What is Sinusotomy of Sphenoid? Overview, Benefits, and Expected Results
Sphenoid sinusotomy is a surgical procedure to access and remove diseased tissue from the sphenoid sinus, which lies behind the eyes and can cause a wide range of ailments if it becomes blocked or infected. In this article, we’ll discuss the purpose, benefits, and expected results of the procedure.
What is Sphenoid Sinus?
The sphenoid sinus is a roughly triangular-shaped chamber located at the base of the skull, just behind the nose and behind the eyes. It is one of the four paranasal sinuses and is connected to the nasal cavity. It is lined with thin sheets of mucosal tissue that can become irritated, inflamed, or infected. When this occurs, blockages in the sinus can result, leading to various sinus-related symptoms.
What is Sphenoid Sinusotomy?
Sphenoid sinusotomy is a surgical procedure to access and remove diseased tissue from the sphenoid sinus. The procedure is more commonly referred to as sinusotomy.
Purpose of Sphenoid Sinusotomy
The purpose of sphenoid sinusotomy is to open up the sphenoid sinus to allow air in and to remove inflamed or infected tissue that could be causing an obstruction and leading to sinus symptoms. In some cases, the procedure may also involve using small instruments to reshape the anatomy of the sinus so that blockages can be prevented in the future.
Benefits of Sphenoid Sinusotomy
The main benefit of a sphenoid sinusotomy is that it can help to provide relief from a range of symptoms associated with a blocked or infected sphenoid sinus, including:
- Facial pain and pressure
- Sinus inflammation
- Nasal congestion
- Bad breath
- Facial numbness
- Difficulty sleeping
Preparing for a Sphenoid Sinusotomy
Prior to any sphenoid sinus surgery, your doctor will conduct a thorough examination of the sinus cavity and discuss the procedure with you. You’ll be advised to take antibiotics to prevent infection and will need to stop taking any medications that increase your risk of bleeding, such as aspirin and ibuprofen.
What to Expect During a Sphenoid Sinusotomy
Sphenoid sinusotomy is usually conducted under general anesthesia and can take anywhere from one to two hours to complete. During the surgery, your doctor will make a small incision between the nose and upper lip to gain access to the sinus cavity. Once inside, they will use specialized tools to clear out any blockages or remove inflamed or infected tissue. In some cases, they may also need to reshape the anatomy of the sinus to prevent future blockages.
Expected Results of a Sphenoid Sinusotomy
A successful sinusotomy of the sphenoid sinus can bring relief from a range of sinus-related symptoms, including headaches, facial pain, inflammation, and nasal congestion. In some cases, the procedure may also prevent future blockages in the sinus cavity. The expected recovery time depends on the individual but is typically around one to two weeks.
Risks of a Sinusotomy
While many people experience positive results after a sphenoid sinusotomy, it is important to be aware that there are risks associated with the procedure. These include potential complications such as infection, bleeding, scarring, and nerve damage. It is important to discuss these risks with your doctor before undergoing the procedure.
Sphenoid sinusotomy is a surgical procedure to access and remove inflamed or infected tissue from the sphenoid sinus. The procedure can help to relieve a range of sinus-related symptoms and can also be used to prevent future blockages in the sinus cavity. While it is generally safe, there are risks associated with the procedure that should be discussed with a doctor prior to undergoing surgery.
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/