Surgical treatment of isolated sphenoid sinusitis - A case series and review of literature

Abstract

Introduction: Isolated sphenoid opacification is a rare pathology. Unlike other sinusitis, the treatment is most often surgical. Only few studies reporting the recurrence rates with long-term follow-ups are available in the literature. In our experience, isolated sphenoid sinusitis tends to have a significant recurrence rate after a first surgical intervention. This study aims to describe our experience with patients operated for isolated sphenoid sinusitis and to compare our reoperation and complication rates with those reported in the literature.

Methods: We conducted an electronic chart review of patients operated at the CHU de Québec between 2007 and 2018 for isolated sphenoid sinusitis.

Results: 29 patients were analyzed. All patients had a sphenoidectomy with a transnasal approach. The reoperation rate was 10.3% (3/29) and the mean recurrence time was 15 (9-26) months. Among the patients reoperated, 2 patients had a fungus ball and one had a mucocele. Both patients with fungal balls had reossification of their sphenoidal ostium whereas the patient with the mucocele rather had a mucosal closure. No patient encountered any serious post-operative complication. Median duration of follow-up was 44 months (IQR: 25-68) for the 29 patients analyzed in our study.

Conclusion: Reoperation rates reported in the literature are probably underestimated. Our series emphasizes the importance of long-term follow-up for these pathologies. Highly inflammatory and chronic conditions such as fungal diseases could be linked to an increase in the occurrence of relapses.

Keywords: Endoscopic sinus surgery; Sinusitis; Sphenoid sinus; Sphenoidal sinusitis; Transnasal sphenoidectomy.

Fig. 1

A. Identification of the superior turbinate, anterior aspect of the sphenoid and it’s natural ostium. B. Wide opening of the sphenoid ostium to the medial orbital wall and the skull base in the superior portion using the Kerrison forceps or a drill.

Fig. 2

71 year-old female with right sphenoid fungus ball. A: initial CT scan showing right sphenoid fungus ball with hyperostosis and calcifications, B: recurrence of right sphenoid fungus ball with ostial ossification.

Fig. 3

82 year-old female with left sphenoid fungus ball. A: initial CT scan showing bone thickenings, calcifications with posterior wall dehiscence and clival erosion. B: recurrence of left sphenoid fungus ball with ostial ossification.

Fig. 4

53 year-old female with left sphenoid mucocele. A: initial CT scan showing complete opacification of the left sphenoid sinus. B: recurrence of opacification with mucosal stenosis of the sphenoid ostium.