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Endoscopic approaches to benign sphenoid sinus lesions: development of an algorithm based on 13 years of experience

Published online by Cambridge University Press:  28 August 2014

A S Elhamshary ,
H E Romeh ,
M F Abdel-Aziz  and
S M Ragab
A S Elhamshary
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tanta University Hospitals, Egypt
H E Romeh
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tanta University Hospitals, Egypt
M F Abdel-Aziz
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tanta University Hospitals, Egypt
S M Ragab*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tanta University Hospitals, Egypt
*
Address for correspondence: Dr Sameh M Ragab, Department of Otolaryngology, Tanta University Hospitals, Tanta, Egypt Fax: 0020 403 416 781 E-mail: sragab@doctors.org.uk
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Abstract

Objective:

To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions.

Methods:

Charts of 392 patients were reviewed and categorised according to disease nature and extent as follows: group 1 comprised isolated sphenoid sinus lesion cases, group 2 consisted of pansinus lesion cases and group 3 comprised lateral sphenoid recess lesion cases. Surgical approaches, difficulties and complications were noted.

Results:

A transnasal approach was employed in 40.8 per cent of cases (23.2 per cent were group 1 patients, 16.1 per cent were group 2 patients and 1.5 per cent were group 3 patients), a transethmoidal approach was utilised in 54.3 per cent of cases (group 2 patients) and a transpterygopalatine fossa approach was selected in 4.9 per cent of cases (group 3 patients). Surgical difficulties were encountered in 11.9, 10.8 and 0 per cent of patients in whom transnasal, transethmoidal or transpterygopalatine approaches were utilised, respectively.

Conclusion:

Radio-pathological categorisation provided a means of developing an algorithm for selecting the most appropriate endoscopic approach. Transnasal sphenoidotomy should be the first choice of approach whenever applicable. Lateral sphenoid recess non-inflammatory diseases should be managed through a transpterygopalatine fossa approach. Revision surgery does not play a key role in the algorithm.

Keywords

Sphenoid SinusEndoscopyEndoscopic Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 9 , September 2014 , pp. 791 - 796
Copyright
Copyright © JLO (1984) Limited 2014 

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