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Unilateral isolated sphenoid sinusitis with contralateral abducens nerve palsy - A rare complication treated in a low-resource setting.

Siu J, Sharma S, Sowerby L - J Otolaryngol Head Neck Surg (2015)

Bottom Line: Unilateral isolated sphenoid sinus disease (ISSD) is a rare diagnosis of the paranasal sinuses that can be associated with complications involving vascular, neurologic, and optic structures in close proximity.A 62 year old female presented to a hospital in Georgetown, Guyana with right lateral rectus palsy, diplopia, and a severe progressively worsening headache.The patient's headache resolved immediately after surgery while the diplopia and lateral rectus palsy resolved completely after 6 weeks.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, Queen's University, Kingston, ON, Canada. jsiu@qmed.ca.

ABSTRACT

Background: Unilateral isolated sphenoid sinus disease (ISSD) is a rare diagnosis of the paranasal sinuses that can be associated with complications involving vascular, neurologic, and optic structures in close proximity.

Case presentation: A 62 year old female presented to a hospital in Georgetown, Guyana with right lateral rectus palsy, diplopia, and a severe progressively worsening headache. CT scan revealed an opaque left sphenoid sinus consistent with unilateral ISSD. A transnasal sphenoidotomy was performed without complication under local anesthetic in the absence of endoscopic guidance. The patient's headache resolved immediately after surgery while the diplopia and lateral rectus palsy resolved completely after 6 weeks.

Conclusion: We present a rare complication of ISSD and highlight challenges associated with diagnosis and management of ISSD in a resource-limited setting. This is the second reported case of unilateral ISSD with contralateral lateral rectus palsy in the literature.

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Coronal section of the posterior aspect of the sphenoid sinus showing its close proximity to important functional structures: the internal carotid artery, cavernous sinus, and oculomotor, trochlear, ophthalmic, abducens, and maxillary nerves [13].
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Fig3: Coronal section of the posterior aspect of the sphenoid sinus showing its close proximity to important functional structures: the internal carotid artery, cavernous sinus, and oculomotor, trochlear, ophthalmic, abducens, and maxillary nerves [13].

Mentions: Prompt diagnosis and surgical intervention of ISSD is crucial in order to prevent serious complications caused by disease spread to the intracranial and orbital regions and involvement of important structures including the cranial nerves, pituitary gland, cavernous sinus, and internal carotid artery (Figure 3) [9]. Previous reports demonstrate that a delayed diagnosis of ISSD has been shown to result in increased morbidity with 23-29% of cases left with permanent disability [11,12].Figure 3


Unilateral isolated sphenoid sinusitis with contralateral abducens nerve palsy - A rare complication treated in a low-resource setting.

Siu J, Sharma S, Sowerby L - J Otolaryngol Head Neck Surg (2015)

Coronal section of the posterior aspect of the sphenoid sinus showing its close proximity to important functional structures: the internal carotid artery, cavernous sinus, and oculomotor, trochlear, ophthalmic, abducens, and maxillary nerves [13].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359434&req=5

Fig3: Coronal section of the posterior aspect of the sphenoid sinus showing its close proximity to important functional structures: the internal carotid artery, cavernous sinus, and oculomotor, trochlear, ophthalmic, abducens, and maxillary nerves [13].
Mentions: Prompt diagnosis and surgical intervention of ISSD is crucial in order to prevent serious complications caused by disease spread to the intracranial and orbital regions and involvement of important structures including the cranial nerves, pituitary gland, cavernous sinus, and internal carotid artery (Figure 3) [9]. Previous reports demonstrate that a delayed diagnosis of ISSD has been shown to result in increased morbidity with 23-29% of cases left with permanent disability [11,12].Figure 3

Bottom Line: Unilateral isolated sphenoid sinus disease (ISSD) is a rare diagnosis of the paranasal sinuses that can be associated with complications involving vascular, neurologic, and optic structures in close proximity.A 62 year old female presented to a hospital in Georgetown, Guyana with right lateral rectus palsy, diplopia, and a severe progressively worsening headache.The patient's headache resolved immediately after surgery while the diplopia and lateral rectus palsy resolved completely after 6 weeks.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, Queen's University, Kingston, ON, Canada. jsiu@qmed.ca.

ABSTRACT

Background: Unilateral isolated sphenoid sinus disease (ISSD) is a rare diagnosis of the paranasal sinuses that can be associated with complications involving vascular, neurologic, and optic structures in close proximity.

Case presentation: A 62 year old female presented to a hospital in Georgetown, Guyana with right lateral rectus palsy, diplopia, and a severe progressively worsening headache. CT scan revealed an opaque left sphenoid sinus consistent with unilateral ISSD. A transnasal sphenoidotomy was performed without complication under local anesthetic in the absence of endoscopic guidance. The patient's headache resolved immediately after surgery while the diplopia and lateral rectus palsy resolved completely after 6 weeks.

Conclusion: We present a rare complication of ISSD and highlight challenges associated with diagnosis and management of ISSD in a resource-limited setting. This is the second reported case of unilateral ISSD with contralateral lateral rectus palsy in the literature.

Show MeSH
Related in: MedlinePlus