Kanjanawasee Dichapong, Chaowanapanja Pattraporn, Keelawat Somboon, Snidvongs Kornkiat
Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Clin Med Insights Case Rep. 2019 Mar 5;12:1179547619835182. doi: 10.1177/1179547619835182. eCollection 2019.
Cholesteatoma of the paranasal sinuses is uncommon. Its clinical characteristics are an expanding growth of the affected paranasal sinuses consisting of keratinizing squamous epithelium with bony wall destruction. Among involved paranasal sinuses, sphenoid sinus cholesteatoma is the least common.
An 82-year-old female diabetic patient presented with subacute onset of fever after experiencing chronic progressive headaches for more than 20 years. Nasal endoscopy found purulent discharge from left sphenoethmoidal recess. Computed tomography (CT) scan of the paranasal sinus showed soft tissue lesions that totally filled the left sphenoid sinus with posterior and inferior wall destruction. There was no evidence of connection to the left mastoid cavity.
Left sphenoidotomy was performed. Histopathology revealed cholesteatoma. Two months after surgery, she became worse and CT showed extensive skull base destruction. The patient underwent bilateral sphenoidectomy and craniotomy with surgical debridement of osteomyelitis of the skull base. She received long-term intravenous ertapenam and sitafloxacin for treating drug-resistant Klebsiella infection. The osteomyelitis could not be controlled, and she died.
Progressive headache can be caused by an uncommon disease such as sphenoid sinus cholesteatoma, which is a surgical condition. Complicating osteomyelitis of the skull base requires extensive debridement surgery and should be anticipated.
鼻窦胆脂瘤并不常见。其临床特征为受累鼻窦呈进行性生长，由角化鳞状上皮构成，并伴有骨壁破坏。在受累鼻窦中，蝶窦胆脂瘤最为少见。
一名82岁的女性糖尿病患者，在经历了20多年的慢性进行性头痛后，出现亚急性发热。鼻内镜检查发现左侧蝶筛隐窝有脓性分泌物。鼻窦计算机断层扫描（CT）显示软组织病变完全充填左侧蝶窦，并伴有后壁和下壁破坏。没有证据表明与左侧乳突腔相通。
实施了左侧蝶窦切开术。组织病理学检查显示为胆脂瘤。术后两个月，病情恶化，CT显示广泛的颅底破坏。患者接受了双侧蝶窦切除术和开颅手术，对颅底骨髓炎进行了手术清创。她接受了长期静脉注射厄他培南和西他沙星治疗耐克雷伯菌感染。骨髓炎无法控制，患者死亡。
进行性头痛可能由蝶窦胆脂瘤等罕见疾病引起，这是一种需要手术治疗的疾病。颅底骨髓炎作为并发症需要进行广泛的清创手术，对此应有所预见。
