Identification of Onodi Cell and New Classification of Sphenoid Sinus for Endoscopic Sinus Surgery

Onodi cells are posterior ethmoid cells superolateral to the sphenoid sinus that is intimately associated with the optic nerve. Embryologically, they are derived from ethmoid cells that have undergone dedifferentiation. The anatomic relationship of the Onodi cell to the optic nerve and the internal carotid artery has not been clearly documented in the literature. Forty-four sagittal sections of cadaver heads and 83 CT scans of the sinuses were examined. Case studies of three patients with Onodi cell sinusitis are presented. Two patients underwent endoscopic sinus surgery, and the other chose conservative medical management. The cadaver specimens revealed Onodi cells in 14% (6/44 sections). They were located lateral, superior, or superolateral to the sphenoid sinus. These relationships were further delineated by studying CT scans of the sinuses of 76 patients. Six patients (8%) had Onodi cells. Four of them had a dehiscence of the optic nerve adjacent to the Onodi cell. Twelve patients (16%) demonstrated a dehiscence of the internal carotid artery. These findings have important implications in endoscopic sinus surgery. The anatomic variability of the posterior ethmoids, sphenoid sinus, internal carotid artery, and optic nerve makes this surgical approach particularly challenging.

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Isolated Sphenoid Sinus Mucocele: A Rare Case and Review of Literature

Journal of Postgraduate Medicine Education and Research ◽

10.5005/jp-journals-10028-1154 ◽

2015 ◽

Vol 49 (2) ◽

pp. 91-93

Author(s):

Karan Gupta ◽

Satheesh Kumar Sunku

Keyword(s):

Nasal Obstruction ◽

Clinical Examination ◽

Endoscopic Sinus Surgery ◽

Sphenoid Sinus ◽

Rare Case ◽

Sinus Surgery ◽

Review Of Literature ◽

Postnasal Drip

ABSTRACT Isolated sphenoid sinus mucoceles are uncommon and difficult to diagnose clinically owing to the inaccessibility of the sphenoid sinus to clinical examination. A case of infected sphenoid sinus mucocele in which the patient complained of progressive nasal obstruction and postnasal drip without any other classical features of sphenoid sinus mucocele is discussed here. The pathology of mucocele and endoscopic sinus surgery as the treatment has been discussed in this article. How to cite this article Gupta K, Virk RS, Sunku SK. Isolated Sphenoid Sinus Mucocele: A Rare Case and Review of Literature. J Postgrad Med Edu Res 2015;49(2):91-93.

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Sphenoid sinus mucocele: 10 cases and literature review

The Journal of Laryngology & Otology ◽

10.1017/s0022215109991551 ◽

2009 ◽

Vol 124 (1) ◽

pp. 44-47 ◽

Cited By ~ 36

Author(s):

S R Soon ◽

C M Lim ◽

H Singh ◽

D S Sethi

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Endoscopic Sinus Surgery ◽

Sphenoid Sinus ◽

Sinus Surgery ◽

Nasal Discharge ◽

Resonance Imaging ◽

Presenting Symptoms ◽

Singapore General Hospital

AbstractIntroduction: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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The Prevalence of an Onodi Cell in Adult Thai Cadavers

Ear Nose & Throat Journal ◽

10.1177/014556130308200314 ◽

2003 ◽

Vol 82 (3) ◽

pp. 200-204 ◽

Cited By ~ 30

Author(s):

Sanguansak Thanaviratananich ◽

Kowit Chaisiwamongkol ◽

Suthee Kraitrakul ◽

Watcharachai Tangsawad

Keyword(s):

