J Rhinol.  2023 Jul;30(2):98-104. 10.18787/jr.2023.00016.

Prevalence and Clinical Implications of Lateral Wall Dehiscence in the Sphenoid Sinus: Sternberg’s Canal

• Kang SH
• Huh G
• Kim M
• Bae YJ
• Won TB
• Kim JW
• Rhee CS
• Cho SW

• KMID: 2544619
• DOI: http://doi.org/10.18787/jr.2023.00016

Abstract

Background and Objectives
Sternberg’s canal is known to result from incomplete fusion of bony compartments constituting the sphenoid bone during the developmental process. This study aimed to evaluate the prevalence and clinical implications of Sternberg’s canal.
Methods
A retrospective review of patients over the age of 18 years who had undergone endoscopic sinus surgery from 2014 to 2019 at a single institution was performed. Patients (n=98) were categorized into those with sphenoid fungal ball (SFB) (n=39), those with primary chronic rhinosinusitis (CRS) (n=39), and controls (n=20) and were evaluated radiologically. A small pit in the lateral wall, located medial to the maxillary division of the trigeminal nerve (V2), in front of the opticocarotid recess was regarded as Sternberg’s canal. Children under the age of 12 years (n=39) without any sinus disease were also evaluated to determine the prevalence of Sternberg’s canal in the pediatric population.
Results
Patients with SFB showed the highest prevalence of Sternberg’s canal (56.4%), followed by those with CRS (20.5%) and controls (10.0%) (p<0.001). Logistic regression revealed that Sternberg’s canal was associated with osteitis of the sphenoid wall, and not with age, sex, or sphenoid sinus pathology. Children under the age of 12 years showed a significantly higher prevalence of the defect than adult controls (46.2%, p<0.001).
Conclusion
Sternberg’s canal was frequently identified in children under the age of 12 years. Sphenoid sinus pathology was often accompanied by osteitis. However, the presence of the canal alone did not predict skull base involvement in patients with SFB. A comprehensive evaluation should hence be performed if skull base involvement is suspected in such patients. Additionally, other clinical implications of Sternberg’s canal should be further evaluated.

Keyword

Sternberg’s canal; Skull base; Lateral recess; Sphenoid sinus; Fungal ball

Figure

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  Fig. 1. A typical CT image of a bony defect in the sphenoid sinus. Sternberg’s canal (arrow) is located medial to the foramen rotundum (arrowhead). CT, computed tomography.

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  Fig. 2. Radiologic evaluation technique. A: Coronal image with a window level of 0 and width of 2,000. B: Axial image with a window level of 0 and width of 2,000. C: Inversed grayscale view of a coronal image. Arrow: Sternberg’s canal.

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  Fig. 3. A representative CT image of children under the age of 12 years. A CT image of a continuous Sternberg’s canal (arrows) in a 10-year-old boy. Sternberg’s canal appeared to be continuous from the lateral wall to the vaginal process of the sphenoid bone (arrowheads). CT, computed tomography.

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  Fig. 4. A representative magnetic resonance image. A: A CT image of Sternberg’s canal (arrow). B: Enhancement along the Sternberg’s canal (arrow) to the orbital apex (arrowhead) on a T1-weighted magnetic resonance image. C: Endoscopic findings after peeling off the mucosa of the lateral wall. Soft tissue along Sternberg’s canal (arrow). D: Enhancement of pterygopalatine fossa (arrowhead). CT, computed tomography.

Reference

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