Meningitis From the Sphenoid Sinus

Abstract

From the time of its description by Fallopius, in 1561, to the publication of Max Schaeffer's paper on diagnosis and treatment, in 1890, interest in the sphenoid sinus was largely centered on the anatomy and pathology. The dictum of Hyrtl that "Die Keilbeinh\l=o"\hleist ganz ausser dem bereiche chirurgische Angriffe" (The sphenoid sinus is entirely outside the domain of surgical attack) was universally accepted.Although Cavanaugh and others said they believed that the first known case of disease of the sphenoid sinus was that described by Rouge, in 1871, investigation has revealed several earlier reports. The earliest one of which I am aware was that of Lieutaud, in 1735. The patient was supposed to have had pulmonary suppuration, but autopsy revealed a purulent disorder of the maxillary, frontal and sphenoid sinuses.A report published in 1810 by Leveque-Lasource concerned a woman 38 years of age. She complained of headache, anorexia and vertigo. She became blind, first in the left and then in the right eye. Deafness in the left ear next appeared, followed by paralysis on the left side, at first partial but later complete. Deafness then appeared in the right ear, and the voice became altered. She gradually weakened and died about fifteen months after the onset of the symptoms. Postmortem examination revealed that the pituitary gland was twice the normal size and contained several fetid abscesses. The sella turcica and the posterior clinoid processes were almost completely destroyed. The sphenoid sinuses were filled with pus, and they communicated with the cranial cavity. In the left middle fossa was a tumor which origi¬ nated in the internal acoustic meatus and occupied three fourths of the posterior face of the petrosa. The tumor filled the orifice of the meatus and destroyed its walls. While it is not so stated, this tumor was undoubtedly part of an extradural abscess originating in the sphe¬ noid sinus.Abercrombie, in his book published in 1843, described a case noted in 1820 which probably represented a case of infection of the sphenoid sinus with extension to the orbit and the meninges. The patient, a woman aged 22, complained of the sudden onset of pain in the left temple, with some extension to the vertex. The following week swell¬ ing appeared in the left upper lid, accompanied by chills. Puncture of the swelling released pus, and a probe revealed denuded bone along

Acute isolated sphenoid sinusitis: a disease with complications

“…The incidence of sphenoid involvement in sinus disease has been shown to have decreased from up to 33 per cent in the preantibiotic era (Teed, 1938) to 8 per cent in a more recent series. (Weisberger and Dedo, 1977).…”

Rhinogenic Optic Neuritis Caused by Sphenoid Mucocele with Sinusitis

“…Because of the anatomical correlation, sinus infection of Onodi cells can lead to inflammation/infection of the optic nerve, so-called "rhinogenic optic neuropathy" [2, 5, 7]. Several mechanisms have been proposed accordingly: (1) direct spreading of the sinus infection through the posterior paranasal sinuses or by osteomyelitis of the sinus wall to the optic nerve [8, 9], (2) compression of the optic nerve caused by ethmoid and/or sphenoid mucoceles [10–14], (3) bacteraemia passing through the mucosa of the sinus [5], (4) vasculitis of the optic nerve [15, 16], and (5) chronic allergic optic neuritis [17]. …”

Optic Neuropathy and Sinus Disease

“…Direct spread of the sinus infection to the optic nerve is probably the most common way in which this occurs [5]. Osteomyelitis affecting the sinus walls secondary to chronic infection may also be in direct contact with the nerve [6].…”