Optic Nerve ◽

High Risk ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Minimum Amount ◽

Bone Thickness ◽

Optic Nerve Injury ◽

Nasal Endoscope ◽

Anatomic Dissection ◽

Onodi Cell

Endoscopic sinus surgery in patients who have an Onodi cell (sphenoethmoid cell) carries a high risk for optic nerve injury. We meticulously dissected 65 embalmed cadaver adult half-heads and attempted to identify an optic canal bulge in each with a nasal endoscope. Our aims were to determine the prevalence of an Onodi cell in adult Thai cadavers, to ascertain the prevalence of an overriding ethmoid cell, and to measure the length of an overriding ethmoid cell's superior and posterior extensions in relation to the anterior sphenoid wall. Moreover, we attempted to determine the minimum amount of bone thickness between an Onodi cell and the optic nerve. We found that an Onodi cell was present in 39 of the 65 specimens (60.0%). We also found that an overriding ethmoid cell was present in 14 specimens, which accounted for 21.5% of the total number of specimens and 36.8% of 38 Onodi cell-positive specimens (the presence or absence of an overriding ethmoid cell was not recorded in one of the 39 Onodi cell-positive specimens). The distance of the overriding ethmoid cell's superior and posterior extensions from the anterior sphenoid wall ranged from 3 to 13 mm (median: 7) and from 4 to 16 mm (median: 9.5), respectively. Measurements of the minimum amount of bone thicknesses between each Onodi cell and optic nerve ranged from 0.03 to 0.54 mm (median: 0.08). Our study demonstrated that the prevalence of an Onodi cell in adult Thai cadavers was as great as the prevalence reported in the only other gross anatomic dissection study performed in Asia and much higher than rates generally reported in Western countries.

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Correlation of Complications during Endoscopic Sinus Surgery with Surgeon Skill Level and Extent of Surgery

American Journal of Rhinology ◽

10.1177/194589240501900311 ◽

2005 ◽

Vol 19 (3) ◽

pp. 274-281 ◽

Cited By ~ 21

Author(s):

Michael B. Soyka ◽

David Holzmann

Keyword(s):

Complication Rate ◽

Retrospective Review ◽

Classification System ◽

Endoscopic Sinus Surgery ◽

Skill Level ◽

Point Of View ◽

Sinus Surgery ◽

New Classification ◽

Great Range ◽

Extent Of Surgery

Background Endoscopic sinus surgery (ESS) produces a great range of potential complications. Rough segregation into “minor” and “major” complications seems insufficient. This study uses a recently published new classification system that is based more on the patient's point of view, with a greater variety of options. Methods A retrospective review was undertaken of 421 ESS procedures. Both, the surgeon's experience and the extent of surgery were correlated with the complication rate. Results The overall complication rate was 39.7% (grades A–D) and did not correlate significantly with either the experience of the surgeon or with the extent of surgery. Conclusion The new classification is simple, precise, and takes complications into account that used to be neglected. ESS is even safe in the hands of less skilled surgeons as long as the degree of difficulty stays highly adapted to his/her ability. Some complications (grade A) seem to be inherent to the procedure.

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A 16-Year Study on Incidence and Progression of Diseased Sphenoethmoidal (Onodi) Cell

BioMed Research International ◽

10.1155/2020/2410415 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Ethan I. Huang ◽

Chia-Ling Kuo ◽

Li-Wen Lee

Keyword(s):

Computed Tomography ◽

Decision Making ◽

Optic Nerve ◽

Endoscopic Sinus Surgery ◽

Visual Loss ◽

Sinus Surgery ◽

Acute Visual Loss ◽

Computed Tomography Images ◽

Onodi Cell

Traumatic operative injury of the optic nerve in an endoscopic sinus surgery may cause immediate or delayed blindness. It should be cautioned when operating in a sphenoethmoidal cell, or known as Onodi cell, with contact or bulge of the optic canal. It remains unclear how frequent progression to visual loss occurs and how long it progresses to visual loss because of a diseased sphenoethmoidal cell. Research to discuss these questions is expected to help decision making to treat diseased sphenoethmoidal cells. From July 2001 to June 2017, 216 patients received conservative endoscopic sinus surgery without opening a diseased sphenoethmoidal cell. We used their computed tomography images of paranasal sinuses to identify diseased sphenoethmoidal cells that could be associated with progression to visual loss. Among the 216 patients, 52.3% had at least one sphenoethmoidal cell, and 14.8% developed at least one diseased sphenoethmoidal cell. One patient developed acute visual loss 4412 days after the first computed tomography. Our results show that over half of the patients have a sphenoethmoidal cell but suggest a rare incidence of a diseased sphenoethmoidal cell progressing to visual loss during the follow-up period.

