Treatment of fungus ball in lateral recess of sphenoid sinus through anterior lacrimal recess approach under nasal endoscope
Kang Yuanchun1, Liu Haibin2, Cheng Yin2, Xie Kaipeng3, Zou Liufeng1, Wu Xiaoqin3, Peng Hu2, Ji Zhenhua2, Yang Zixuan2, Liu Huanhai2, Zhang Guomin3, Chen Jinhuang1, Liao Jianchun2
1Department of Otolaryngology Head and Neck Surgery, Longhai First Hospital, Zhangzhou 363100, China; 2Department of Otolaryngology Head and Neck Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai 200003, China; 3Department of Otolaryngology Head and Neck Surgery, No.909 Hospital of the Joint Logistics Support Force of PLA, Zhangzhou 363000,China
Abstract：Objective To explore the clinical effects of the cryptic fungus ball on the outside of the butterfly sinus under the help of the nasal endoscopy by summarizing the CT and MRI imaging features of the disease.Methods Clinical data of 5 patients with fungal sinusitis combined with butterfly sinus hidden nest fungus admitted from January 2008 to January 2018 in Changzheng Hospital Affiliated to the Naval Medical University, Longhai First Hospital, No. 909 Hospital of the Joint Logistics Support Force of PLA were retrospectively analyzed, including 1 male and 4 female, aged 26-64 years old. Before surgery, all 5 patients were performed sinus CT examination, only 3 of them had routine sinus MRI examination. All of them had the treatments of nasal endoscopy assistant outer side of the butterfly sinus fungal ball excision by the road before the tears. Then the pathway went on from the upper jaw sinus rear wall into the wing nest after exposing the front wall of the butterfly sinus outside the hidden nest, open the outer hidden nest front wall to deal with the hidden nest fungal ball. Postoperative outpatient visits for 6 months, using the 1997 Haikou Standards to assess the efficacy of surgery.Results (1) Sinus CT and MRI scan showed: the butterfly sinus cavity and the outer hidden nest in the soft tissue nodule were irregular hyperplasia, higher density, uneven. T1WI showed equal signal density and irregular low signal in sphenoid sinus and lateral recess, while T2WI showed high signal in sphenoid sinus and lateral recess by MR scan. (2) The five patients had successful surgery, none of which had complications. During 6 to 12 months follow-up, 5 patients were cured without relapse.Conclusions There are characteristic CT and MRI imaging manifestation with the fungus ball of lateral recess of sphenoid sinus. The nasal endoscopic assisted pathway by the tears before the hidden nest into the road to deal with the lesions in the outer hidden nest of the butterfly sinuses is convenient to reach the outer hidden nest of the butterfly sinuses to thoroughly remove the fungal lesions in the hidden nest. This operation has good clinical application value.
Bendersky DC, Landriel FA, Ajler PM, et al. Sternberg's canal as a cause of encephalocele within the lateral recess of the sphenoid sinus: a report of two cases[J]. Surg Neurol Int, 2011, 2: 171-175. DOI:10.4103/2152-7806.90034
[5]
Castelnuovo P, Dallan I, Pistochini A, et al. Endonasal endoscopic repair of Sternberg's canal cerebrospinal fluid leaks[J]. Laryngoscope, 2007, 117(2): 345-349. DOI:10.1097/01.mlg.0000251452.90657.3a.
[6]
王翦, Sharatchandra Bidari, Albert Rhoton. 蝶窦外侧壁的显微解剖及其在扩大经蝶手术中的应用[J]. 中国神经肿瘤杂志, 2009, 7(3): 180-183.
Mabry RL, Marple BF, Folker RJ, et al. Immunotherapy for allergic fungal sinusitis: three years' experience[J]. Otolaryngol Head Neck Surg, 1998, 119(6): 648-651. DOI:10.1016/S0194-5998(98)70027-0.
[11]
Waxman JE, Spector JG, Sale SR , et al. Allergic aspergilus sinusitis: concepts in diagnosis and treatment of a new clinical entity[J]. Laryngoscope, 1987, 97: 261-266.
Loftus PA, Wise SK. Allergic fungal rhinosinusitis: the latest in diagnosis and management[J]. Adv Otorhinolaryngol, 2016, 79: 13-20. DOI:10.1159/000444958.
[14]
Osawa S, Rhoton AL Jr, Seker A, et al. Microsurgical and endoscopic anatomy of the vidian canal[J]. Neurosurgery, 2009, 64(5 Suppl 2): 385-411; discussion 411-412. DOI:10.1227/01.NEU.0000338945.54863.D9.
[15]
Cavallo LM, Messina A, Gardner P, et al. Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical Considerations[J]. Neurosurg Focus, 2005 ,19(1): E5. DOI:10.3171/foc.2005.19.1.6.
[16]
Kassam AB, Snyderman C, Gardner P, et al. The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report[J]. Neurosurgery, 2005, 57(1 Suppl): E213; discussion E213. DOI:10.1227/01.neu.0000163687.64774.e4.
Gao L, Zhou L, Dai Z, et al. The Endoscopic prelacrimal recess approach to the pterygopalatine fossa and infratemporal fossa[J]. J Craniofac Surg, 2017, 28(6): 1589-1593. DOI:10.1097/SCS.0000000000003419.
2019, Vol. 24 
