Isolated sphenoid sinus disease; a retrospective review of underlying pathologies and their clinicopathological implications
Keywords:Sphenoid sinusitis, Endoscopic sinus surgery, Holocranial headache, Ophthalmoplegia, Sphenoidotomy
Background: Isolated sphenoid sinus disease (ISSD) includes a small cohort of patients evaluated for sinus disease which tend to be diagnostically challenging and may lead to devastating complications. This study aims to evaluate the spectrum of etiological factors and to analyze clinic-radiological characteristics of ISSD
Methods: It is a retrospective review of cases of ISSD managed by the department of otolaryngology of a tertiary care medical centre between January 2017 and December 2019. A total of 21 patients were included and their demographic details, co-morbidities, symptomatology, cross-sectional imaging, treatment received and follow-up details were retrieved from medical records for analysis and comparison.
Results: The most common diagnoses in our cohort were invasive fungal sinusitis (n=9), chronic non-specific sinusitis (n=7) and allergic fungal sinusitis (n=3) in that order, with mean duration of symptoms 58.2 days, 300 days and 260 days respectively. Cases of invasive disease had a shorter course, more frequent cranial nerve involvement, with radiological features of heterogenous soft tissue densities and bone erosion. Cases of chronic non-specific sinusitis and allergic fungal sinusitis had more long-standing disease with a milder course and less ominous radiological features. Biopsy report from one of the patient’s was that of squamous cell carcinoma while the other patient was diagnosed with a sphenoid mucocoele.
Conclusions: ISSD is an uncommon entity in clinical practice with non-specific symptoms and a potential for grave complications. Therefore, the condition must be borne in mind by clinicians and prompt treatment must be initiated.
Friedman A, Batra PS, Fakhri S, Citardi MJ, Lanza DC. Isolated sphenoid sinus disease: etiology and management. Otolaryngol Head Neck Surg. 2005;133(4):544-50.
Ng YH, Sethi DS. Isolated sphenoid sinus disease: differential diagnosis and management. Curr Opin Otolaryngol Head Neck Surg. 2011;19(1):16-20.
Beton S, Basak H, Ocak E, Kucuk B, Yorulmaz I, Meco C. How Often Does Isolated Sphenoid Sinus Disease Turn Out to be a Neoplasm? J Craniofac Surg. 2016;27(1):41-3.
Ruoppi P, Seppä J, Pukkila M, Nuutinen J. Isolated sphenoid sinus diseases: report of 39 cases. Arch Otolaryngol Head Neck Surg. 2000;126(6):777-81.
Sieskiewicz A, Lyson T, Olszewska E, Chlabicz M, Buonamassa S, Rogowski M. Isolated sphenoid sinus pathologies-the problem of delayed diagnosis. Med SciMonit. 2011;17(3):CR180-4.
Marcolini TR, Safraider MC, Socher JA, Lucena GO. Differential diagnosis and treatment of isolated pathologies of the sphenoid sinus: retrospective study of 46 cases. Int Arch Otorhinolaryngol. 2015;19(2):124-9.
Fooanant S, Angkurawaranon S, Angkurawaranon C, Roongrotwattanasiri K, Chaiyasate S. Sphenoid Sinus Diseases: A Review of 1,442 Patients. Int J Otolaryngol. 2017;2017:9650910.
Gao X, Li B, Ba M, Yao W, Sun C, Sun X. Headache Secondary to Isolated Sphenoid Sinus Fungus Ball: Retrospective Analysis of 6 Cases First Diagnosed in the Neurology Department. Front Neurol. 2018;9:745.
Lim H-S, Yoon YH, Xu J, Kim YM, Rha K-S. Isolated sphenoid sinus fungus ball: a retrospective study conducted at a tertiary care referral center in Korea. Eur Arch Otorhinolaryngol. 2017;274(6):2453-9.
Nour YA, Al-Madani A, El-Daly A, Gaafar A. Isolated sphenoid sinus pathology: spectrum of diagnostic and treatment modalities. AurisNasus Larynx. 2008;35(4):500-8.
Chen L, Jiang L, Yang B, Subramanian PS. Clinical features of visual disturbances secondary to isolated sphenoid sinus inflammatory diseases. BMC Ophthalmol. 2017;17(1):237.
Celenk F, Gulsen S, Gonuldas B, Baysal E, Durucu C, Kanlikama M et al. Isolated sphenoid sinus disease: An overlooked cause of headache. J Craniomaxillofac Surg. 2015;43(9):1914-7.
Gupta R, Shukla R, Mishra A, Parihar A. Isolated acute sphenoid sinusitis presenting with hemicranial headache and ipsilateral abducens nerve palsy. BMJ Case Rep. 2015;2015.
Tang IP, Brand Y, Prepageran N. Evaluation and treatment of isolated sphenoid sinus diseases. CurrOpinOtolaryngol Head Neck Surg. 2016;24(1):43-9.
Soon SR, Lim CM, Singh H, Sethi DS. Sphenoid sinus mucocele: 10 cases and literature review. J Laryngol Otol. 2010;124(1):44-7.
Fadda GL, D’Eramo A, Gned D, Succo G, Galizia A, Cavallo G. An unusual case of complicated rhinosinusitis of the sphenoid sinus involving the cavernous sinus and skull base: Endoscopic sinus surgery and medical therapy. SAGE Open Med Case Rep. 2019;7:2050313X19852885.
Fawaz SA, Ezzat WF, Salman MI. Sensitivity and specificity of computed tomography and magnetic resonance imaging in the diagnosis of isolated sphenoid sinus diseases. Laryngoscope. 2011;121(7):1584-9.
El Mograbi A, Soudry E. Ocular cranial nerve palsies secondary to sphenoid sinusitis. World J Otorhinolaryngol Head Neck Surg. 2017;3(1):49-53.
Li E, Howard MA, Vining EM, Becker RD, Silbert J, Lesser RL. Visual prognosis in compressive optic neuropathy secondary to sphenoid sinus mucocele: A systematic review. Orbit. 2018;37(4):280-6.
Devaraja K, Doreswamy SM, Pujary K, Ramaswamy B, Pillai S. Anatomical Variations of the Nose and Paranasal Sinuses: A Computed Tomographic Study. Indian J Otolaryngol Head Neck Surg. 2019;71(3):2231-40.