Sphenoethmoidal Recess Research Articles

Comparing Endoscopic Measurements of the Anterior and Posterior Ethmoidal Arteries with CT Measurements: A Cadaveric Study.

To reveal the reliability of radiological measurements of the ethmoid arteries. Five fresh frozen cadaveric heads underwent computed tomography and endoscopic sinus surgery. The lateromedial length of the anterior ethmoidal artery (AEA) and its distance to the axilla of the middle turbinate (MTA), the sphenoethmoidal recess (SR) and the posterior ethmoidal artery were measured. The posterior ethmoidal artery (PEA) was referenced to the SR. These anatomical parameters were measured both radiologically and endoscopically, and the compatibility of the two was examined. Ten nasal cavities were dissected. We found that the distance of MTA to the AEA was 16±8 mm in dissection, 21±4 mm radiologically in the sagittal section, the distance of SR to the AEA was 14±3 mm in dissection, 19±4 mm radiologically in the sagittal section, and the distance of the AEA to the PEA was 10±3 mm in dissection, 12±3 mm radiologically in the axial section. The distance of the PEA to SR was 6±3 mm in dissection, 8±2 mm radiologically in the sagittal section. The distance of the AEA to the MTA, the distance of the AEA to the PEA and the distance of the PEA to the SR were compatible with each other in the dissection and in the radiologically evaluation, whereas the distance of the AEA to the SR was not compatible.

A new computed tomography protocol to assess the olfactory cleft

INTRODUCTION: The olfactory cleft is a region of significant importance within the nasal cavity, given the heightened focus on olfactory disorders in recent years. It is considered a 3-dimensional space that starts at the most anterior olfactory filament and ends just anteriorly to the sphenoid sinus. This study aimed to outline the profile of the olfactory cleft as an anatomical area of extreme relevance in the diagnosis of diseases of the nose, paranasal sinuses and olfactory disorders. The aim to establish parameters of radiological normality for the olfactory cleft enables us to recognize and differentiate nasal disorders by identifying the widening or narrowing of the olfactory cleft during the preoperative assessment, thus facilitating the planning of the optimal treatment. This supports a theory about the evolution and development of the nose (Evo Devo Theory) that shows the olfactory nose (ethmoid and olfactory cleft) represents the seat of most diseases of the nose and paranasal sinuses. MATERIALS AND METHODS: 700 random CT scans of the nose and sinuses have been studied. A homogeneous group of CT scans of patients without paranasal sinus diseases were included in this study, seeking to define a reference anatomical measure as a criterion for tomographic normality. Measurements of the olfactory cleft were taken in the lateral-lateral direction between the middle concha and the septum on each side of the nose cavity at three specific anatomical points in the anterior skull base in the anteroposterior direction, corresponding to the beginning, middle and end of the olfactory cleft. For data analysis, exploratory statistical techniques have been used that allowed a better visualization of the general characteristics of the data. The appropriate statstical analysis was performed using Statistical Package for Social Sciences (SPSS). RESULTS: According to the statistical analysis performed, the reference values that were found evaluating and studying the three points were: at the first point - First Olfactory Neuron Point (FONP) – was 1.3 to 2.1 mm, at the second point - Middle Point (MP) was 1.1 to 1.6 mm, and at the third point – Sphenoethmoidal recess point (SERP) was 1.1 to 1.8 mm. The average in the first point was 1.78 mm, while in the second and third points were 1.41 and 1.48 mm, respectively. CONCLUSION: It is concluded that the tomographic olfactory cleft reference values are respectively: at the first point – First Olfactory Neuron Point- 1.3 to 2.1 mm, at the second point - Middle Point - 1.1 to 1.6 mm, and at the third point – Sphenoethmoidal recess point -1.1 to 1.8 mm.

In Vivo Fluticasone Absorption in Surgical Patients.

Intranasal corticosteroids (INCS) are a treatment mainstay of chronic rhinosinusitis and allergic rhinitis. Current computational models demonstrate that >90% of INCS drug deposition occurs on the head of the inferior turbinate and nasal valve, rather than the actual sinuses. These models do not consider mucociliary clearance which propels mucus posteriorly, nor do they consider the absorption of the drug. The purpose of this study is to better understand the exact anatomical location where INCS are absorbed. Patients with chronic rhinosinusitis and allergic rhinitis taking fluticasone pre-operatively who were scheduled for functional endoscopic sinus surgery and inferior turbinate reduction, respectively, were recruited. Intra-operative tissue samples were obtained from predetermined locations within the sinonasal cavity. Mass spectrometry was then used to quantify the amount of absorption in each specific anatomic location to determine the largest amount of absorption. Eighteen patients were included in our study. The greatest fluticasone absorption levels across the sinonasal anatomy were at the anterior inferior turbinate (5.7 ngl/mL), ethmoid sinus, (4.4 ng/mL), posterior inferior turbinate (3.7 ng/mL), maxillary sinus (1.3 ng/mL), and the sphenoethmoidal recess (0.72 ng/mL) respectively. Absorption was significantly higher in revision surgery compared to surgically naïve patients. Computation fluid dynamic models of the nasal passage are useful models to help predict intranasal particle flow. However, these models do not incorporate or consider the important mucociliary clearance system, leading to absorption of fluticasone throughout the sinonasal cavity far beyond that predicted by these models. 2 Laryngoscope, 134:1551-1555, 2024.

