixth nerve palsy prompted the radiological diagnosis with computed tomography and magnetic resonance imaging. INTERVENTION Transsphenoidal drainage of the lesion lead to marked improvement in the patient. CONCLUSION This is the third reported case of a clival mucocele. Mucoceles of nasal sinuses can erode intracranially, causing neurological sequalae, and clival involvement is extremely rare. Early drainage leads to marked improvement.
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Affiliation(s)
- R Chua
- Department of Neurosurgery, Indiana University Medical Center, Indianapolis, USA
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41
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Abstract
Juxtaposed between the posterior nasal cavity and skull base, the diseased sphenoid sinus presents unique challenges when surgical drainage is required. Endoscopic techniques have gained widespread popularity for the treatment of sphenoid sinusitis, yet the efficacy of such treatment remains largely unknown. Thirty-four patients who underwent endoscopic sphenoidotomy were monitored over a period of 6 months to 5 years. Surgery was performed with the superior turbinate used as the key landmark for identification and enlargement of the natural sphenoid ostium. Surgical access was through either a transnasal or transethmoid approach, depending on whether disease was limited to the sphenoid sinus. Prospective analysis of 26 patients with established outcome measures demonstrated a significant reduction in facial pain, nasal drainage, and congestion 6 months after surgery ( p < 0.0001). Medication use was also reduced but to a lesser extent ( p < 0.05). Endoscopic sphenoidotomy appears to be a safe technique that effectively reduces patient morbidity associated with sphenoid sinusitis.
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Affiliation(s)
- R Metson
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA
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42
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Dandie GD, Pell MF, Atlas MD. Endoscopic transsphenoidal approach to the pituitary fossa technical note. J Clin Neurosci 1996; 3:65-8. [DOI: 10.1016/s0967-5868(96)90085-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/1995] [Accepted: 08/11/1995] [Indexed: 10/26/2022]
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43
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Eiras Ajuria J, López López A. Mucocele esfenoidal: descripción de dos casos. Neurocirugia (Astur) 1995. [DOI: 10.1016/s1130-1473(95)70799-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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44
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Stankiewicz JA, Newell DJ, Park AH. Complications of Inflammatory Diseases of the Sinuses. Otolaryngol Clin North Am 1993. [DOI: 10.1016/s0030-6665(20)30796-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Rejab E, Said H, Saim L, Thim L. Sphenoid sinus mucocoele: a possible late complication of radiotherapy to the head and neck. J Laryngol Otol 1991; 105:959-60. [PMID: 1761955 DOI: 10.1017/s002221510011792x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A case of sphenoid sinus mucocoele following radiotherapy in a patient with nasopharyngeal carcinoma is reported. Diagnosis was made by radiological investigation and confirmed at surgery performed via a sublabial transeptal approach. Its content was completely removed and continuous drainage of the sinus was maintained by an indwelling tube. It is felt that the sphenoid mucocoele developed as a result of occlusion of the sinus ostium by scarred mucosa following radiotherapy.
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Affiliation(s)
- E Rejab
- Department of Otolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur
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46
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Nicolai P, Redaelli de Zinis LO, Tomenzoli D, Maroldi R, Antonelli AR. Sphenoid mucocele with intracranial invasion secondary to nasopharyngeal acinic cell carcinoma. Head Neck 1991; 13:540-4. [PMID: 1791147 DOI: 10.1002/hed.2880130611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We present a case of sphenoid mucocele with large invasion of the middle cranial fossa, secondary to a nasopharyngeal acinic cell carcinoma, occurring in a 52-year-old man. To the best of our knowledge, this association has not been reported so far. We discuss the importance of imaging techniques in delineating the relationship between the two lesions, as long as the clinical and therapeutic problems related both to sphenoid mucocele and acinic cell carcinoma.
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Affiliation(s)
- P Nicolai
- Department of Otorhinolaryngology, University of Brescia, Italy
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Green DC, Calcaterra TC. Sphenoethmoid sinus mucocele presenting with amenorrhea and galactorrhea. Otolaryngol Head Neck Surg 1991; 104:856-7. [PMID: 1908980 DOI: 10.1177/019459989110400615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- D C Green
- UCLA Division of Head and Neck Surgery
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Abstract
Sphenoid sinus mucous cysts are rare, benign, expansile masses, which can form mucoceles if the entire sinus is filled. Due to their close proximity to numerous important anatomical structures, they can cause a variety of different symptoms. The incidental finding of a sphenoid sinus mucous cyst during cephalometric radiology for orthodontic analysis is reported.
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Affiliation(s)
- A G Farman
- School of Dentistry, University of Louisville, Kentucky
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