Significant variability exists regarding the dimensions of the sphenoid sinus, attachment of the intersinus septum, number of septa, and pneumatization of the sphenoid bone. Sphenoid sinus surgery is an important component of the management paradigm of inflammatory sinus disease as well as integral to the approaches to the sellar and parasellar regions for skull base lesions. Endoscopic picture of the anterior and inferior surfaces of the sphenoid bone. There are four paired sinuses surrounding the nasal cavity. The sphenoid bone is the most complex bone of the human body. Jun 12, 2019 when an acute inflammatory response occurs in the sphenoid sinus, the result is sphenoid sinusitis or sphenoiditis. The sphenoid sinuses vary in size and shape, and owing to the lateral displacement of the intervening septum, which may insert on the carotid canal, they are rarely symmetrical. Paranasal sinuses are air filled hollow sacs seen around the skull bone. Despite it is benign, its expansive nature may slowly cause erosion of the paranasal sinuses osseous limits by compression and consequent osseous reabsorption, which leads to. May 27, 2014 the anatomy of the sphenoid sinus is highly variable. Evaluation and surgical management of isolated sphenoid sinus. Although usually referred to as a single struc ture, the nasal cavity consists of paired midfacial. Endoscopic endonasal surgery of the sphenoid sinus. It occupies the body of the sphenoid but may extend into its greater and lesser wings.
This article incorporates text in the public domain from page 150 of the 20th edition of grays anatomy 1918 external links. Sphenoid sinus anatomical relations and their implications in. Sinusitis definition sinusitis refers to an inflammation of the sinuses, airspaces within the bones of the face. Therefore, the greatest number of the lateral sinus films and a part of the axial views were not suitable for the present special study of the finer details of. A sphenoid sinus infection, also called, sphenoid sinusitis is an infection of the sinuses at the center of the skull located behind the nose and eyes. The sphenoid sinus is located in the sphenoid bone near the pituitary gland and the optic nerve. They cannot be palpated during an extraoral examination.
When an acute inflammatory response occurs in the sphenoid sinus, the result is sphenoid sinusitis, or sphenoiditis. Isolated sphenoid sinus pathologies the problem of delayed. Pneumatization can extend into the greater sphenoid wing resulting in lateral recesses. These approaches require a clear understanding of the anatomy of the sphenoid sinus and its surrounding regions. This process is experimental and the keywords may be updated as the learning algorithm improves. The sphenoid sinuses are paired spaces formed within the body of the sphenoid bone, communicating with the roof of the nasal cavity via the sphenoethmoidal recess in its anterior wall. Dr zeeshan ahmad sr neurootology department of neurosurgery sgpgims, lucknow 2. Then the anterior face of the sphenoid as well as the posterior septum was resected en bloc with the tumor. The surgical anatomy of the nose and paranasal sinuses is published with great detail in most standard textbooks, but it is the purpose of this chapter to describe those structures in a very clear and systematic presentation focused for the endoscopic sinus surgeon.
The relationship of the sphenoid sinuses to the carotid artery, optic nerve, floor of sella turcica. Sphenoid sinus definition of sphenoid sinus by medical. Generally about one week of no lifting, straining or nose blowing. An estimated 3% of all sinusitis cases occur in the sphenoid sinuses. We report three cases of sphenoid sinus retention cyst with headache treated in our department in which clinical improvement was achieved by surgery. In a previous report 1 an alteration of the frontal sinus wall which occurred frequently in paranasal cancer was discussed. Study of sphenoid sinus anatomy in relation to endoscopic surgery. Acute isolated sphenoid sinusitis is seen in fewer than 3% of all cases of sinusitis. The aim of this study is the evaluation of the anatomical structures of sphenoid sinus ostium used as a reference point for transsphenoidal surgery by cone beam computed tomography. The authors aimed to characterize neuroimaging and intraoperative variations in the sagittal and coronal surgical anatomy of healthy controls and patients with sellar lesions. Because of the location of the sphenoid sinuses, this type of sinusitis is often very difficult to diagnose and treat. Each has a small, round hole that opens into the posterosuperior part of the nasal cavity.
