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Background and Objectives: Brain imaging studies in pediatric patients with headaches often reveal inflammation of the sphenoid sinus. When we encounter patients presenting with headaches without respiratory symptoms, determining the causal relationship between isolated sphenoid sinusitis observed in brain imaging studies and headache is challenging. This study aims to evaluate the clinical characteristics of pediatric patients with headaches and isolated sphenoid sinusitis identified by brain imaging studies and to determine the effects of antibiotics on headache relief. Materials and Methods: Among patients aged <18 years with headaches, those in whom isolated sphenoid sinusitis was observed on brain imaging were included. Their medical records were retrospectively reviewed to evaluate their clinical characteristics and outcomes. Based on antibiotic and analgesic effects, the included patients were categorized into acute bacterial sinusitis (BS) and non-BS groups, and clinical data were compared between the two groups. Results: Brain imaging studies were performed for 1751 patients, and 205 (11.7%) and 41 (2.3%) patients demonstrated sinusitis and isolated sphenoid sinusitis, respectively. For the 41 patients with isolated sphenoid sinusitis, migraine with or without aura (58.5%) was the most frequent type of headache. Throbbing pain (34.1%) occurred most frequently, and the temporal area (51.2%) was the most common location of headache. Nausea/vomiting (56.1%) was the most common accompanying symptom, followed by ocular symptoms (34.1%). Only one (2.4%) patient complained of neurologic symptoms. Headache improved in 26 (63.4%) patients, with improvement without antibiotic therapy in 19 (46.3%) patients. The acute BS and non-BS groups demonstrated comparable characteristics, except for a higher frequency of ocular symptoms in the acute BS group than in the non-BS group (p = 0.044). Conclusions: Isolated sphenoid sinusitis was rarely identified in pediatric patients with headache examined using brain imaging studies. Considering the clinical characteristics and antibiotic effects, early intensive antibiotic therapy cannot be prioritized. [ABSTRACT FROM AUTHOR]

Background and Objectives: Brain imaging studies in pediatric patients with headaches often reveal inflammation of the sphenoid sinus. When we encounter patients presenting with headaches without respiratory symptoms, determining the causal relationship between isolated sphenoid sinusitis observed in brain imaging studies and headache is challenging. This study aims to evaluate the clinical characteristics of pediatric patients with headaches and isolated sphenoid sinusitis identified by brain imaging studies and to determine the effects of antibiotics on headache relief. Materials and Methods: Among patients aged Results: Brain imaging studies were performed for 1751 patients, and 205 (11.7%) and 41 (2.3%) patients demonstrated sinusitis and isolated sphenoid sinusitis, respectively. For the 41 patients with isolated sphenoid sinusitis, migraine with or without aura (58.5%) was the most frequent type of headache. Throbbing pain (34.1%) occurred most frequently, and the temporal area (51.2%) was the most common location of headache. Nausea/vomiting (56.1%) was the most common accompanying symptom, followed by ocular symptoms (34.1%). Only one (2.4%) patient complained of neurologic symptoms. Headache improved in 26 (63.4%) patients, with improvement without antibiotic therapy in 19 (46.3%) patients. The acute BS and non-BS groups demonstrated comparable characteristics, except for a higher frequency of ocular symptoms in the acute BS group than in the non-BS group (p = 0.044). Conclusions: Isolated sphenoid sinusitis was rarely identified in pediatric patients with headache examined using brain imaging studies. Considering the clinical characteristics and antibiotic effects, early intensive antibiotic therapy cannot be prioritized.

This paper presents a literature review and a case of an 83-year-old otherwise healthy female patient with a history of recent syncope, a sudden-onset right-sided temporal headache, diplopia, and vision loss. An exam revealed right-sided upper eyelid ptosis, myosis, vision loss, ophthalmoplegia, and a positive relative afferent pupillary defect on the right eye. CT showed sphenoid sinus opacification, eroded lateral sinus wall, Vidian canal, disease extension to the posterior ethmoid air cells, orbital apex, medial orbital wall, and pterygopalatine fossa. An orbital apex syndrome (Jacod's syndrome), Horner syndrome, and pterygopalatine fossa infection were diagnosed due to the acute invasive fungal sinusitis developed from a sphenoid sinus fungal ball. The patient was treated with antimicrobial therapy and transnasal endoscopic surgery twice to decompress the orbital apex, drain the abscess and obtain specimens for analysis. The right-sided ptosis, visual loss, ophthalmoplegia, and headache resolved entirely. No immune or comorbid diseases were identified, microbiological and histopathological analyses were negative, and MRI could not be performed on the presented patient. For that reason, the diagnostic procedure was non-standard. Nevertheless, the treatment outcome of this vision and life-threatening disease was satisfactory. Treating the fungal ball in an older or immunocompromised patient is essential to prevent invasive fungal rhinosinusitis and fatal complications. [ABSTRACT FROM AUTHOR]

