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

ASSESSMENT OF VARIATIONS IN SPHENOID SINUS PNEUMATIZATION IN PAKISTANI POPULATION AT TERTIARY CARE HOSPITAL. A RETROSPECTIVE MULTIDETECTOR COMPUTED TOMOGRAPHY STUDY

Aim: The aim of the study is to evaluate the role of computed tomography in identifying the various pattern of pneumatization in the sphenoid sinuses.Knowledge of pattern of pneumatization is essential for various trans-sphenoidal surgical procedures. Methodology: This is a retrospective study conducted at tertiary care hospital Lahore General Hospital Department of Diagnostic Radiology from the period of June 2020 to December 2020.The study consisted of a total of 80 patients from age group of 20 years to 70 years who were referred to the Department of Diagnostic Radiology for CT scan(PNS) .Patients of age less than 20 years , previous facial surgeries , trauma of skull base and having tumor of sphenoid sinuses were excluded. Sphenoid sinuses images were evaluated for pneumatization by posterior and anterior extensions. RESULTS: The patients included were in the age range of 20-70 year with an average age of 43.5 year in which 44 (55%) were male and 36(45) were female The pneumatization pattern observed in the sphenoid sinuses in descending order was as follows , post sellar prevalence was 75%, prevalence of sellar was 10% and 2.5% was presellar. Conchal prevelance was observed to be 0%. Conclusion: Sphenoid sinus anatomy review before trans-sphenoidal surgery is vital for safer endoscopic instrumentation of the patients . Keyword: Sphenoid sinus, pneumatization, cerebral fluid leak, endoscopy

Retromaxillary recess of the sphenoid sinus: an overlooked recess

Background Retro-maxillary recess of the sphenoid sinus is an area that is yet to have appropriate description in the literature and usually overlooked. The objective of the current study was to determine the incidence and detailed description of the retromaxillary recess of the sphenoid sinus by multi-slices computed tomography (MSCT) in adults. Paranasal MSCT scan of asymptomatic adults was done for all our subjects to obtain delicate anatomical details of the recess using coronal, axial, and sagittal reformatted capability. Each sphenoid sinus in the CT was revised to find and describe the retro-maxillary recess of the sphenoid sinus regarding its extensions and dimensions. Results This study included 100 adult subjects (200 sphenoid sinuses); retro-maxillary recess was detected in 16.5% (33 sides) of them using MSCT. They were distributed in 20 subjects (20% of all examined sphenoid sinuses). Sixty-five percent of reported recesses were bilateral. Range of antero-posterior diameter (depth) of the recess was 3.9 to 14 mm while its width range was 1.1 to 9 mm. The thickness of the bony septum between the recess and the maxillary sinus ranged from 0.2 to 3.2 mm. Conclusion Current work described in details the retromaxillary recess in CT and its nearby surrounding important structures in all directions. From our results, it is recommended to add the retromaxillary recess of the sphenoid sinus to the preoperative CT checklist particularly in revision cases.

About cystic stretching of the Highmor's cavity

The existence of cystic stretching of the frontal and sphenoid sinuses, as well as the labyrinth of the ethmoid bone, is beyond any doubt - a similar kind of disease has been described at different times by many authors.

Mucormycosis in a patient with COVID-19 with uncontrolled diabetes

A wide range of bacterial and fungal coinfections may be associated with COVID-19. We report a case of rhino-orbital mucormycosis in a patient with COVID-19. A 67-year-old man, known case of diabetes, hypertension and ischaemic heart disease, was being treated for COVID-19 pneumonia when he developed right cheek eschar and ophthalmoplegia. Imaging studies revealed pansinusitis of bilateral maxillary and sphenoid sinuses with thickening and enhancement of right-sided soft tissue, lacrimal gland, mastication muscles, temporal lobe infiltrate and cerebellum infarct. Emergency right face debridement, right eye exenteration and bilateral functional endoscopic sinus surgery were done. Histopathological examination confirmed mucormycosis diagnosis. He was given amphotericin B and broad-spectrum antibiotics. It is important to have high index of suspicion for fungal coinfections in patients with COVID-19 with pre-existing medical conditions. There is a need to emphasise judicious and evidence-based use of immunomodulators in patients with COVID-19 to avoid triggering and flaring up of fungal infections.

