El Mograbi Aiman, Soudry Ethan
Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
World J Otorhinolaryngol Head Neck Surg. 2017 Mar 6;3(1):49-53. doi: 10.1016/j.wjorl.2017.02.001. eCollection 2017 Mar.
The clinical presentation of sphenoid sinusitis can be highly variable. Rarely, sphenoid sinusitis may present with cranial nerve complications due to the proximity of these structures to the sphenoid sinus.
A case series from Rabin Medical Center and all cases of cranial nerves palsies secondary to sphenoid sinusitis that have been reported in the literature were reviewed.
Seventeen patients were identified. The abducent nerve was the most common cranial nerve affected (76%), followed by the oculomotor nerve (18%). One patient had combined oculomotor, trochlear and abducent palsies. The most common pathology was isolated purulent sphenoid sinusitis in 64% followed by allergic fungal sinusitis (AFS) in 18%, and fungal infection in 18%. 94% had an acute presentation. The majority (85%) received a combined intravenous antibiotics and surgical treatment. The remainder received conservative treatment alone. Complete recovery of cranial nerve palsy was noted in 82% during follow up.
Sphenoid sinusitis presenting as diplopia and headaches is rare. A neoplastic process must be ruled out and early surgical intervention with intravenous antimicrobial therapy carry an excellent outcome with complete resolution of symptoms.
蝶窦炎的临床表现可能高度多变。由于这些结构与蝶窦相邻，蝶窦炎很少会出现颅神经并发症。
回顾了拉宾医疗中心的一系列病例以及文献中报道的所有继发于蝶窦炎的颅神经麻痹病例。
共确定了17例患者。展神经是最常受影响的颅神经（76%），其次是动眼神经（18%）。1例患者合并动眼神经、滑车神经和展神经麻痹。最常见的病理类型是孤立性化脓性蝶窦炎（64%），其次是变应性真菌性鼻窦炎（AFS，18%）和真菌感染（18%）。94%为急性表现。大多数患者（85%）接受了静脉抗生素和手术联合治疗。其余患者仅接受保守治疗。随访期间82%的患者颅神经麻痹完全恢复。
以复视和头痛为表现的蝶窦炎很少见。必须排除肿瘤性病变，早期手术干预联合静脉抗菌治疗可取得良好效果，症状完全缓解。