Background: Optic neuritis is a rare but possible complication of sphenoid sinusitis. Case Report: We present a case of a young woman with recurrent optic neuritis associated with chronic sphenoid sinusitis. A 29-year-old woman with visual impairment of the left eye to Snellen distance best-corrected visual acuity (DBCVA) of 0.5 and migraine headaches accompanied by vomiting and dizziness reported to the ophthalmic emergency room. The preliminary diagnosis was demyelinating optic neuritis. On head computed tomography, a polypoid lesion of the sphenoid sinus was found and qualified for elective endoscopic treatment. During a 4-year follow-up, evaluation of DBCVA, fundus appearance, visual field, ganglion cells layer (GCL), peripapillary retinal nerve fiber layer (RNFL) thickness, and ganglion cells and visual pathway function (pattern electroretinogram - PERG, pattern visual evoked potentials - PVEPs) were performed. Four years after the occurrence of the initial symptoms, surgical drainage of the sphenoid sinus was performed, which revealed a chronic inflammatory infiltrate and a sinus wall defect on the left side around the entrance to the visual canal. After surgery, headaches and other neurological symptoms resolved, but DBCVA deteriorated in the left eye to finger counting/hand motion, partial atrophy of the optic nerve developed, the visual field defect progressed to 20 central degrees, GCL and RNFL atrophy appeared, and deterioration of ganglion cells and visual pathway function were observed. Conclusions: In patients with optic neuritis and atypical headaches, sphenoid sinusitis should be considered in the differential diagnosis. Delayed laryngological intervention can cause irreversible damage to the optic nerve. [ABSTRACT FROM AUTHOR]

Background: Isolated sphenoidal sinusitis is an uncommon cause of headaches in children and adolescents. Recognizing the condition on physical examination alone can be challenging, and delayed diagnosis often occurs. Case presentation: A 4-year-old child presented with symptoms of headache, fever, and vomiting. Nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) were used to confirm the diagnosis of isolated sphenoiditis. The patient was treated with antibiotics and steroids. However, the patient developed meningoencephalitis as a complication of the untreated isolated sphenoiditis. Conclusion: Isolated sphenoidal sinusitis can lead to serious complications if left untreated. Adjunctive imaging and prompt treatment are essential to prevent such complications in children and adolescents. This case highlights the importance of considering isolated sphenoiditis in the differential diagnosis of pediatric headaches and the need for early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Introduction – To study the anatomical variations of sphenoid sinus and its related structures and to know the association of extension of pneumatisation of sphenoid sinus with sphenoid sinusitis. Materials And Methods - This was a prospective study. Analysis of 100 patients CT PNS scans who was attending Otolaryngology clinic OPD with signs/symptoms of chronic sinusitis evaluated between September 2019 to April 2021. The pneumatization of adjacent structures of sphenoid sinuses and its relation with the protrusion of neurovascular structures surrounding the sinus and the association between the extension of pneumatisation of sphenoid sinus and presence of sphenoid sinusitis have been investigated. Chi-square test was used for statistical analysis. The p value < 0.05 was expressed as significant. Result - The association of extension of pneumatisation of sphenoid sinus with sphenoid sinusitis was statistically significant (p < 0.001) i.e. sphenoid sinusitis is seen more in patients having absence of extension of peumatization of sphenoid sinus. We also observed that seller type of pnematization (89%) is most common type. Type 1 variation (76%) is most common for Optic nerve variations, Type 3 is most common type (83%) for variation of Foramen rotendum, and Vidian canal (85%) passing through the sphenoid sinus. Conclusion – In conclusion we observed that seller type of pnematization is most common type. Type 1 variation is most common for Optic nerve variations, Type 3 is most common type for variation of Foramen rotendum, and Vidian canal passing through the sphenoid sinus, we also concluded that sphenoid sinusitis is more common in sphenoid sinus with absence of extension of pneumatisation. [ABSTRACT FROM AUTHOR]

Cavernous sinus thrombophlebitis (CST) is a rare disease that may be life-threatening. The overall morbidity and mortality of CST are still high although the introduction of antibiotics has greatly promoted the reduction of them, which mostly due to delayed treatment caused by misdiagnosis. CST with internal carotid artery thrombosis and multiple cerebral infarction secondary to chronic sphenoid sinusitis is rare, but it is essential to rapidly identify, diagnose and treat the disease, since it can lead to serious neurological sequelae. We encountered a patient with chronic sphenoid sinusitis-associated internal carotid artery thrombosis and multiple cerebral infarction, identified his vascular lesions using high-resolution magnetic resonance imaging, and discussed relevant diagnosis and treatment for him, his prognosis as well as the pathogenesis based on a literature review, hoping to inform clinical treatment of CST patients.

