Definition & Overview
A sinusotomy is a medical procedure used to treat an inflamed sinus or prevent sinus inflammation. Doctors also use it to treat other sinus diseases, such as infections and lesions.
The sphenoidal sinuses are a pair of air spaces in the paranasal sinus located within the sphenoid. They are located just behind the ethmoid bone in the middle of the skull. The two sinuses vary in size and shape. They are also often asymmetrical due to the displacement of the septum. They sometimes cause complications, such as inflammation or a tumour. In such cases, sphenoidal sinusotomy may become necessary.
Who Should Undergo and Expected Results
A sphenoidal sinusotomy may be necessary for patients who suffer from sinus diseases, such as:
- Sphenoiditis or sphenoidal sinusitis - This refers to the inflammation of the nasal mucosa in the sphenoid sinuses usually in conjunction of paranasal sinusitis
- Fungal sphenoiditis
- Bacterial infection
- Inverted papilloma
- Fibrous dysplasia
- Sphenochoanal polyps
Most sinusotomies performed on the sphenoidal sinuses are used for the treatment of diseases affecting the paranasal sinuses in general. This is because isolated diseases of the sphenoidal sinuses are very rare, making up only 1 to 2% of all sinus infections.
Regardless of the nature of the problem, diseases of the sinuses involving the sphenoid are challenging to treat due to the limited access to the area. They are also difficult to diagnose as most symptoms are very difficult to recognise. These symptoms include:
- Facial pain
- Purulent rhinorrhea
- Retropharyngeal drip
- Nasal obstruction
- Abnormal vision
Another challenge to proper diagnosis is the limitations of imaging tests. Most imaging tests cannot provide a detailed image of the sphenoid sinuses due to its remote location.
Unfortunately, when not diagnosed and treated in time, sphenoidal sinus diseases can lead to serious complications. This is because the sphenoidal sinuses are anatomically related to the brain, meninges, optic nerve, cranial nerve, and the internal carotid artery. As with all sinus infections, there is a risk that the infection may spread to the structures of the brain, which can lead to fatal outcomes.
Thus, a sinusotomy often becomes the only treatment option. If there is an abnormal growth, such as a lesion or tumour, the surgeon may also conduct a biopsy. During the biopsy, a sample of the tissue from the suspicious growth is taken. The sample is then further analysed to determine the nature of the growth.
How is the Procedure Performed?
A sinusotomy of the sphenoidal sinus can be performed in three grades:
- Grade I – This is used to identify the sphenoidal ostium.
- Grade II – This is used to open up the sphenoid to half its height.
- Grade III – The incision on the sphenoidal sinus extends to the floor of the sinus.
In the past, a sinusotomy was a highly risky operation that involved a facial or oral incision. Now, however, the procedure is performed endoscopically. The endoscopic procedure reduces post-operative risks associated with the procedure. It also reduces surgical pain, trauma, and tissue damage.
The following steps are taken during the procedure:
- The patient is first prepared by decongesting the nose and administering anaesthesia.
- The surgeon inserts a hollow endoscopic tube into the nasal passages and guides it all the way to the sphenoidal sinuses.
- The surgeon can either go through the nasal cavity or the nasal septum. In the latter approach, the surgeon gains access to the midline of the sphenoidal sinuses.
- The surgeon then inserts other microscopic surgical instruments through the endoscopic tube. These instruments are used to widen the opening to the sinus, allowing the surgeon to make an incision to reduce inflammation or to perform a biopsy without open surgery.
- After the procedure, the instruments and the tubes are removed.
- The surgeon will place a nasal dressing to protect the nose as it heals.
Possible Risks and Complications
A sinusotomy of the sphenoid can cause pain and discomfort that can last for a few days. However, these are very minimal due to the endoscopic nature of the procedure. It is also normal for patients to experience bleeding, mucus discharge, or nasal obstruction due to dried blood in the nasal passageways. This can be relieved with the use of antibacterial lubricant nasal sprays containing a saline solution.
Patients may also experience a change in voice tone after the procedure.
To ensure that the sinuses are healing properly, patients need to undergo follow-up endoscopic visual monitoring.
There is also a small risk of rare but severe complications such as:
- Vision loss
- Haemorrhage of the sphenoid
- Cosmetic deformities
- Septal perforation
Damage to vital structures near the sphenoidal sinuses; these can be nasal, neurologic, or vascular
Simmen D, et al. “Sphenoidal Sinusotomy (I, II, III).” Manual of Endoscopic Sinus and Skull Base Surgery. 2014. DOI: 10.1055/b-0034-91928
Marcolini TR, Safraider MC, Socher JA, Lucena GO. “Differential diagnosis and treatment of isolated pathologies of the sphenoid sinus: Retrospective study of 46 cases.” Int Arch Otorhinolaryngol. 2015 Apr; 19(2): 124-129. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399171/