Cerebrospinal fluid rhinorrhea from the lateral recess of sphenoid sinus: More to it than meets the eye.

BACKGROUND: Cerebrospinal fluid (CSF) leak from the lateral recess of the sphenoid sinus is rare when compared to leaks from other sites. The extended endonasal approach along with a transpterygoid extension provides adequate exposure for repair of these defects. MATERIALS AND METHODS: We retrospectively analyzed a series of seven patients who underwent eight transpterygoid approaches for repair of the CSF leak from the lateral recess of the sphenoid sinus. We analyzed the patient characteristics, site of leaks, type of repair done, and presence of increased intracranial pressure (ICP) in these individuals. RESULTS: Seven patients underwent eight transpterygoid approaches for CSF leaks from the lateral recess of the sphenoid sinus. The leak was bilateral in one patient. The materials used for repair consisted of fat, fascia lata, free mucosal flap or a vascularised nasoseptal flap, and fibrin glue. Evidence of increased ICP was found in five of the seven patients. CSF diversion was needed in three of the seven patients (two ventriculoperitoneal shunt and one thecoperitoneal shunt). CONCLUSION: Endoscopic endonasal transpterygoid approach provides an excellent visualization of the skull-base defect and facilitates adequate instrument manipulation within the corridor, allowing successful repair of the defect with low rates of recurrence. Increased ICP can have a role in causing spontaneous CSF rhinorrhea from this location.

Alveolar Recess Cell (ARC): A Newly Described Intra Maxillary Sinus Cell with Variable Pneumatisation of Alveolar Process of Maxilla.

Anatomical variations in the maxillary sinus pneumatisation are limited unlike the ethmoids. We present rare variations of the maxillary sinus along its floor other than septations and includes wide pneumatisation of alveolar and palatal recess with cell formation. An intra-maxillary cell that opens into the maxillary infundibulum well within the sinus is described here and our senior author has coined the new term-alveolar recess cell. Its involvement in the sinus pathologies and additional surgical approaches for the disease clearance is discussed here.

Dirofilariasis Presenting as Orbital Abscess Complicating Ethmoid Sinusitis.

Dirofilariasis in deep tissue plane is seldom reported in literature. A 58 year old woman presented with right orbital abscess complicating ethmoid sinusitis. She underwent endoscopic ethmoidectomy with abscess drainage where a dirofilaria worm was extracted. Treatment requires surgical removal of the worm without the need for anti-parasitic medications.

Unilateral Absence of Ethmoid Sinus and Nasal Turbinates: A Rare Case Report.

A variety of anatomical variation of paranasal sinus and nasal turbinates exist, as its development is a complex and long standing process. Computerized Tomography (CT) of the paranasal sinuses is a very valuable tool in diagnosing these variations. Preoperatively defining the anatomical variations of the intranasal structures is essential in performing the safe functional endoscopic sinus surgery and to avoid unnecessary complications. Several degrees and combinations of aplasias and hypoplasias have been reported. We report a case of 37-year-old male who presented with bilateral nasal block and rhinorrhea and his CT paranasal sinuses showed gross septal spur in left side, absence of right middle, inferior and superior turbinates, absent right ethmoid air cells, aplastic right frontal sinus, left concha bullosa with bilateral maxillary sinusitis.

Endoscopic Endonasal Approach of Blow Out Fracture Reduction- A Novel Technique.

Blunt trauma to orbit can lead to orbital blow out fracture. Computerized tomography of paranasal sinuses plays the main role in diagnosing it. Repairing the defect and restoring the orbital contents is a challenging task for the surgeon. Endoscopic endonasal approach in reduction of blow out fracture provides good cosmetic outcomes and grossly minimize surgical complications. We report a case of 18-year-old male presented with diplopia, restriction of eye movements and enophthalmos due to Road traffic accident. CT paranasal sinuses showed right side floor, medial orbital wall fracture with medial rectus muscle entrapment. We planned endoscopic endonasal approach to reduce the fracture and multilayered repair done using bone resected from choncha bullosa, fat and fascia lata. Patient relieved of symptoms post operatively without any complications.

A Case of Evolving Bilateral Sphenoidal Meningoencephaloceles: Case Report and Review of the Literature.

BACKGROUND: The evolution of sphenoid sinus meningoencephaloceles and cerebrospinal fluid (CSF) rhinorrhea is poorly understood. CASE DESCRIPTION: We present a case demonstrating the gradual evolution of encephaloceles from both the lateral walls of a previously normal sphenoid sinus in a patient with dural arteriovenous fistula; the CSF leak that developed after staged embolization of the dural arteriovenous fistula was managed by an endoscopic endonasal transpterygoid approach. CONCLUSIONS: We suggest that over a period of time, chronic elevation of intracranial pressure can result in gradual erosion of the lateral wall of the sphenoid with development of meningoencephaloceles and CSF leaks.