The patient was a 36-year-old woman in the 34th week of pregnancy who presented with headache. Magnetic resonance imaging (MRI) revealed bilateral internal carotid artery (ICA) stenosis and inflammatory changes in the sphenoid sinus. No cerebral infarction was detected on diffusion-weighted magnetic MRI. She was diagnosed with ICA stenosis induced by sphenoid sinusitis and underwent surgical treatment with intravenous antibiotics and corticosteroids. Her headache improved, and MRI showed remarkable improvement in bilateral ICA stenosis and no cerebral infarction. Severe sinusitis can also cause ICA stenoses. An early diagnosis and appropriate treatment of causative sinusitis can improve ICA stenosis and prevent stroke.

Introduction: Unilateral sphenoid sinus opacification on computed tomography is caused by a variety of pathologies including inflammatory and infectious sinusitis, benign and malignant tumors, and encephaloceles. The purpose of this study was to report craniofacial pain locations and outcomes in inflammatory unilateral sphenoid sinusitis (USS) patients who underwent endoscopic sinus surgery (ESS)., Methods: A multi-institutional retrospective cohort study was conducted on all adult patients who had ESS for USS from 2015 to 2022. Patient demographics, presenting symptoms and nasal endoscopy findings, extent of surgical dissection, and craniofacial pain locations and outcomes were recorded. Exclusion criteria included age <18 years, non-inflammatory etiology, immunodeficiency, invasive fungal sinusitis, lack of follow-up, lack of preoperative pain location, and neoplasia. Descriptive statistics were calculated., Results: Of 57 patients with USS, 44 (77.2%) reported craniofacial pain at one or more locations. Retrobulbar (n = 19, 43.2%) was the most common pain location followed by frontal (n = 17, 38.6%) and occipital (n = 10, 22.7%). Surgical intervention resulted in pain resolution in 33/44 patients (75%), with a mean follow-up of 83.7 (±97.8) days. There were no significant associations between presenting symptoms, imaging findings, endoscopy, surgical extent, or final pathology and the presence or resolution of facial pain (p > 0.05)., Conclusion: In USS patients, the most common craniofacial pain locations were retrobulbar, occipital, and frontal, with a minority being vertex. Based on short-term follow-up, ESS resolved the craniofacial pain in 75% of cases. There were no clinical variables that predicted the presence or resolution of craniofacial pain., Level of Evidence: IV Laryngoscope, 2025., (© 2025 The American Laryngological, Rhinological and Otological Society, Inc.)

Isolated lesions of the sphenoid sinus are uncommon. Cavernous sinus thrombosis is generally sought due to a systemic disease rather than a local pathology. It may be due to hidden primary pathology like isolated acute sphenoid fungal rhinosinusitis. In present study, we have discussed the early management of such hidden lesions with complication. A retrospective review of 5 cases of isolated acute sphenoidal fungal rhinosinusitis leading to cavernous sinus thrombosis was carried out. All cases were managed as emergency cases. Diagnostic nasal endoscopy was normal in all cases, with sinus disease evident in radiology in only 60% cases. Diagnostic endoscopic sinus surgery was performed in 40% cases. All patients underwent urgent surgical debridement along with IV antifungals. Complete recovery was seen in ocular movements in 40% and partially in 40%, whereas only 25% had complete improvement in vision. While four cases showed favourable outcome, one patient could not be saved despite all efforts. Exploring the sinus in cavernous sinus syndrome or orbital apex syndrome despite non-conclusive imaging, is warranted as early intervention may significantly impact the chances of survival. "Time is vision" in cases with acute fungal sinusitis and is equal to the aphorism of cardiologists i.e. "time is muscle. [ABSTRACT FROM AUTHOR]

Background: Miller Fisher Syndrome is a variant of Guillain-Barre Syndrome, classically characterized by the triad of ataxia, areflexia and ophthalmoplegia. However, many conditions can mask the presentation of Miller Fisher Syndrome, potentially leading to grave consequences due to delayed diagnosis or even misdiagnosis. Case Report: We describe a case of Miller Fisher Syndrome mimicking acute sphenoid sinusitis with intracranial complications in an otherwise healthy 19-year-old man. Accurate diagnosis with prompt treatment led to full clinical recovery of our patient. Conclusion: Sphenoid sinusitis warrants great vigilance and thorough neurological examination due to its proximity to structures such as the cavernous sinus and its associated cranial nerves. This case highlights its potential to mask more devastating conditions like Miller Fisher Syndrome and the successful role of medical management without the need for sphenoidotomy. [ABSTRACT FROM AUTHOR]

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.

