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Management of isolated sphenoid sinus disease in children: a surgical perspective
Lisa M Elden1, Megan E Reinders, Ken Kazahaya
1Division of Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States. elden@email.chop.edu
Insights
Isolated sphenoid sinus disease in children is rare. Surgical drainage is often necessary for severe headaches and complications, with MRI aiding diagnosis.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Neurology
- Medical Imaging
Background:
- Isolated sphenoid sinus disease is uncommon in pediatric populations.
- Clinical presentation often includes severe headaches with subtle sinus symptoms.
Purpose of the Study:
- To define the range of diseases affecting the sphenoid sinus in children.
- To establish optimal surgical drainage timing for opacified sphenoid sinuses.
Main Methods:
- Retrospective chart review over ten years.
- Analysis of children diagnosed with isolated sphenoid sinus disease.
- Utilized Computed Tomography (CT) and Magnetic Resonance Imaging (MRI).
Main Results:
- Fourteen pediatric patients diagnosed with isolated sphenoid sinus disease.
- Common conditions included bacterial sphenoiditis, mucoceles, and tumors.
- Headache was the most frequent symptom; complications arose in infected cases.
- MRI proved superior to CT in delineating disease extent for complex cases.
Conclusions:
- Isolated sphenoid sinus disease requires careful evaluation in children.
- Prompt surgical intervention is crucial for severe presentations.
- Advanced imaging like MRI is vital for diagnosis and management planning.
Objective:
To determine the spectrum of diseases and optimal timing of surgical drainage for the opacified sphenoid sinus in children.
Methods:
Ten year retrospective chart review of children with isolated sphenoid sinus disease.
Results:
Fourteen patients (mean age 11 ± 2.8 years, range 6.5-15.1 years) were diagnosed with isolated sphenoid sinus disease. Five patients had acute, severe bacterial sphenoiditis, four had sphenoid mucoceles, three had suspected tumors involving the sphenoid bone, clivus or sella, and two were identified incidentally when imaging studies were obtained for unrelated reasons. Headache was the most common symptom. Cranial nerve or other intracranial complications were present in all of those referred because of infection, but in none of the other patients. Computed tomography (CT) revealed the presence of disease in all cases. Compared with CT, magnetic tomography (MRI) was more helpful in identifying the extent of disease spread in two patients with acute bacterial sphenoiditis and in three patients with suspected tumors. All improved with surgical drainage or biopsy of the suspected tumor. In two cases, children were treated conservatively with antibiotics and the primary symptoms resolved.
Conclusions:
Isolated sphenoid sinus disease is rare in children. Those with clinically significant disease presented with progressive, severe headaches and minimal sinus symptoms. MRI studies were important to identify the source of headache and evolving complications in several of these patients.