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Tuberculosis of Sphenoid Sinus: Report of Two Cases

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1712053 ◽

2020 ◽

Vol 10 (01) ◽

pp. 42-45

Author(s):

Vadisha Srinivas Bhat ◽

Samatha K. J. ◽

Devika T. ◽

Shrinath D. Kamath P. ◽

Rajeshwary Aroor ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Sphenoid Sinus ◽

Histopathological Examination ◽

Clinical Findings ◽

Sinus Surgery ◽

Definite Diagnosis ◽

Radiological Appearance ◽

Antituberculosis Treatment

AbstractIsolated lesions of the sphenoid sinus are uncommon and difficult to diagnose. In the absence of characteristic clinical findings, the diagnosis of such lesions depends mainly on imaging. However, as radiological appearance cannot provide the clinician with a definite diagnosis, histopathological examination of the specimen is mandatory for the diagnosis. Endoscopic sinus surgery has been an excellent approach for diagnosis as well as treatment of isolated sphenoid sinus lesions. The disease can be effectively treated by antituberculosis treatment. We report two cases of tuberculosis involving the sphenoid sinus only.

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Sphenoid sinus mucocele: late complication of Sphenoidotomy

The Journal of Laryngology & Otology ◽

10.1258/002221503322113021 ◽

2003 ◽

Vol 117 (7) ◽

pp. 561-563 ◽

Cited By ~ 5

Author(s):

Anastasios G. Hantzakos ◽

Andrew L. Dowley ◽

Matthew W. Yung

Keyword(s):

Endoscopic Sinus Surgery ◽

Sphenoid Sinus ◽

Nerve Palsy ◽

Late Complication ◽

Oculomotor Nerve ◽

Sinus Surgery ◽

Oculomotor Nerve Palsy ◽

Potential Complication ◽

Endoscopic Decompression

Sphenoid sinus mucocele is an infrequent but well-recognized entity in sinus pathology. The symptoms produced by it are related to the anatomical surroundings of the sphenoid sinus. We describe a case of sphenoid sinus mucocele presenting with ipsilateral oculomotor nerve palsy 10 years after endoscopic sphenoidotomy. The patient underwent emergency endoscopic decompression of the sphenoid sinus with marsupialization of the mucocele, resulting in immediate remission of his symptoms. We conclude that the otorhinolaryngologist should be aware of such a potential complication when counselling the patient prior to endoscopic sinus surgery.

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Examining the Safety of Nasogastric Tube Placement after Endoscopic Sinus Surgery

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949810700806 ◽

1998 ◽

Vol 107 (8) ◽

pp. 662-664 ◽

Cited By ~ 13

Author(s):

Neil Bhattacharyya ◽

Harsha V. Gopal

Keyword(s):

Nasogastric Tube ◽

Endoscopic Sinus Surgery ◽

Sphenoid Sinus ◽

Middle Turbinate ◽

Sinus Surgery ◽

Tube Placement ◽

Nasogastric Intubation ◽

Nasogastric Tubes ◽

Fresh Cadaver ◽

Nasogastric Tube Placement

Several cases of intracranial injury during the placement of nasogastric tubes have been reported, usually in the setting of anterior skull base fractures. The fovea ethmoidalis and sphenoid sinus are often exposed after endoscopic sinus surgery, so that these structures are potentially placed in the line of contact during nasogastric tube placement. In order to evaluate the ability of the fovea ethmoidalis and roof of the sphenoid sinus to withstand penetration from possible contact during nasogastric tube placement, 12 fresh cadaver heads were studied. After complete endoscopic ethmoidectomy and wide sphenoidotomy, standard 18F and 16F nasogastric tubes were inserted to produce deliberate direct contact with both the fovea ethmoidalis and the sphenoid sinus roof. No penetrations of the fovea occurred in 20 specimen sides with the 18F tube; penetration did occur with the 16F tube in 1 of 13 sides (7.7%). With respect to the sphenoid sinus, no intracranial penetrations occurred in 16 and 11 sides for the 18F and 16F tubes, respectively. The sphenoid sinus was easily entered even in the presence of an intact middle turbinate. These data suggest that although intracranial penetration during nasogastric intubation after endoscopic sinus surgery is an unlikely event, there is a non-negligible risk of such injury. Nasogastric intubation should be performed with caution in patients with a history of sinus surgery.

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