The sphenoid sinus is adjacent to the cavernous sinus, pituitary gland, optic nerve, and internal carotid artery, and sphenoid sinusitis can cause various inflammation of these surrounding structures. However, intracranial complications of sinusitis are quite rare. We experienced a case of sinusitis with a pituitary abscess. A 64-year-old man with uncontrolled diabetes complained of fatigue, and blood tests revealed possible adrenal insufficiency. Supplementary steroid treatment improved his symptom. The patient then experienced diplopia due to left abducens nerve paralysis, and subsequent enhanced magnetic resonance imaging (MRI) of the head revealed left sphenoid sinusitis, left cavernous sinus inflammation, an epidural abscess contiguous to the cavernous sinus, and an intra-sellar pituitary abscess. Antibiotic treatment with vancomycin (2 g/day), cefepime (6 g/day), and metronidazole (1.5 g/day) was started immediately, and left-side endoscopic sinus surgery (ESS) was performed. Histological examination revealed fungal growth in the erosive mucosa, but it was present only on the surface of the mucosa, and we assessed the pathophysiology as a bacterial infection rather than an invasive fungal infection. Culture tests of the pus drained from the sphenoid sinus during ESS were negative for bacteria, fungi, and mycobacteria. ESS and antibiotic treatment for 6 weeks, as is used for treating osteomyelitis, improved the MRI findings and left eye movement. Despite the development of antibiotic treatments, the prognosis of patients with intracranial abscess remains poor. However, early diagnosis has been reported to reduce the mortality and residual neurologic disturbance rates, and early enhanced MRI should be considered.

Atypical skull-base osteomyelitis is a rare but fatal disease that usually involves infection of the ethmoid, sphenoid, occipital, or temporal bones that form the skull base. Unlike typical (so-called otogenic), atypical skull-base osteomyelitis has no otogenic cause. Instead, some authors call atypical skull-base osteomyelitis sinonasal, since the infection most often originates from the nose and paranasal sinuses. Diagnosing and treating this disease is challenging. To assist in managing atypical skull-base osteomyelitis, a review of the most recent literature, with patient cases and multidisciplinary perspectives from otolaryngologists, neurosurgeons, radiologists, infectious disease specialists, pathologists, and clinical microbiologists, is provided in this paper.

Orbital cellulitis is a serious infection that can lead to severe complications if not promptly diagnosed and treated. This case report describes an unusual presentation of bilateral orbital cellulitis in a previously healthy 29-year-old female, complicated by cerebral vein thrombosis and meningitis. The patient's young age and lack of significant medical history make this case particularly noteworthy. Initially presenting with a local infection over the right nose that rapidly progressed to bilateral orbital cellulitis, subsequent imaging revealed extensive complications including bilateral cavernous sinus thrombosis, sphenoid sinusitis, and intracranial abscesses. Blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA), an uncommon finding in community-acquired orbital cellulitis. The patient underwent sinus endoscopy and bilateral sphenoidotomy, followed by a prolonged course of intravenous and oral antibiotics. This case highlights the potential for severe complications in orbital cellulitis, even in young, healthy individuals, and emphasizes the importance of prompt, aggressive treatment and multidisciplinary management. It is imperative for clinicians to maintain a high index of suspicion for atypical pathogens and rare complications in seemingly routine cases., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Carpintieri et al.)

Introduction Orbital apex syndrome, an uncommon condition seen in ENT practice, is characterised by multiple cranial neuropathies, presenting as visual loss, ophthalmoplegia, ptosis and hypoesthesia of forehead due to involvement of Cranial nerves III, IV, VI and V1. Case Report This is a case of an 80-year-old female patient, with poorly controlled Type 2 Diabetes mellitus and Hypertension, who presented with right sided headache of 10 days duration, drooping of right eyelid and decreased vision in right eye for 3 days. Clinically, there were features suggestive of right orbital apex syndrome. MRI Brain showed abnormal enhancement in right orbital apex with subtle enhancement of optic nerve in optic canal and intense enhancement of mucosal thickening in sphenoid sinus. Aerobic culture report of the purulent nasal discharge revealed Staphylococcus epidermidis. Discussion Aetiology of this condition is varied. Rarely known to occur following bacterial sinusitis, it is most commonly seen secondary to fungal sinusitis or orbital cellulitis involving orbital apex. Here we report an unusual case occurring secondary to Staphylococcus epidermidis sinusitis. In conclusion, although acute orbital apex syndrome is usually associated with invasive fungal sinusitis, clinicians must be aware that bacterial sinusitis may also present with a similar aggressive pattern.