PARANASAL SINUSITIS (APEENASA/PEENASA) AND ITS MANAGEMENT IN AYURVEDA

Sinusitis is defined as the inflammation of the mucosa either of any one or all of the paranasal sinuses. In humans, there are four paired sinuses which are termed as paranasal sinuses and they are maxillary, frontal, ethmoid and sphenoid sinuses. Ayurveda being an ancient holistic science aims at alleviating the disease and protection and prevention of the positive health. Shalakya Tantra is one of the Astangas of Ayurveda that deals with the Uttamanga and the diseases related to Urdhvajatru. Paranasal sinusitis, the most common disease in Shalakya tantra can be correlated to the disease Apeenasa, Peenasa, Dusta Pratishyaya etc in Ayurveda based on its signs and symptoms. Apeenasa and Peenasa are used interchangeably for paranasal sinusitis in Ayurveda and they are managed with Deepana Pachana, Vamana, Virechana, Dhumapana, Nasya Karma or Shirovirechana. Nasya Karma, one of the Panchakarma therapy and the best therapy for the Urdhwajatrugata Rogas plays a vital role in the successful management of the sinusitis. In this therapy, the medicine is administered through nose either in the form of ghee, oil, powder, liquid or smoke. It is particularly useful in the treatment of diseases occurring in the organs situated above the clavicle but indirectly it works on the whole body by improving the functioning of the endocrine glands and nervous system.

Combined external and endoscopic transnasal approach with use of a diamond burr in the removal of a fishing harpoon hook traversing bilateral sphenoid sinuses in a 22-year-old man

A 22-year old construction worker was shot with a fishing harpoon gun on the left side of his face. He consulted at the emergency room 12 days postinjury, stable but with blurring of vision on the right. The shaft of the harpoon was protruding at the left preauricular area; the tip was neither visible nor palpable. Craniofacial CT scan and skull anteroposterolateral radiographs revealed the tip of the harpoon to be at the right orbital apex. A hook attached 1 cm from the tip was lodged in the sphenoid sinus. The hook was dismantled from the shaft via a combined external and endoscopic transnasal approach, enabling the shaft to be gently pulled. The hook, together with the tip, were removed endoscopically. The patient’s visual acuity improved. He was discharged after 2 days on oral antibiotics with no deficits on follow-up.

The Functional State Of The Mucous Membrane Of The Nasal Cavity And Paranasal Sinuses After Radical And Minimally Invasive Surgical Interventions

Improving the effectiveness of treatment of chronic rhinosinusitis (CRS) is a priority task of modern otorhinolaryngology, not only domestic, but also foreign. This interest in the problem is due to the widespread prevalence of this pathology. In different countries, the criteria for accounting for the incidence, algorithms for the diagnosis and treatment of rhinosinusitis differ significantly, and for CRS these differences are more pronounced than for acute. A retrospective analysis of the structure and prevalence of ENT diseases according to inpatient observations for 5 years showed that chronic diseases of the nose and paranasal sinuses (SNP) occupied a priority place among hospitalized patients (45.8 ± 0.9% and 55.5 ± 1,0%). In the structure of the main diseases of SNP, the largest share in the adult population is occupied by inflammation of the maxillary sinus (HPP), in which there is an annual increase in the incidence of 1-1.5%, the second most frequent is inflammation of the ethmoid labyrinth cells, then the frontal and sphenoid sinuses.

EVALUATION OF VARIATIONS IN SPHENOID SINUS PNEUMATIZATION USING MULTIDETECTOR COMPUTED TOMOGRAPHY IN PATIENTS ATTENDING TERTIARY CARE HOSPITAL, VISAKHAPATNAM

BACKGROUND: The purpose of our study was to assess the prevalence of different patterns of pneumatization in the sphenoid sinuses as detected on the computed tomography (CT) images of paranasal sinuses of the patients presenting with various pathologies. This is a retrospective radiological study of CT im MATERIALS AND METHODS: ages of paranasal sinuses, done at Radio diagnosis department of a Tertiary care hospital. The study comprised CT images of 500 patients in the age range of 18-75years who were referred for CT scan of paranasal sinuses for various pathologies between the period of July 2018 and July 2019. All images of paranasal sinuses had been acquired following a standardized protocol in axial plane. Their reconstructed images in axial, coronal and sagittal planes were evaluated, using Osirix software, for the extent and different patterns of sphenoid sinus pneumatization. The Images of sphenoid sinuses were assessed for the posterior, lateral and anterior extension of their pneumatization The sphenoid sinuses pneumatization patterns in the RESULTS: descending order of prevalence were complete sellar (75.0%), incomplete sellar (22.6%), presellar (2.4%) and conchal (0%). The clival extensions was seen in 75% of patients and lateral extension sides in 49.1% patients. Lateral recesses as assessed on coronal images was seen in 49.1 % of cases with the prevalence in descending order being extension into pterygoid process 59.8 %, greater wing of sphenoid 9.2 %, full lateral 41% and lesser wing (anterior clinoid process) 19.3%. The pure forms were relatively less common and combined forms being more common. A preoperative review of the sphenoid anatomy should allow for safer endo