Mra Zan, Roach Jeffrey C, Brook Allan L
Departments of Otorhinolaryngology-Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
Rhinology. 2002 Mar;40(1):34-40.
Sphenoid opacifications may be discovered during the radiological work up of patients presenting with fever, headache, or neurological changes. While most of these patients do not require surgical intervention, prompt assessment and management is nevertheless required. Ten patients who underwent sphenoidotomy for drainage or biopsy at Montefiore Hospital during a 4-year period from September 1995 through January 2000 are presented. Nine out of 10 patients had predisposing factors such as AIDS, diabetes, leukemia, and end-stage renal disease. The most common presentation was altered mental status. One patient rapidly developed cavernous sinus thrombosis. Microbiology of sphenoid cultures included various fungi, Mycobacterium avium intracellulare, coagulase negative Staphylococci, and Corynebacterium. Neoplastic processes included non-Hodgkin's lymphoma and sinonasal undifferentiated carcinoma. When evaluating hospitalized patients with sphenoid sinus disease, a thorough history and a bedside nasal endoscopy should be performed. Conservative management in the form of intravenous antibiotics and topical decongestion should always be the first line of treatment. Those patients with clinical or radiological evidence of disease extending beyond the confines of the sphenoid sinus require immediate surgical intervention.
在对出现发热、头痛或神经功能改变的患者进行影像学检查时，可能会发现蝶窦混浊。虽然这些患者中的大多数不需要手术干预，但仍需要及时评估和处理。本文介绍了1995年9月至2000年1月这4年期间在蒙特菲奥里医院接受蝶窦切开引流或活检的10例患者。10例患者中有9例存在易感因素，如艾滋病、糖尿病、白血病和终末期肾病。最常见的表现是精神状态改变。1例患者迅速发展为海绵窦血栓形成。蝶窦培养物的微生物包括各种真菌、鸟分枝杆菌胞内菌、凝固酶阴性葡萄球菌和棒状杆菌。肿瘤性病变包括非霍奇金淋巴瘤和鼻窦未分化癌。在评估住院的蝶窦疾病患者时，应进行全面的病史询问和床边鼻内镜检查。以静脉使用抗生素和局部减充血为形式的保守治疗应始终作为一线治疗方法。那些有临床或影像学证据表明疾病超出蝶窦范围的患者需要立即进行手术干预。