Fungal sphenoiditis is a rare case in clinical practice. Usually affecting just one sinus, Aspergillus is the most common cause of fungal sinusitis. Atypical headache with unresponsive to analgetics is one of symptom from Isolated Sphenoid sinusitis. This case report presents a 37 year old female with isolated sphenoiditis fungal. The patient came with atypical headache as the major symptom. Based on the morphology of the sphenoid sinus and its surrounding structures, diagnosis is often challenging. After some medicine, the chief complaint did not disappear. A functional endoscopic sinus surgery was performed to remove the fungal ball, and the patient get good result. • Atypical headache have numerous causes. • Because of high costs, neurologists in developing countries do not perform CT scans when patients arrive • This leads to a delayed or incorrect diagnosis. • Isolated Sphenoid Fungal Sinusitis is a rare case, seen in fewer than 3% of all sinusitis patients. • Its optimal management is endoscopic intranasal transphenoidal approach without the need for antifungal therapy [ABSTRACT FROM AUTHOR]

Introduction: Isolated sphenoid sinus inflammatory diseases (ISSIDs) are responsible for about 75% of isolated sphenoid sinus opacifications. Computer tomography (CT) and magnetic resonance imaging (MRI) should be used in a complementary manner for the assessment of ISSIDs. This evaluation sheds some light on the extent of disease and intracranial and intra-orbital involvement. Materials and Methods: The current study aimed to evaluate the medication histories of 14 patients who underwent endoscopic sinus surgery (ESS) for ISSIDs within 2015-2018. This assessment was carried out to analyze the presenting symptoms, diagnostic work-up, additional therapies, and complications. Moreover, it can help us compare our data with pertinent literature. Results: As evidenced by the obtained results, ISSID lesions included bacterial sphenoiditis (42.9%), fungus ball (21.4%), invasive fungal sphenoiditis (14.3%), mucocele (14.3%), and retention cysts (7.1%). In addition, headache was found to be the major complaint, followed by nasal symptoms. Diplopia, and signs and symptoms of the involvement of other cranial nerves were less frequent. All patients underwent endoscopic transnasal sphenoidectomy. The overall survival rate was reported as 92.9% (13/14), and all patients with cranial nerve palsies demonstrated complete clinical remission. Conclusion: Both the review of related literature and our clinical cases were indicative of the dangerous consequences of ISSIDs. Their varied and unspecific presentation and the limited reliability of nasal endoscopy required the cooperation of ENT (ear, nose, and throat) team with other specialists to make an accurate diagnosis and decide on the most appropriate therapeutic choices. If the signs of intracranial complications were detected, surgery should be promptly performed to maximize the chances of recovery.

Horner syndrome is described in this case report as a rare complication of bacterial sphenoid sinusitis. A patient presented with miosis, ptosis, and ophthalmic nerve palsy with acute sphenoid sinusistis and cavernous sinus thrombosis on MRI. The impairment of sympathetic fiberscan can be explained through the direct septic effects of the sphenoid sinusitis and indirectly through thrombosis of the cavernous sinus at the level of the carotid plexus.

Objective To retrospectively analyze the etiology of sphenoid sinusitis secondary to endoscopic transnasal skull base surgery, summarize the characteristics of diagnosis and treatment, and evaluate the prognosis. Methods Clinical data of 24 cases of sphenoid sinusitis secondary to endoscopic transnasal skull base surgery from June 2005 to December 2017 were collected. Endoscpic extended sphenoidectomy was performed to remove the lesion. Nasal CT, MRI, nasal endoscope, Visual Analogue Scale (VAS) and Lund-Kennedy score were used to evaluate the prognosis of patients. Results Clinical symptoms of those patients included headache (21 cases, 87.50%), nasal obstruction (11 cases, 45.83%) and runny nose (9 cases, 37.50% ). Preoperative nasal sinus imaging examinations showed extensive hyperosteogenesis of sphenoid sinus walls and/or discontinuous bone substance of sella turcica, and moderate enhancement of mucosa of sphenoid sinus walls. Intraoperative endoscopic display showed edema, polyp and scar formation of mucosa in posterior ethmoidal sinus and sphenoid sinus. There were significant differences between preoperative and postoperative VAS scores, such as headache (F = 118.961, P = 0.000), nasal obstruction (F = 3.519, P = 0.035) and runny nose (F = 30.563, P = 0.000), and Lund-Kennedy score (F = 26.064, P = 0.000). VAS scores in headache (P = 0.000, for all) and runny nose (P = 0.000, for all) and Lund-Kennedy score (P = 0.000, for all) 3 months and one year after surgery decreased significantly in comparison with before surgery. Conclusions Insufficient surgical field for endoscopic transnasal skull base surgery, inappropriate and unreasonable use of artificial materials can lead to severe sphenoid sinus inflammation and more severe symptoms such as headache, nasal obstruction and runny nose. An extended sphenoidectomy should be adopted under endoscope and the lesions and artificial repair materials must be cleaned, so as to improve the symptoms and achieve mucosal epithelization. DOI: 10.3969/j.issn.1672-6731.2019.04.008

