Clinical Diagnosis And Surgical Approach Of The Isolated Sphenoid Sinus Disease

Objective To summarize the clinical characteristics,diagnostic methods and treatment of isolated sphenoid sinus disease,so as to improve clinicians’understanding of isolated sphenoid sinus disease,reduce the probability of misdiagnosis and missed diagnosis,enable patients to get effective treatment and avoid the occurrence of related complications.Methods The clinical data of 79 patients with isolated sphenoid sinus lesions were collected during January 2010 to November 2017 in the department of Otolaryngology head and neck surgery in Qilu Hospital of Shandong University,including gender,age,clinical symptoms and the characteristics of the disease and the relationship between the first diagnosis department,auxiliary examination,surgical approach and the complications and prognosis caused by sphenoid sinus related lesions were studied.Results Among the 79 patients with ISSD,the most common clinical symptoms were headache(82.3%),followed by ocular symptoms(21.5%),including 8 cases of decreased vision and 2 cases of blindness.23 patients were first diagnosed in Department of Neurology,7 patients were first diagnosed in Departmentof Ophthalmology,3 patients were first diagnosed in Department of Neurosurgery,and 15 patients were first diagnosed in Department of ENT.79 cases were diagnosed by CT or MRI and pathology includinginflammatory disease in 67 cases,benign tumor in 4 cases,malignant tumor in 3 cases,cerebrospinal fluid rhinorrhea in 5 cases.The inflammatory disease include 30 cases of fungal sinusitis,14 cases of sphenoid sinus mucocele,11 cases of sinusitis,8 cases of sphenoid sinus mucosa cyst,4 cases of sphenoid sinus polyps.The benign tumor include inverted papilloma in 3 cases,hypophysoma in 1 case.The types of malignant tumor include poorly differentiated carcinoma,squamous cell carcinoma and diffuse large B cell lymphoma.79 of the patients were treated by endoscopic sinus surgery,and nasal endoscopic olfactory cleft approach was most commonly used.During and after the operation there was no serious complications.After the operation,the symptoms of the headache,the eye and the nose of the majority of the patients gradually disappeared,but there was no improvement in the visual acuity of 1 patients with blindness.76 patients with benign sphenoid sinus diseases were followed up by endoscopic sinus surgery,59 patients had good sinus opening,17 patients had narrowed sinus orifice,but drainage was unobstructed.3 patients with malignant tumors received chemotherapy and radiotherapy in the oncology department at 10-15 days after operation.1 of the patients with diffuse large B cell lymphoma had no recurrence at 1 years after operation,and the remaining 2 patients lost their visits in 6 months and 13 months after the operation.Conclusion The incidence of ISSD is rare,the clinical symptoms are not obvious,the patients have a common headache and ocular symptoms,but the nasal symptoms are relatively rare.The patients are mostly in the neurology department and ophthalmology.The clinicians responsible for the first diagnosis and treatment are limited by the special thinking or the understanding of the ISSD,which may lead to misdiagnosis and missed diagnosis.Due to the lack of timely diagnosis and treatment,with the progress of the lesions,it can lead to severe complications such as optic edema,blindness,cavernous sinus syndrome,Orbit apex syndrome,OAS,supraorbital fissure syndrome,and intracranial infection.Therefore,when intractable headaches or unexplained eye symptoms occur,the possibility of isolated sphenoid sinus diseases should be taken into consideration.The CT or MRI of the sinus should be diagnosed as early as possible,and the surgical treatment should be performed as soon as possible in order to prevent the occurrence of irreversible or even life-threatening complications.The CT and/or MRI examination of the paranasal sinus can determine the diagnosis of ISSD,which helps clinicians to assess the scope of the lesion and exclude the related sphenoid sinus complications;endoscopic sphenoid sinus opening is a safe and classic method for the treatment of ISSD,and the nasal olfactory cleft approach is the most common surgical path for the treatment of sphenoid sinus lesions.