Detailed anatomical analysis of the sphenoid sinus and. Endoscopic anatomy of sphenoid sinus for pituitary surgery. Pignatari, daniel timperley, fernando oto balieiro, and fabio pires santos tips and pearls the sphenoid sinuses have a critical role in ventral skull base surgery due to their central strategic location and their close relationship with vital neurovascular structures of the central. The sphenoid sinus, the less commonly involved, represents 1% to 8% of the paranasal mucoceles 5. Grays anatomy, revised american, from the 15th english ed. Neoplastic lesions of this region are even less common and account for 1516% of isolated sphenoid sinus disease cases 3,4. The sphenoid sinus is one of the four paired paranasal sinuses that is contained within the body of the sphenoid bone.
The sphenoid sinus is the most posterior paranasal sinus. Pdf endoscopic anatomy of sphenoid sinus for pituitary. Jan 27, 2015 the sphenoid sinuses are located in the sphenoid bone near the optic nerve and the pituitary gland on the side of the skull. Talaa alexandriat, egypt in recent years the transsphenoidal approach to the pituitary gland has come into vogue and a study of the surgical anatomy of the sphenoid sinus has become. Pdf endoscopic anatomy of the sphenoid sinus hossam.
Because of its shape, it is also known as the wasp bone. A considerable degree of variability exists in the anatomy of the sphenoid sinus, sella turcica, and surrounding skull base structures. However, since no symptoms develop in the majority of cases, surgery is not performed. With advances in endoscopic sinus surgery ess, radiologist and otolaryngologists should have thorough knowledge of anatomy of paranasal sinus pns. The sphenoid bone is divided into the following parts.
The anatomy of the sphenoid sinus, as it relates to endoscopic sinus surgery, was studied in 93 cadaver heads 186 sphenoid sinuses using endoscopic dissections as well as sagittal sections. The ct anatomy of the bony canals, foramina and fissures that run through the sphenoid bone or run along its borders must be known. Typically, patients with sphenoid sinus disease report a long clinical history and often present with retroorbital. The sphenoid directly or indirectly articulates with every bone in the skull. These are large number of intercommunicating cavities present inside the ethmoid bone and open into the nose.
When an acute inflammatory response occurs in the sphenoid sinus, the result is sphenoid sinusitis or sphenoiditis. Obstruction in the omc can lead to subsequent infection of the maxillary, frontal, and sphenoid sinuses. However, with the availability of current diagnostic modalities such as. The neurosurgical anatomy of the sphenoid sinus and sellar. The authors study was performed using the conebeam computed tomography images of 16 to 82year old 200 112 female, 88 male patients newton 5g, verona, italy. This variability has a direct impact on surgical planning for endoscopic skull base cases. Study of sphenoid sinus anatomy in relation to endoscopic. The sphenoid sinuses are located in the sphenoid bone near the optic nerve and the pituitary gland on the side of the skull. The sphenobasilar sb junction the sphenoid articulates with the base of the occipital bone to form the sphenobasilar. Inflammation of the sphenoid sinus tends to feel like a nagging headache on the vertex of the head or up behind the eyes. Oct 29, 2016 endoscopic anatomy of nose and sphenoid sinus 1.
The sphenoid sinus is surrounded by several vital anatomical structures. Other articles where sphenoidal sinus is discussed. Isolated sphenoid sinus pathologies are relatively rare. Nasoendoscopic treatment of the sphenoid sinus mucoceles. Description the sinuses are paired air pockets located within the bones of the face. The journal of laryngology and otology february 1999, vol. The surgical anatomy of the nose and paranasal sinuses is published with great detail in most standard textbooks, but it is the purpose of this chapter to describe those structures in a very clear and systematic. Osteitis of the sphenoid sinus jama otolaryngologyhead. The alteration appears on xray films as blurring, demineralization, andor condensation of. Chronic sphenoid sinusitis occurs more often in patients with pansinusitis, and fewer than 3% of inflammatory lesions of the sinuses primarily involve the sphenoid sinus. Jan 25, 2018 endoscopic anatomy of lateral wall of sphenoid sinus 1. We report 2 cases of isolated acute isolated sphenoid sinusitis with unusual presentations. Endoscopic sinus surgery removal of sphenoid polyps video a a a.
Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications. The frontal sinus is situated on top of the nose and behind the brow ridges. Despite it is benign, its expansive nature may slowly cause erosion of the paranasal sinuses osseous limits by compression and consequent osseous reabsorption, which leads to commitment of adjacent structures 6. The sphenoidal sinus opens into the sphenoethmoidal recess of. Among patients with rhinosinusitis, isolated sphenoiditis is diagnosed in 2. The anatomy of the sphenoid sinus is highly variable. The disease is relatively uncommoncomparatively, chronic sphenoid sinusitis is more commonand may be limited to the sphenoid sinus or, more commonly, may involve multiple sinuses or pansinusitis. Given this dual perspective, the surgeon must carefully appraise the surgical goals in the setting of the patients anatomy and pathology. Retentioncysts most commonly occur in the maxillary sinus, and they are infrequent in other paranasal sinuses. The floor of sphenoid sinus is occasionally composed int. Anatomy and endoscopic picture of the face of the sphenoid. Paranasal sinus maxillary sinus sphenoid sinus frontal sinus endoscopic sinus surgery these keywords were added by machine and not by the authors. It is frequently misdiagnosed because of its vague symptoms and the paucity of clinical findings.
Endoscopic anatomy of lateral wall of sphenoid sinus. Clip shows endoscopic removal of sphenoid polyps, balloon sinuplasty and septoplasty. Jul 18, 2016 14 sphenoid sinus in skull base surgery aldo cassol stamm, shirley s. The ostia of the sphenoid sinus are usually located in the spheno ethmoidal recess, medial to the superior or supreme turbinate where they can usually be seen well with the endoscope. The disease is relatively uncommon comparatively, chronic sphenoid sinusitis is more common and may be limited to the sphenoid sinus or, more commonly, may involve multiple sinuses or pansinusitis. The sphenopalatine foramen f is located inferolateral to the ostium. The common symptoms of sinusitis are headache, usually located near the sinuses most involved, and nasal discharge. Spine of sphenoid bone marked with black circle references. More recently, further extension of these approaches has led to the development of endoscopic skull base surgery, using the sphenoid sinus as the gateway to the anterior, middle and the posterior cranial fossa.
Image guided navigation systema new technology for complex. Sphenoid sinus surgery recovery what does the doctor say. The two sinuses are separated by a septum which may or may not be in the midline. Sphenoid sinusitis definition of sphenoid sinusitis by. Additionally, pneumatization can also involve the posterior orbital wall, pterygoid processes, and lesser sphenoid wing. Original article anatomy and ct reconstruction of the anterior area of sphenoid sinus shousen wang, jinchao zhang, liang xue, liangfeng wei, zhiyu xi, rumi wang department of neurosurgery, fuzhou general hospital, fujian medical university, fuzhou 350025, p.
There are seven bones that form the orbit eye socket, and the. A sphenoid subluxation can affect total body structure. A median portion, known as the body of sphenoid bone, containing the sella turcica which houses the pituitary gland. Pneumatization degree of sphenoid sinus, diameter of sphenoid sinus ostium, and distance lower edge of superior turbinate to sphenoid sinus ostium were measured by using sagittal sections. The anatomical relations of the sphenoid sinus and their. Septum deviation of sphenoid sinus and the distance between 2 ostia were evaluated by coronal and axial sections, respectively. In the early period the sphenoid sinuses were not examined routinely. A minimally invasive treatment for chronic sinusitis.
