Isolated Sphenoid Sinus Lesion: A Clinical Analysis of 56 Cases

Kim, Si Whan; Mo, Ji Hun; Hwang, Chan Ho; Kim, In Sang; Lee, Chul Hee; Rhee, Chae Seo; Min, Yang Gi

Abstract

BACKGROUND AND OBJECTIVES
Isolated lesions of the sphenoid sinus are a rare disease entity that occurs after a wide use of antibiotics. This lesion may have severe complications such as cranial nerve palsies due to its deep location in the skull. The use of endoscopic surgery for the sphenoid sinus has become popular for its several advantages. We report our experiences of 56 case-isolated sphenoid lesions with a review of articles. SUBJECTS AND METHOD: Fifty-six patients with isolated sphenoid lesions who were treated at Seoul National University Hospital from January 1985 through December 2003 were analyzed. Patients who have lesions confined to the sphenoid sinus on radiologic images (CT or MRI) were included. A retrospective chart review was performed with respect to the patient's symptom, pathology and surgical outcome. RESULTS: Thirty-nine of 56 cases were inflammatory lesions, 8 neoplastic lesions, and 9 fibrous dysplasias. Headache was the most common symptom (66%), followed by nasal symptoms such as nasal obstruction and postnasal drip. Ophthalmologic symptoms were observed in 14 cases. Endoscopic transnasal sphenoidotomy was perforemd in 33 of 39 cases of inflammatory diseases. Symptoms were completely improved in 32 cases after the operation and ophthalmologic symptoms were nearly all improved in all cases. CONCLUSION: The wide use of CT and MRI has increased the detection of isolated lesions of the sphenoid sinus. Complications like cranial nerve palsies were uncommon unlike from the reports that came out in the country. Primary physicians must rule out isolated lesions of the sphenoid to account for intractable headaches.