Purpose of review: To explain our current understanding of headache attributed to rhinosinusitis, an often inappropriately diagnosed secondary headache. Recent findings: Recent studies have shown that headache attributed to rhinosinusitis is often over-diagnosed in patients who actually have primary headache disorders, most commonly migraine. Failure to recognize and treat rhinosinusitis, however, can have devastating consequences. Abnormalities of the sinuses may also be treatable by surgical means, which may provide headache relief in appropriately selected patients. Summary: It is important for the practicing physician to understand how rhinosinusitis fits into the differential diagnosis of headache, both to avoid overdiagnosis in patients with primary headache, and to avoid underdiagnosis in patients with serious sinus disease. [ABSTRACT FROM AUTHOR]

We herein report an 81-year-old woman with no significant medical history who developed a fever, headache, and right eyelid swelling. Magnetic resonance imaging (MRI) showed eye proptosis, sphenoid opacity, enlarged cavernous sinus, and dilated right superior ophthalmic vein (SOV). Subsequent enhanced MRI revealed intraventricular debris and thrombosis in the right SOV and the left transverse and sigmoid sinuses. Blood cultures were positive for Aggregatibacter aphrophilus, as identified by mass spectrometry. The patient responded well to antibiotics, anticoagulants, and surgical drainage of sphenoid sinusitis. To our knowledge, this is the first case of A. aphirophilus sphenoid sinusitis causing orbital cellulitis, meningitis, and venous sinus thrombosis.

Isolated sphenoid sinusitis (ISS) is a rare but potentially serious condition, often leading to severe complications due to delayed diagnosis and treatment. This case report discusses a 75-year-old male with type 2 diabetes mellitus who presented with severe left-sided headache and neck pain. Diagnostic imaging revealed isolated sphenoid sinusitis with prevertebral extension, a rare occurrence that highlights the potential for deep neck space involvement. The patient underwent endoscopic transnasal incision and drainage of the prevertebral abscess with a left sphenoidotomy, resulting in full recovery without recurrence. This case emphasizes the importance of prompt recognition and intervention in ISS, particularly in cases with atypical presentations. The report also discusses the complex anatomy of the sphenoid sinus and its surrounding structures, the broad differential diagnosis of sphenoid sinus opacification, and the necessity for a multidisciplinary approach to management. This case contributes to the limited literature on ISS with prevertebral extension and underscores the critical need for early diagnosis and aggressive treatment to prevent severe complications., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lee et al.)

Although the cavernous sinus and internal carotid artery are in close proximity to the sphenoid sinus, vascular complications in sphenoid sinusitis are rare due to the intervening mucosa and bone. Variations like dehiscence or aggressive infection can cause vascular complications, leading to cavernous sinus thrombosis, while perivascular inflammation of the internal carotid artery can result in stenosis or occlusion. Untreated or aggressive sphenoid sinusitis can cause neurological complications such as cerebral infarcts, meningitis, subdural empyema, cerebral abscess, and cranial nerve injuries. Magnetic resonance imaging (MRI) of the brain with angiography can depict these complications at an early stage. Additionally, mastoiditis can cause dural venous sinus thrombosis, which, if left untreated, can result in venous infarcts. We report a case of an 11-year-old male with sphenoid sinusitis who developed a left middle cerebral artery (MCA) territory infarct, cavernous sinus thrombophlebitis, subdural empyema, and meningitis. He also developed left transverse and sigmoid sinus thrombosis due to left mastoiditis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khaladkar et al.)

Objective: To review a sequela of skull base reconstruction with a porous polyethylene implant. Methods: Case report. Results: A 61-year old patient with a past surgical history of transsphenoidal hypophysectomy presented with chronic post nasal drip. Endoscopy demonstrated crusting along the residual intersinus sphenoid septum. The patient was taken to the operating room to remove the residual septum, which was discovered to be a porous polyethylene implant. The implant was removed and the patient's symptoms resolved. Repeat endoscopy showed healthy mucosalization of the sphenoid sinus. Conclusions: While porous polyethylene has a relatively safe biocompatibility profile, infection, extrusion, or migration of the implant are potential complications after skull base reconstruction, and subsequent chronic sinusitis can develop. It is important for surgeons to recognize these potential complications when planning reconstruction and select appropriately.

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. [ABSTRACT FROM AUTHOR]

Sinonasal organized hematomas (OHs) are rare lesions that primarily localize to the maxillary sinus. The rate of growth of these masses has not been described in the literature. We present a case of a 59-year-old gentleman with polyostotic fibrous dysplasia who presented with acute loss of vision in the left eye from an expanding OH of the sphenoid sinusitis. After expanded endonasal, transpterygoid approach and debulking, patient experienced significant vision improvement. Close follow-up imaging preoperatively allowed radiologic documentation of the rate of OH growth and this is presented in detail. [ABSTRACT FROM AUTHOR]

