Surgical Management of Acute Sphenoid Sinusitis: A Review

Sphenoidal sinusitis is usually described as acute inflammation of the sphenoid sinuses - either one or both - (the two large cavities just behind the nose and between the eyes). The disease is relatively uncommon—comparatively, chronic sphenoid sinusitis is more common—and may be limited to the sphenoid sinus or, more commonly, may involve multiple sinuses or pansinusitis. Acute sphenoid sinusitis can lead to symptoms such as headaches, nausea, and even complications in the orbit. For low vision, early diagnosis and treatment is essential to preserve vision and life. This study aims Learn about surgical approaches to the treatment of acute sinusitis

Sphenoid sinusitis: a rare cause of ischaemic stroke

We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and oral antibiotics to treat chronic left sphenoid sinusitis. Initially presenting with right-sided weakness and aphasia, a diagnosis of acute ischaemic stroke was made. Antibiotics had been commenced 1 month prior to the ischaemic stroke. Imaging at that time showed changes in keeping with chronic sphenoid sinusitis along with a small dehiscence in the lateral wall of the left sphenoid sinus and thrombosis of the left superior ophthalmic vein. During that admission blood cultures grew Streptococcus constellatus, a member of the Streptococcus milleri group. We discuss the unusual aetiology of this stroke, the emerging evidence associating chronic rhinosinusitis with stroke and the complex multidisciplinary approach required for management in this case.

501 Lateral Rectus Muscle Palsy Secondary to Sphenoid Sinusitis: A Case Report and Literature Review

Background Isolated sphenoid sinus disease (ISSD) is a rare, often misdiagnosed condition of the paranasal sinus. If left untreated, it can lead to complications involving pituitary gland, cavernous sinus, neurologic, and vascular structures nearby. Case report We present a case of a 60-year-old female 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. MRI scans revealed opacification in left sphenoid sinus consistent with left sphenoid sinusitis. There were no signs of cavernous sinus thrombosis. She was then referred to ENT and underwent endoscopic transnasal sphenoidotomy procedure. Culture results showed Haemophilus Influenza and fungal pseudohyphae. Her palsy and headaches recovered completely 3 months later with a course of antibiotics and antifungals. Literature review for lateral rectus palsy secondary to sphenoid sinusitis without cavernous sinus thrombosis showed it is not a common condition and this case report should serve as a reminder to consider paranasal sinus disease when assessing these patients. Conclusions The onset of ISSD is often insidious and diagnosis of this condition remains a challenge. MRI and CT imaging remain the gold standard for recognising and managing this condition.

Trigeminal Neuralgia from Acute Sphenoid Sinusitis: Consideration of Anatomical Sphenoid Sinus Variation – A Case Report

Although the etiology of classical trigeminal neuralgia is clearly understood to be neurovascular compression, the exact etiology of trigeminal neuralgia with continuous pain is often unknown. Mild sphenoid sinusitis is not usually considered to induce trigeminal neuralgia, especially when limited to the maxillary nerve. We report a rare case of trigeminal neuralgia of the maxillary nerve caused only by mild sphenoid sinusitis and discuss the significance of the anatomical structure and diagnostic procedures. A 45-year-old woman noticed a sudden onset of temporal pain followed by numbness on her right cheek. Her right gingiva also experienced sensory disturbance. The symptoms gradually subsided after the initial onset, but they persisted. She visited our hospital for further examinations and had no febrile episodes throughout the course. A tingling sensation and sensory disturbance were only identified in the maxillary nerve. No other neurological symptoms were noted. Magnetic resonance imaging revealed mild sphenoid sinusitis on the right side. The absence of the bony boundary between the sphenoid sinus and maxillary nerve was revealed using thin-sliced computed tomography (CT). The patient’s symptoms were diagnosed as maxillary neuropathy caused by mild sinusitis. The bony defect around the maxillary nerve was considered to have affected development of the pathological process. Even mild sphenoid sinusitis can cause inflammation to spread to the maxillary nerve if no bony boundary exists between it and the sphenoid sinus. A coronal CT study is highly beneficial for clarifying the pathophysiological mechanism of trigeminal neuralgia limited to the maxillary nerve.

Cavernous sinus thrombosis as a serious complication of sphenoid sinusitis in children

Introduction:The cavernous sinus is a venous plexus delimited by the dura mater and sited at the base of skull, laterally to the sella turcica and to the sphenoid sinus. The cavernous sinus thrombosis (CST) is a serious illness that may result from infection of any tissue drained by the cavernous sinus (septic thrombosis). Septic thrombosis (ST) may occur through the suppurative process by the level of the orbit, of the upper half of the face or paranasal sinuses , constituting a critical complication of sinusitis. Objectives: To verify the association between cavernous sinus thrombosis and sphenoid sinusitis in children, in the bibliographic productions of the last 10 years. Methods:This is an integrative literature review, with a search carried out in the database of the Medical Literature and Retrieval System onLine (MEDLINE), using a combination of the following Health Sciences Descriptors (DECS): “Sphenoid Sinusitis” and “Thrombosis” And “ Cavernous sinus” in “ Children ”. Incomplete studies were excluded from the research, carried out before 2012, totaling 7 bibliographic studies for detailed analysis. Results:CST can result from infection of any tissue drained from the cavernous sinus. This includes the face, tonsils, soft palate, teeth and ears.Only 15% of cases of CST in patients up to 12 years of age, originated from the paranasal sinuses. However, more recent studies advance that sinusitis is currently the most common etiology. When the sinuses are the cause of CST, the sphenoid sinus emerged as the most common primary source of infection predisposing to CST, since it has important anatomical relationships with the cavernous sinus. Streptococcus has been reported as the most common organism associated with sphenoid sinusitis. Conclusion:Although CTS is a rare clinical condition, acute and persistent sphenoid sinusitis can progress to such a condition, despite medical treatment. The main support of treatment includes early diagnosis, aggressive intravenous antibiotics and appropriate surgical treatment.