Kumar Amit, Gupta Kartikesh, Tyagi Amit Kumar, Varshney Saurabh, Kumar Niraj
Department of Otorhinolaryngology, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India.
Department of Neurology, All India Institue of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):987-993. doi: 10.1007/s12070-020-02059-6. Epub 2020 Aug 19.
Isolated lesions of the sphenoid sinus are uncommon. Cavernous sinus thrombosis is generally sought due to a systemic disease rather than a local pathology. It may be due to hidden primary pathology like isolated acute sphenoid fungal rhinosinusitis. In present study, we have discussed the early management of such hidden lesions with complication. A retrospective review of 5 cases of isolated acute sphenoidal fungal rhinosinusitis leading to cavernous sinus thrombosis was carried out. All cases were managed as emergency cases. Diagnostic nasal endoscopy was normal in all cases, with sinus disease evident in radiology in only 60% cases. Diagnostic endoscopic sinus surgery was performed in 40% cases. All patients underwent urgent surgical debridement along with IV antifungals. Complete recovery was seen in ocular movements in 40% and partially in 40%, whereas only 25% had complete improvement in vision. While four cases showed favourable outcome, one patient could not be saved despite all efforts. Exploring the sinus in cavernous sinus syndrome or orbital apex syndrome despite non-conclusive imaging, is warranted as early intervention may significantly impact the chances of survival. "Time is vision" in cases with acute fungal sinusitis and is equal to the aphorism of cardiologists i.e. "time is muscle.
蝶窦孤立性病变并不常见。海绵窦血栓形成通常是由全身性疾病而非局部病变引起的。它可能源于隐匿的原发性病变，如孤立性急性蝶窦真菌性鼻-鼻窦炎。在本研究中，我们讨论了此类伴有并发症的隐匿性病变的早期处理方法。对5例因孤立性急性蝶窦真菌性鼻-鼻窦炎导致海绵窦血栓形成的病例进行了回顾性分析。所有病例均按急症处理。所有病例的诊断性鼻内镜检查均正常，仅60%的病例在影像学上显示鼻窦病变。40%的病例进行了诊断性鼻内镜鼻窦手术。所有患者均接受了紧急手术清创并静脉注射抗真菌药物。40%的患者眼球运动完全恢复，40%部分恢复，而只有25%的患者视力完全改善。虽然4例患者预后良好，但尽管全力抢救，仍有1例患者未能挽救过来。在海绵窦综合征或眶尖综合征中，即使影像学检查结果不明确，探查鼻窦也是必要的，因为早期干预可能会显著影响生存几率。在急性真菌性鼻窦炎病例中，“时间就是视力”，这与心脏病专家的格言“时间就是肌肉”类似。