Aspergillosis refers to diseases caused by one of the almost 50 pathogenic species of Aspergillus. Aspergillus fungal involvement of the sphenoid sinus becomes a diagnostic challenge. The surgical approach and fungal study of the material obtained will constitute the diagnostic-therapeutic guideline. Advances in diagnostic imaging tests and microbiological tests help in the timely recognition of this entity. Although it can occur mainly in immunocompromised patients, they can also occur in patients without added morbidity. An effective therapy is the evacuation of infected tissue by transnasal approach to the sphenoid sinus in combination with adequate antifungal medication. We present an atypical case of sinusitis of fungal etiology in a 60-year-old female patient who had headache, mucopurulent rhinorrhea and epistaxis. [ABSTRACT FROM AUTHOR]

Petrositis is a rare and severe complication of acute otitis media and mastoiditis. Although the extension of the inflammatory process from the petrous apex to the adjacent Meckel cave can lead to trigeminal pain, an irritation of the trigeminal nerve roots resulting in acute or chronic hyperactivity of masticatory muscles has never been reported. We report here the unusual case of an 86-year-old man who presented with a handicapping myofascial pain and dysfunction syndrome of the right temporal muscle as a heralding manifestation of an unusual form of petrositis. The patient progressively developed a retropharyngeal abscess, a right sphenoid sinusitis, and fatal meningitis. This case demonstrated that (1) myofascial pain and dysfunction syndrome that does not respond to conventional treatments may suggest an unusual etiology and warrant further medical investigations and a detailed medical history and that (2) petrositis can manifest itself with atypical clinical symptoms and radiologic signs. [ABSTRACT FROM AUTHOR]

Headache and rhinosinusitis are 2 of the most common conditions seen in clinical practice. Consider sinusitis in those with new-onset headache, along with nasal congestion, maxillary tooth discomfort, anosmia, cough, or fever. Most chronic and recurring headaches, especially if migraine features are present, are not due to sinus disease, with the possible exception of rhinogenic headache due to nasal contact points. Nasal endoscopy and neuroimaging with computed tomography or MRI can confirm diagnosis and guide treatment with antibiotics, adjuvant therapies and surgery., Competing Interests: Disclosure Within the past 24 months, Dr.M.J. Marmura has received compensation for consultation from Lundbeck, Upsher-Smith, and Theranica. He has participated in speaker bureaus for Eli Lilly. He has received institutional support for serving as principal investigator from Teva and AbbVie. nt., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Isolated sphenoid sinus inflammatory diseases (ISSIDs) are responsible for about 75% of isolated sphenoid sinus opacifications. Computer tomography (CT) and magnetic resonance imaging (MRI) should be used in a complementary manner for the assessment of ISSIDs. This evaluation sheds some light on the extent of disease and intracranial and intra-orbital involvement. Materials and Methods: The current study aimed to evaluate the medication histories of 14 patients who underwent endoscopic sinus surgery (ESS) for ISSIDs within 2015-2018. This assessment was carried out to analyze the presenting symptoms, diagnostic work-up, additional therapies, and complications. Moreover, it can help us compare our data with pertinent literature. Results: As evidenced by the obtained results, ISSID lesions included bacterial sphenoiditis (42.9%), fungus ball (21.4%), invasive fungal sphenoiditis (14.3%), mucocele (14.3%), and retention cysts (7.1%). In addition, headache was found to be the major complaint, followed by nasal symptoms. Diplopia, and signs and symptoms of the involvement of other cranial nerves were less frequent. All patients underwent endoscopic transnasal sphenoidectomy. The overall survival rate was reported as 92.9% (13/14), and all patients with cranial nerve palsies demonstrated complete clinical remission. Conclusion: Both the review of related literature and our clinical cases were indicative of the dangerous consequences of ISSIDs. Their varied and unspecific presentation and the limited reliability of nasal endoscopy required the cooperation of ENT (ear, nose, and throat) team with other specialists to make an accurate diagnosis and decide on the most appropriate therapeutic choices. If the signs of intracranial complications were detected, surgery should be promptly performed to maximize the chances of recovery. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the relationship between Onodi cells and optic canal by paranasal sinus computed tomography (PNSCT).Methods: In this retrospective study, 508 PNSCT (265 males and 243 females) was examined. Onodi cell presence, pneumatization types, optic canal types; and also sphenoid sinusitis and anterior clinoid process pneumatization were evaluated.Results: The prevalence of Onodi cells was 21.2% of the patients. Onodi cells were observed 40.7% on the right side and 25.9% on the left side. In 33.4% of the patients, bilateral Onodi cells were present. Male/Female ratio was 24.5%/17.6%. Onodi cell types were detected as Type I > Type II > Type III bilaterally. There was a positive correlation between the right and left Onodi cell types (p < 0.05). Optic canal types were detected as Type IV > Type I > Type II > Type III. bilaterally. There was a positive correlation between right and left optic canal types. Onodi cell presence and ACP pneumatization were found as statistically significant (p < 0.05). In 65.5% of the patients, Onodi cells and ACP pneumatization were absent. ACP pneumatization was present in 35.4% of the cases. In nine cases, bilateral Onodi cells and ACP pneumatization were detected. Sphenoid sinusitis was detected in 11.4% of Type I and 13.8% of the Type II Onodi cells on the right side. On the left side, it was detected in 12.9% of the Type I and 19.0% of Type II Onodi cells.Conclusion: Identification of Onodi cell is very important clinically because of its proximity to optic nerve canal. We concluded that type IV Onodi-optic canal relationship was the most common finding in our study. Onodi cell presence and their patterns of pneumatization must be evaluated on PNSCT preoperatively to avoid optic canal damage. [ABSTRACT FROM AUTHOR]

