Clinical Classification Of Sphenoid Sinus Diseases

Objective: Various sphenoid sinus diseases were reported in the literature. In order to understand the sphenoid sinus diseases better, a clear classification was needed. Although there were some classifications of sphenoid sinus diseases, but these classifications did not show clearly the characteristics of the sphenoid sinus diseases. The specialty of sphenoid sinus diseases was based not only on the pathologic nature, but also on the site and involving extent. Different sphenoid sinus diseases may present the same symptoms. However identical diseases, due to different involving extent or different adjacent structures, might present different symptoms and their prognosis might be different. Reasonable classification of sphenoid sinus diseases could help to the diagnosis and management.Methods: Between 1980 and 2000, 70 cases of sphenoid sinus diseases were retrospective reviewed. Medline and CBMdisc search were used to look for the articles dealing with the sphenoid sinus diseases. Although 93 kinds of sphenoid sinus diseases were found, sphenoid sinus diseases were classified into three types based on their original, site and involving extent: 1) Isolated sphenoid diseases: lesions located in the sphenoid sinus without involving the adjacent structures. 2) Invasive sphenoid sinus diseases: lesions originated in sphenoid sinus or adjacent structures, involving not only sphenoid sinus but also adjacent structures. 3) Metastatic sphenoid sinus diseases: malignant tumors metastasized to the sphenoid sinus.Results: According to our classification, there were 37 cases of the isolated sphenoid diseases, 33 cases invasive sphenoid sinus diseases, and no metastatic sphenoid sinus diseases in our seriesDiscussion: More and more kinds of sphenoid sinus diseases were reported in the literature. The clinical presentation of these diseases was nonspecific. Differentiation of acute or chronic isolated sphenoid sinusitis, mucocele, sphenochonal polyp (SCP), fibrous dysplasia, encephalomeningocele, vascular diseases, benign tumor, malignant tumor and some rare diseases was needed. CT and MRI could help to find the original site, extent and the adjacent structures involved. Acute or chronic isolated sphenoid sinusitis, fungal sinusitis, mucocele, sphenochonal polyp (SCP), fibrous dysplasia, sphenoidal cerebral spinal fluid fistula, Rathke's cyst, inverting papilloma, meningioma, low differentiated squamous carcinoma and adenoid cystic carcinoma were treated with endoscopic surgery. Different types of sphenoid sinus diseases were treated with different methods in the series. Isolated sphenoid sinus diseases, invasive sphenoid sinus diseases and metastatic sphenoid sinus diseases should be differentiated. For isolated sphenoid sinus diseases, such as inflammatory lesions, mucocele, sphenochonal polyp (SCP), sphenoidal cerebral spinal fluid fistula, endoscopic surgery was of choice; For invasive sphenoid sinus diseases, the choice of management should be based on the extent and pathologic nature of the lesions.