Sinusitis is common, but rarely localized to the sphenoid sinus. The sphenoid sinus has an intimate anatomical relationship with the cavernous sinus, internal carotid artery, and many cranial nerves (II, III, IV, V1-V2, VI). Therefore, the spread of infection or inflammation beyond the sphenoid sinus to these structures may result in serious or even fatal intracranial or orbital complications.
We retrospectively analyzed the data of 21 surgical cases of sphenoid sinus disease diagnosed at the Department of Otolaryngology, Japanese Red Cross Wakayama Medical Center, between January 2015 and December 2021. We investigated the symptoms, diagnosis, and treatment outcomes.
The most common initial symptom was headache (13 cases), followed by nasal symptoms (6 cases), and ocular symptoms (5 cases). Ocular symptoms included eye movement disorder (5 cases) and visual disturbance (1 case). Nasal endoscopy was performed in all cases, but in 6 cases, the endoscopic examination revealed no abnormalities. Of all the patients with sphenoid sinus disease, 17 had non-neoplastic lesions (inflammation, fungal sinusitis, and mucocele), and 4 had tumors. All the patients underwent endoscopic sinus surgery, and the lesions were completely removed. The cases with eye movement disorder improved or partially improved, but the case with visual disturbance showed no improvement.
Headache associated with sphenoid sinus disease is derived from the trigeminal nerve, and the pain possibly occurs in various parts of the head. In our study, a case of mucocele with eye movement disorder had oculomotor nerve palsy, and a case of inflammation with eye movement disorder tended to have abducens nerve palsy. Early surgical treatment is important to obtain the best chance of improvement of eye movement disorder; however, visual disturbance associated with sphenoid sinus disease may show no improvement.
