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Acute isolated sphenoiditis: tactics and treatment

DOI: https://doi.org/10.29296/25877305-2019-04-08

Professor S. Karpishchenko, MD; A. Voloshina; O. Stancheva; D. Yusupov Acad. I.P. Pavlov First Saint Petersburg State Medical University

Isolated sphenoiditis is a rare condition and is often undiagnosed due to scarce non-specific clinical signs. The acute onset of the disease is represented mainly by neurological disorders, such as headache, diplopia, and cranial neuralgia. Rhinological manifestations of the disease are extremely rare. The diagnosis of isolated sphenoiditis is based on radiological findings (computed tomography (CT), magnetic resonance imaging, and paranasal sinus (PS) radiography. By taking into account the proximity of the sphenoid sinus to the vital structures (pituitary, internal carotid artery, pairs of cranial nerves III, IV, V, VI), PS CT are of the greatest diagnostic and tactical value, which allows for a detailed assessment of not only the basilar sinus, but also the adjacent intranasal structures. Timely diagnosis can prevent the development of important intracranial complications, such as meningitis, cavernous sinus thrombosis, brain abscess, subdural abscesses, episcleritis, and retrobulbar neuritis. Therefore, patients with isolated sphenoiditis should be examined by a neurologist and, in the presence of visual impairment, by an ophthalmologist at the prehospital stage and during treatment. Endoscopic endonasal sphenotomy is the optimal treatment for isolated sphenoiditis. Expanding the natural ostium of the basilar sinus and the nasal cavity restores mucociliary function, evacuates the pathological content in the sinus, and permits the patient to achieve stable remission. The paper describes a clinical case of acute isolated sphenoiditis in a 25-year-old patient with migraine-like headache. This case shows that even timely initiated medical therapy is insufficient in some cases; there is a need for surgical intervention.

isolated sphenoiditis
transnasal sphenotomy

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