These are 2 sinuses which lie inside the body of sphenoid and are separated from each other by a bony septum. The sphenoid sinuses are highly variable in their configuration. This article attempts to trace the history of anatomy of paranasal sinuses from early 16th century till date. Sinusitis is most often due to an infection within these spaces. Bhanu prakash usmle, fmge and neet pg 33,204 views 3. Surgical anatomy of the paranasal sinuses springerlink. Alongside the past development of endoscopic sinus surgery, knowledge about the anatomy of the sinuses has become crucial for surgeons. The mucus that accumulates in the sealedoff sinus causes pressure on the sinus walls, resulting in discomfort, fever, pain, and difficult breathing. Introduction endoscopic sinus surgery ess is widespread as the treatment of sphenoid sinus diseases1. Nasal obstruction should improve after first in office post op debridement which should be about one week post op. An understanding of sphenoid sinus anatomy and the different techniques available.
Surgical anatomy of the sphenoid sinus on the ct using. Nasal and sinus endoscopy for medical management of. In their system, a type i sphenoidotomy involves identification of the sphenoid ostium without further instrumentation. Since then, the development of endoscopic sinus surgery ess ushered in a new philosophy allowing the surgeon to target the ostiomeatal complex omc, an area in the anterior ethmoid sinus region. Talaa alexandriat, egypt in recent years the transsphenoidal approach to the pituitary gland has come into vogue and a study of the surgical. Surgical anatomy of the sphenoid sinus on the ct using multiplanar reconstruction technique. Mar 01, 2011 isolated sphenoid sinus pathologies are relatively rare. It makes up most of the middle part of the base of the skull and contributes to the floor of the middle cranial fossa of the skull the soft tissue structures such are the cranial nerves and parts of the brain are associated with this bone and have intense relations to it. Knowing the details of the anatomy of the sphenoid sinus and the extent of pneumatization can guide the surgeon through difficult corners of this approach. Anatomy and pathology of the skull base, ct and mri imaging. In the majority of cases of sphenoid sinus pathology, symptoms do not arise in the early stages of the.
Inflammation of the sphenoid sinus tends to feel like a nagging headache on. Endoscopic sinus surgery removal of sphenoid polyps. The anterior surface of the sphenoid bone presents in the midlaine, a vertical ridge of bone, the ethmoidal crest also known as the sphenoidal crest, which articulates with the perpendicular plate of the ethmoid, forming part of the septum of the nose. To better define this anatomy, 20 sphenoid sinuses in cadavers were dissected to reveal important anatomical relationships, dimensions, volume and. Isolated sphenoid sinus pathologies the problem of. Dec 12, 2017 ethmoid bone anatomy head and neck animated osteology mbbs, fmge and neet pg duration. The paranasal sinus region is one of the most complex areas of the human body and is consequently very difficult to study. Ethmoid bone anatomy head and neck animated osteology mbbs, fmge and neet pg duration. Endoscopic anatomy of lateral wall of sphenoid sinus 1. The skull base is formed by two paired bones, frontal and temporal, and 3 unique, ethmoid, sphenoid and occipital. Original article anatomy and ct reconstruction of the. Like other sinus issues, encouraging sinus drainage is critical. It is divided in anterior, middle and posterior cranial. Detailed anatomical analysis of the sphenoid sinus and sphen.
This was observed in 35% of our irradiated patients. The maxillary sinus is located on both sides of the cheeks, and on the sides of the nose. Endoscopic anatomy of the sphenoid sinus researchgate. The sphenoid bone is one of the bones that form the eye socket. Skull base anatomy the anatomy of the skull base is complex and its knowledge is essential for the treatment planning of the different processes that could affect this area. As the sphenoid sinus is closely surrounded by such important structures as the carotid artery, the optic canal and the. Orange, calif or a related product, orthophthalaldehyde eg. Later the film technique was aimed at visualizing the soft tissue alterations rather than the finer bony details.
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