Series of isolated sphenoid disease: Often neglected but perilous

Abstract

Isolated sphenoid sinus disease (ISSD) is an uncommon entity and may present with non-specific symptoms. As sphenoid sinus is located adjacent to vital structures, a diseased sphenoid sinus can potentially lead to devastating complications such as cranial neuropathies, cavernous sinus thrombosis and intracranial abscess. Herein, we report a case series of three patients who presented with different localization of headache as their main symptom. Endoscopic nasal assessment showed abnormal nasal cavity findings with mucosal thickening and soft tissue mass occupying the sphenoid sinus revealed by computed tomography (CT) scan. All the sphenoid sinuses were drained via endoscopic approach. Post operatively, antibiotics or anti-fungal were given, however, these three cases displayed the possible variation in severity of this disease. Case 1 had an uncomplicated inflammatory disease of the sphenoid sinus, which is of bacterial origin, while the other two cases had fungal infection. Case 2 achieved disease stability with anti-fungal treatment, but Case 3 had a serious complication after treatment with permanent vision loss. A patient who presents with atypical headache, not responsive to analgesia should be investigated promptly with nasal endoscopic examination and radiological imaging for isolated sphenoid sinus disease to avoid devastating complications.

Risk Factors for Isolated Sphenoid Sinusitis after Endoscopic Endonasal Transsphenoidal Pituitary Surgery

“…The pathophysiology of sphenoid sinusitis involves sphenoid ostium blockage, impaired mucociliary clearance, stasis, and secondary infections, including those caused by bacteria and fungal hyphae [6,7]. The most frequent symptoms of sphenoid sinusitis include retro-orbital headache and visual symptoms such as blurred vision, diplopia, transient visual loss, and isolated oculomotor palsy, and nasal obstruction and epistaxis [26,27]. Highly inflammatory diseases like fungal infections may increase the risk of reossification of the sphenoid ostium following sphenoidotomy [22].…”

Isolated fungal sinusitis of the sphenoid sinus - A case report

“…Isolated sphenoid sinusitis is an inflammation of the sphenoid sinus caused by infection. Fungus is a microorganism that can cause infection in the paranasal sinuses (8). Fungal infections in the paranasal sinuses are usually caused by the irrational use of drugs, such as long-term use of antibiotics and steroids, impaired sinus ventilation, and a humid environment (6,9).…”

The Sphenoid Sinus Revisited

“…Thus, the sphenoid sinus has gained equal importance as any other paranasal sinus cavity. In fact, a variety of pathologies can now be diagnosed and treated (13)(14)(15).…”

“…Headache is often the initial symptom. Should it rapidly worsen or in case of persistence despite analgesics, then nasal endoscopy and head imaging are required (15,23). On the images, the sphenoid sinus should be carefully inspected for any anomaly.…”