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Mucocele of the Sphenoid Sinus

Mucocele of Sphenoid Sinus


Presentation

  • While presenting this case, we briefly review the literature on the subject of sphenoid sinus mucoceles.[ncbi.nlm.nih.gov]
  • OBJECTIVE: This study was designed to describe clinical manifestation, treatment and outcomes in patients with sphenoid sinus mucocele presenting to Amiralam Hospital, Tehran, Iran.[ncbi.nlm.nih.gov]
  • Abstract A mucocele of the sphenoid sinus with visual impairment and headache is presented. Mucocele of the sphenoid sinus is relatively rare. The preoperative diagnosis was uncertain in this case but sphenoid sinus mucocele was considered.[ncbi.nlm.nih.gov]
  • However a review of the literature shows that these lesions may present with different MRI appearances probably related to the variability of the cyst content. Further series are needed for a better definition of the MRI behaviour of the lesions.[ncbi.nlm.nih.gov]
  • Abstract A case is presented in which a sphenoid sinus mucocele was indicated by rapidly progressive blindness in the left eye.[ncbi.nlm.nih.gov]
Aspiration
  • Endoscopic decompression of the left sphenoid sinus was performed, and approximately 200 ml of thick, sterile mucoid secretion was aspirated. Despite the size of the mucocele, no significant destruction of the sphenoid walls was evident.[ncbi.nlm.nih.gov]
Suggestibility
  • The bilaterla optic nerve neuropathy focused attention on the sphenoid sinus, and the patient's previous history of intranasal surgery further suggested the possibility of a mucocele. Computed tomography confirmed the suspicion.[ncbi.nlm.nih.gov]
  • These 3 cases suggest that attention should be focused not only on the sella turcica, but also on the sphenoid sinus, in analyzing the magnetic resonance imaging data.[ncbi.nlm.nih.gov]
  • PATIENTS AND METHOD: In a period of 4 years, we observed six patients in whom a mucocele of the sphenoid sinus was suggested pre- or intraoperatively. Symptoms and signs included headache, visual loss and palsies of the III and VI cranial nerve.[ncbi.nlm.nih.gov]
  • Histopathological diagnosis was given as Aspergillosis.The appearance on wet mount was suggestive of Aspergillus .The fungal culture yielded Aspergillus fumigatus.[scopemed.org]
  • Computed tomography (CT) demonstrated a 4-cm well-circumscribed cystic lesion occupying the right-side ethmoid, maxillary, sphenoid, and frontal sinuses, suggestive of mucocoele ( Figure 2 ).[nature.com]
Recurrent Headache
  • Symptoms include recurrent headache and visual complications.[ncbi.nlm.nih.gov]
  • He complained of visual impairment and pain in his left eye, recurrent headache, nasal drainage, facial pressure, diplopia and postnasal discharge. The symptoms began 2 years ago.[waent.org]

Workup

Sinus Opacification
  • If it becomes infected, it is called mucopyocele Can be seen in any age group, commonly relapsed Imaging Findings Complete sinus opacification Bone remodeling, expansion and thinning/thickening of the wall On fluid-sensitive MR sequence, it is very bright[radiologyinthai.blogspot.com]
  • opacifications Air-fluid level Mass Fractures 21 Water view Best for maxillary sinuses and orbital rims Blow-out fractures 22 Caldwell view Best for frontal sinus 23 Lateral view Best for sphenoid sinus and frontal sinus 24 Submental vertex (basal) view[slideplayer.com]

Treatment

  • Steroid treatment was given postoperatively, but vision recovered to 6/12 in the left eye only. The importance of urgent clinical diagnosis and treatment is stressed.[ncbi.nlm.nih.gov]
  • The transnasal surgical approach is considered to be best for treatment.[ncbi.nlm.nih.gov]
  • The treatment consists of endoscopic transnasal marsupialization, since the mucocele is lined by normal epithelium with an inflammatory reaction that will heal with drainage.[ncbi.nlm.nih.gov]
  • She refused treatment but returned seven years later with a spontaneous pneumocephalus and dementia. A mucocele of the sphenoid sinus was discovered. Her symptoms resolved after removal of the mucocele and obliteration of the sphenoid sinus.[ncbi.nlm.nih.gov]
  • The patient was diagnosed with central DI and intranasal desmopressin treatment of 10 mcg 1 1 was given. His adenohypophyseal hormones were normal. After this treatment, water consumption and thamuria were fully regressed.[entokey.com]

Prognosis

  • It is a benign cystic lesion with an excellent prognosis when treated appropriately.[ncbi.nlm.nih.gov]
  • The prognosis for the recovery of the visual loss is poor if the onset is sudden or if there is no light perception preoperatively. 7 An external surgical approach was often used for the management of sphenoid mucoceles before endoscopic surgery techniques[waent.org]
  • Prognosis The importance of accurate pretreatment evaluation and staging with paranasal sinus tumors is critical, the stage and type of the paranasal sinus tumor are the most important factors in determining the prognosis.[skullbaseinstitute.com]
  • Treatment and prognosis In general, drainage and marsupialisation of an affected sinus are sufficient. If large bony defects are present, reconstructive surgery may be necessary (e.g. of the orbital floor).[radiopaedia.org]

Etiology

  • In the etiology of the mucocele, other than the inflammatory processes including sinusitis or nasal polyposis, the iatrogenic causes such as endoscopic sinus surgery are also present.[entokey.com]
  • Friedman A, Batra PS, Fakhri S, et al (2005) Isolated sphenoid sinus disease: etiology and management. Otolaryngol Head Neck Surg 133:544–550 PubMed CrossRef Google Scholar 5.[link.springer.com]
  • Mucoceles are rare in the pediatric population because the sphenoid sinus completes its pneumatization about 12 years of age. 2 The etiology of mucoceles is not clear.[waent.org]
  • Accumulation of mucoid secretions behind an obstructed paranasal sinus ostium is the primary etiology. This accumulation expands the sinus cavity and produces thinning or erosion and remodeling of the bony wall.[appliedradiology.com]
  • […] acute Chronic sinusitis - recurrent with acute exacerbations Fungal sinusitis - acute invasive (fulminant) - chronic indolent - Mycetoma (fungus ball) - Allergic fungal 34 Acute sinusitis Preceding viral infection is the most common cause Bacterial etiology[slideplayer.com]

Pathophysiology

  • […] orbit 25 Computed tomography Excellent views of the sinuses Coronal section Best for osteomeatal complex and ethmoidal disease 26 MRI Excellent soft tissue definition Neoplastic disease evaluation Fails to demonstrate bone Expensive Claustra- phobia 27 Pathophysiology[slideplayer.com]

Prevention

  • At the time of surgery, prevention would require either endoscopic control of the mucosal remnants, in case of sinus exclusion, or leaving the sphenoid sinus air-filled under a sealed sella.[ncbi.nlm.nih.gov]
  • Wide spectrum antibiotics were given to all the patients for 3 to 5 days in order to prevent any iatrogenic infection. All patients did well after surgery without postoperative complications.[ncbi.nlm.nih.gov]
  • Because of the close proximity with vital structures, early diagnosis and treatment of the disease is essential to prevent morbidity.[waent.org]
  • Key words: Sphenoid mucocele, Aspergillus fumigatus, Aspergillosis Advertisement American Journal of Preventive Medicine and Public Health SUBMIT YOUR ARTICLE NOW[scopemed.org]
  • Appropriate therapy of the mucocele may correct the associated complications, such as exophthalmos, and may prevent visual loss. Back To Top[appliedradiology.com]

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