Volume 03 Issue 10-2023
55
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
55-60
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
Sphenoiditis is an inflammatory disease of the mucous membrane of the sphenoid sinus. As a rule, changes in the main
sinus are combined with other rhinological pathology, while its isolated lesion accounts for only 1-2% of cases among
all inflammatory pathologies of the paranasal sinuses. The anatomical and topographical features of the location of
the sphenoid sinus, as well as the nonspecificity of symptoms, lead to late diagnosis of this disease. Among the
complaints presented by patients, the most common is headache without clear localization (72%). In second place in
terms of frequency of occurrence, visual disturbances are detected in the form of diplopia, progressive unilateral
vision loss, and narrowing of the visual fields on the affected side. Visual symptoms account for 21% of patients with
isolated sphenoiditis (IS). Rhinological manifestations of the disease include: mucus running down the back of the
throat and nosebleeds. Thus, patients are under the supervision of doctors of related specialties for a long time:
ophthalmologists, neurologists and other specialists.
KEYWORDS
Sphenoiditis, sphenoid sinus, sphenoethmoidal recess.
INTRODUCTION
Research Article
ENDOSCOPIC TRANSNASAL SPHENOTOMY AND RESECTION OF
BULLOUS MIDDLE TURBINATE
Submission Date:
October 17, 2023,
Accepted Date:
October 22, 2023,
Published Date:
October 27, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue10-10
Khasanov U.S.
Researcher Tashkent Medical Academy, Uzbekistan
Ruzimurodov A.
Researcher Tashkent Medical Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 10-2023
56
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
55-60
SJIF
I
MPACT
FACTOR
(2021:
5.
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)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
An isolated lesion of the sphenoid sinus is a rare
pathology and its frequency of occurrence does not
exceed 1-3% of all inflammatory diseases of the
paranasal sinuses [1]. However, the involvement of
only one sinus in the pathological process is a
nonspecific manifestation of inflammatory changes,
much more often it is an indicator of a tumor process
[2].
With the development of radiological methods for
examining patients, the number of detections of
asymptomatic lesions of one or two sphenoid sinuses
has increased. Carrying out qualitative and quantitative
analysis of computer tomograms of patients, as well as
magnetic resonance imaging, allows us to suggest the
nature of pathological changes in the sinus [4]. In the
case of a tumor process or fungal sphenoiditis, the
treatment of choice is a surgical approach, while in
case of inflammatory or polypous changes in the
mucous membrane of the sphenoid sinus, drug
treatment is sufficient [8]. However, at the moment
there are no criteria for choosing treatment tactics in
this group of patients.
The spectrum of pathologies found in the sphenoid
sinus is very variable and includes both neoplasms and
inflammatory changes in the mucous membrane. The
variety of diseases is due to the location of the main
sinus so that the lesion is associated with both sinus
pathology and pathological changes originating from
the cranial cavity [1-4]. Among the neoplasms, benign
ones are distinguished, such as inverted papilloma,
pituitary adenoma, and malignant ones: squamous cell
carcinoma, adenocarcinoma, sinonasal low-grade
cancer, metastases of other organs [6]. In addition,
fungal diseases, antrachoanal and sphenochoanal
polyps, cystic formations, mucoceles, acute and
chronic inflammatory changes in the mucous
membrane of the sphenoid sinus, fibrous dysplasia,
bone osteomas are isolated [5,7,9-13]. Pathologies
associated with the cranial cavity include meningocele,
encephalocele,
meningoencephalocele,
sinonasal
liquorrhea and vascular aneurysms.
results. During endoscopic examination, degeneration
of the middle turbinate was discovered in 5 patients. Of
these, only 3 patients belong to the group of
ineffective conservative treatment. Under anesthesia,
to provide access to the anterior wall of the sphenoid
sinus, in 8% of patients, the bullous middle turbinate
was dissected with a scalpel along its anterior surface,
followed by removal of the lateral portion (Figure 1).
Volume 03 Issue 10-2023
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Publisher:
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Servi
Figure 1. Removal of the lateral portion of the middle turbinate using Blakesley forceps
This procedure was performed only on the affected
side of the sphenoid sinus. Since one patient had
bilateral turbinate degeneration, it was decided not to
perform surgical correction on the unaffected side.
Further, the stages of sphenotomy were similar to
those in the previously described method.
The only distinctive feature in this case was the
technique of anterior nasal tamponade, when one of
the hemostatic tampons was installed directly into the
space between part of the middle turbinate and the
nasal septum to preserve diastasis. The transseptal
approach when opening the sphenoid sinus is most
often used in transnasal surgery of the skull base,
namely the pituitary gland. The method provides a
minimally invasive approach, as well as the ability to
access two sphenoid sinuses simultaneously. In
otorhinolaryngological practice, the transseptal
approach is used much less frequently, due to the
absence of the need to unite the main sinuses with
each other.
A clinical example of a patient who underwent
transseptal sphenotomy due to the need for
simultaneous correction of the nasal septum and
removal of a cyst of the sphenoid sinus, closely
adjacent to the rostrum zone, Based on computed
tomography data, the presence of a mass in the area of
Volume 03 Issue 10-2023
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Publisher:
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Servi
the bottom of the sphenoid sinus, as well as significant
differences in the size of the patient’s sphenoid sinus,
a decision was made on a transseptal approach (Figure
2).
Figure 2. Computed tomography of a patient with a cyst of the right sphenoid sinus
From the classic incision in the vestibule of the nasal cavity on the left, a deformed section of quadrangular cartilage
was isolated and removed. Next, using a raster, the mucous membrane with the perichondrium was separated from
the bony part of the septum up to the rostrum. Removal of the bone mass of the latter provided good visualization of
the cystic formation (Figure 3).
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Figure 3. Mucous cyst of the sphenoid sinus
* the tip of the cyst is indicated
Removal of the cyst and aspiration of the contents was
complemented by the discovery of a natural
anastomosis with the right main sinus and minimal
expansion of the latter (sphenotomy type 1) to
improve sinus ventilation.
CONCLUSIONS
Thus, a careful study of preoperative computed
tomography and individual planning of surgical access
to the affected sinus is the key to successful
sphenotomy without complications. Endoscopic
transseptal access when opening the sphenoid sinus
can be used in case of hypopneumatization of the sinus
due to deviation of the nasal septum, as well as the
presence of Onodi cells in adults and pediatric patients.
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