Isolated Sphenoid Sinus Inflammatory Disease-A Report of 14 Cases

Abstract

Introduction: Isolated sphenoid sinus inflammatory diseases (ISSIDs) are responsible for about 75% of isolated sphenoid sinus opacifications. Computer tomography (CT) and magnetic resonance imaging (MRI) should be used in a complementary manner for the assessment of ISSIDs. This evaluation sheds some light on the extent of disease and intracranial and intra-orbital involvement.

Materials and methods: The current study aimed to evaluate the medication histories of 14 patients who underwent endoscopic sinus surgery (ESS) for ISSIDs within 2015-2018. This assessment was carried out to analyze the presenting symptoms, diagnostic work-up, additional therapies, and complications. Moreover, it can help us compare our data with pertinent literature.

Results: As evidenced by the obtained results, ISSID lesions included bacterial sphenoiditis (42.9%), fungus ball (21.4%), invasive fungal sphenoiditis (14.3%), mucocele (14.3%), and retention cysts (7.1%). In addition, headache was found to be the major complaint, followed by nasal symptoms. Diplopia, and signs and symptoms of the involvement of other cranial nerves were less frequent. All patients underwent endoscopic transnasal sphenoidectomy. The overall survival rate was reported as 92.9% (13/14), and all patients with cranial nerve palsies demonstrated complete clinical remission.

Conclusion: Both the review of related literature and our clinical cases were indicative of the dangerous consequences of ISSIDs. Their varied and unspecific presentation and the limited reliability of nasal endoscopy required the cooperation of ENT (ear, nose, and throat) team with other specialists to make an accurate diagnosis and decide on the most appropriate therapeutic choices. If the signs of intracranial complications were detected, surgery should be promptly performed to maximize the chances of recovery.

Keywords: Cavernous sinus; Isolated sphenoid sinus inflammatory diseases; Sphenoid sinusitis; Visual disturbance.

Fig 1

(A) Coronal CT scan shows an opacity of the lateral recess of the right sphenoid sinus (SS) with thickening and sclerosis of bone surrounding the pterygoid process (white arrow) and the orbital apex (white arrowhead). Focal interruption of the foramen rotundum (small star) and lateral recess of the sphenoid sinus is also present.(B) Axial T2-weighted MRI demonstrates a marked hypointense signal (small star) in the lateral recess of the SS with inflamed mucosa at the periphery. (C) Axial gadolinium enhanced T1-weighted MRI shows soft tissue protruding through the breach in the lateral recess wall of the SS (black arrowhead), invading the right internal pterygoid muscles, the masticatory fossa (double small star), and the pterygopalatine fossa (single small star) and infiltrating CN V2 (black arrow) and CN V3 (white arrow) trigeminal branches. Endocranially, the tissue was extended into the cavernous sinus surrounding the Gasser ganglion (double angled arrow). (D) Intraoperative view during endoscopic sinus surgery indicates the erosion of the lateral recess wall of the right SS (white arrow)

Fig 2

(A) Axial CT scan displays a complete opacification of the right sphenoid sinus, (B) hyperpneumatization of the pterygoid recess, and corresponding endoscopic endonasal surgery image

Fig 3

Axial (A) and coronal (B) CT scan demonstrates the opacification of the left sphenoid sinus with calcifications (white arrows) and marked thickening of the walls of the sinus. (C) Coronal T2-weighted MRI indicates an isointense signal from the fungal mass (asterisk) with hyperintense inflamed mucosa at the periphery of the sinus. Intraoperative view of the fungal concrement in the sphenoid sinus floor (D)

Fig4

(A) Axial CT scan displays heterogeneous opacification in the left sphenoid sinus with remodeling of the adjacent bone. (B) Intraoperative images demonstrate mucocele after the opening of the anterior wall of the sphenoid sinus. (C) Endoscopic removal of the mucocele