孤発性蝶形骨洞病変における2.2 mm軟性内視鏡検査の有用性

抄録

Isolated sphenoid sinus disease (ISSD) is rare and difficult to diagnose. CT and MRI are recommended as useful aids for the diagnosis. Endoscopic examination typically provides non-specific findings and does not contribute to a direct diagnosis of ISSD. This study, conducted using a retrospective case series, was aimed at investigating the usefulness of diagnostic nasal endoscopy (DNE) for ISSD. Twenty-nine patients with ISSD were included and subjected to CT and DNE. DNE was performed using a flexible endoscope with a diameter of 2.2 mm after pre-treating the sphenoethmoidal recess (SER). The study population included 15 patients with fungal sinusitis or sinusitis caseosa, 5 patients with mucus retention cysts, 2 patients with non-specific inflammatory sinusitis, 3 patients who showed spontaneous resolution, and 4 patients with benign or malignant neoplasms. The DNE findings were positive in 21 patients. Endoscopic examination of the SER revealed positive findings in 7 patients (21%), and direct evaluation of the inside of the sphenoid sinus could be performed in 16 patients (55%). Among these patients, the pathology was based on the gross confirmation of lesions. Although the positive endoscopic finding rate was 21% when the observation range was limited to the SER, which is consistent with previous findings, the total positive finding rate reached 76% with the reported endoscopic method. We demonstrated that DNE has the ability to provide beneficial information, in contrast to previously described methods, and is useful for a prompt and direct diagnosis of ISSD.