Objective To retrospectively analyze the etiology of sphenoid sinusitis secondary to endoscopic transnasal skull base surgery, summarize the characteristics of diagnosis and treatment, and evaluate the prognosis. Methods Clinical data of 24 cases of sphenoid sinusitis secondary to endoscopic transnasal skull base surgery from June 2005 to December 2017 were collected. Endoscpic extended sphenoidectomy was performed to remove the lesion. Nasal CT, MRI, nasal endoscope, Visual Analogue Scale (VAS) and Lund - Kennedy score were used to evaluate the prognosis of patients. Results Clinical symptoms of those patients included headache (21 cases, 87.50%), nasal obstruction (11 cases, 45.83%) and runny nose (9 cases, 37.50% ). Preoperative nasal sinus imaging examinations showed extensive hyperosteogenesis of sphenoid sinus walls and/or discontinuous bone substance of sella turcica, and moderate enhancement of mucosa of sphenoid sinus walls. Intraoperative endoscopic display showed edema, polyp and scar formation of mucosa in posterior ethmoidal sinus and sphenoid sinus. There were significant differences between preoperative and postoperative VAS scores, such as headache (F = 118.961, P = 0.000), nasal obstruction (F = 3.519, P = 0.035) and runny nose (F = 30.563, P = 0.000), and Lund - Kennedy score (F = 26.064, P = 0.000). VAS scores in headache (P = 0.000, for all) and runny nose (P = 0.000, for all) and Lund - Kennedy score (P = 0.000, for all) 3 months and one year after surgery decreased significantly in comparison with before surgery. Conclusions Insufficient surgical field for endoscopic transnasal skull base surgery, inappropriate and unreasonable use of artificial materials can lead to severe sphenoid sinus inflammation and more severe symptoms such as headache, nasal obstruction and runny nose. An extended sphenoidectomy should be adopted under endoscope and the lesions and artificial repair materials must be cleaned, so as to improve the symptoms and achieve mucosal epithelization. [ABSTRACT FROM AUTHOR]

Natamon Charakorn, Kornkiat Snidvongs Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand Abstract: Chronic sphenoid rhinosinusitis is a spectrum of inflammatory diseases in isolated sphenoid sinus which may persist over a period of 12 weeks. It is a different entity from other types of rhinosinusitis because clinical presentations include headache, visual loss or diplopia, and patients may or may not have nasal obstruction or nasal discharge. Nasal endoscopic examination is useful, and computed tomography is mandatory. The disease requires comprehensive knowledge and appropriate imaging technique for diagnosis. To treat patients with chronic sphenoid rhinosinusitis, surgical treatment with endoscopic transnasal sphenoidotomy is often required. As there are no recent updated reviews of chronic sphenoid rhinosinusitis, in this article, we review the anatomy of the sphenoid sinus and its clinical relationship with the clinical signs and symptoms of the disease, the imaging findings of each diagnosis and the comprehensive surgical techniques. Keywords: sphenoid sinus, sphenoid sinusitis, chronic, rhinosinusitis, fungal rhinosinusitis, mucocele

Orbital apex syndrome (OAS) is an uncommon disorder characterized by visual loss, ophthalmoplegia, ptosis and hypoaesthesia of the forehead[1]. OAS may result from a variety of inflammatory, infectious, neoplastic and vascular conditions that cause damage to the superior orbital fissure (with resultant oculomotor (III), trochlear (IV), abducens (VI) and ophthalmic branch of the trigeminal nerve (V1) palsies) and to the optic canal leading to optic nerve (II) dysfunction. This case report describes the clinical development of OAS in a patient with bacterial sphenoid sinusitis.

Extrapulmonary tuberculosis is an infrequently reported condition. However, in endemic settings, it contributes to a significant number of cases. The most common site of extrapulmonary tuberculosis is the lymph nodes. Herein, an exceedingly rare case of extrapulmonary tuberculosis presenting as bilateral cervical lymphadenitis with external cerebral watershed infarct along with sphenoid and maxillary sinusitis in an Indian male is presented. A detailed literature search revealed that a case with all these clinical conditions together has never been reported to date. A diagnostic workup supported by radiometric investigations helped in the diagnosis, and timely management was initiated., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Yadav et al.)