Relationship of Lesion Location to Postoperative Steroid Use in Eosinophilic Chronic Rhinosinusitis.

Eosinophilic chronic rhinosinusitis (ECRS) is known to recur after surgery. The treatment choice for recurrent ECRS, such as oral steroids or biological agents, must be chosen carefully, and identifying the lesion location may be useful. This study aimed to evaluate the postoperative course of ECRS patients and assess the relationship between endoscopic lesion location and postoperative oral steroid use. Patients with chronic rhinosinusitis who underwent bilateral endoscopic sinus surgery from April 2018 to March 2020 were divided into two groups based on the presence or absence of oral steroid use after surgery. The primary endpoint was the lesion location on endoscopic findings during surgery: middle turbinate, middle meatus, superior turbinate, superior meatus, nasal septum, and sphenoethmoidal recess. Subjective symptoms, blood tests, and computerized tomography (CT) findings (Lund-Mackay score) were evaluated as secondary endpoints. Among 264 patients, 88 were diagnosed histologically with ECRS (mean 48.98 ± 1.40 years, 67 males/21 females). Twenty-three patients were steroid-using, 65 were steroid-free, and six stopped attending their appointments. Patients with sphenoethmoidal recess lesions were significantly more likely to require steroids (p=0.019). There was a significant association between steroid use and younger age (p=0.041), olfactory dysfunction (p=0.021), and all sinuses (Frontal sinus: p < 0.001, Anterior ethmoid sinus: p=0.002, Posterior ethmoid sinus: p=0.011, Maxillary sinus: p=0.018, Sphenoid sinus: p=0.034, Total score: p < 0.001). A sphenoethmoidal recess lesion was a risk factor for requiring postoperative steroids. Young age, olfactory dysfunction, and preoperative severe CT findings were also significant risk factors. 3 Laryngoscope, 133:2511-2516, 2023.

Solitary sphenoid sinus benign lesions: management and prognostic values as retrospective audit of seven case series

BackgroundSolitary sphenoid sinus pathology is uncommon. The deep position of the sphenoid sinus makes symptoms related to solitary sphenoid sinus pathology non-specific and contributes to a significant diagnosis delay. Moreover, surrounding anatomical elements cause its pathology to be potentially serious and make surgical management challenging.MethodsThis retrospective study includes 7 cases presented with primary benign sphenoid sinus pathology managed between January 2019 and January 2022. Epidemiological features, clinical aspects, and treatment modalities are presented.ResultsSix female patients and one male patient were operated; their age ranges from 11 to 67 years old. Etiologies are divided into infection, tumors, and pseudo tumors. Sphenoid sinus approach was performed through the sphenoethmoid recess in 5 cases, through the septum in one patient and through the ethmoid in one patient.ConclusionEndoscopic procedures have significantly improved the management of the sphenoid sinus pathology. They offer good access and control of the sphenoid pathology but require a perfect mastery of radiologic and endoscopic anatomy and its variations.

Comparison of Diagnostic Quality of Multidetector Computed Tomography and Cone-Beam Computed Tomography in High and Low Resolution Modes for Assessment of the Nasal Cavity.

We aimed to compare the diagnostic quality of multidetector computed tomography (MDCT) and cone-beam computed tomography (CBCT) in high (HR) and low (LR) resolution modes for assessment of the nasal cavity and paranasal sinuses. This in vitro study was conducted on 5 dry human skulls by using a CBCT and a MDCT scanner in HR and LR modes to assess their diagnostic quality for 21 anatomical landmarks of the nose. The quality of images was evaluated by two oral and maxillofacial radiologists and a dentist using a four-point Likert scale of (I) poor, (II) decreased, (III) good, and (IV) excellent. Data were analyzed by STATA at 95% confidence interval. The Chi-square test was applied to compare the quality of visualization of landmarks based on the type of scanner. The diagnostic quality of HR CBCT and CT for the majority of landmarks was higher than that of LR CBCT and CT (P<0.05). The diagnostic quality of HR CBCT for agger nasi cells (P=0.010), olfactory cleft (P=0.032), sphenoethmoidal recess (P=0.032), and nasolacrimal duct (P=0.014) and LR CBCT for the middle turbinate (P=0.046) and middle meatus (P=0.031) was significantly higher than that of MDCT. The diagnostic quality of HR CBCT and CT for the majority of the landmarks in the nasal cavity and paranasal sinuses was higher than that of LR CBCT and CT. For the majority of landmarks, the diagnostic quality of CBCT and CT was the same; while for some landmarks, the diagnostic quality of HR and LR CBCT was higher than HR and LR CT. In general, CBCT has high efficacy for evaluation of the paranasal sinuses and the nasal cavity, and provides diagnostic information comparable to those provided by CT, but with a much lower radiation dose.

Allergic fungal rhinosinusitis presented as a unilateral nasal mass: A first case report from Thailand and literature review

Allergic fungal rhinosinusitis (AFRS) is a relatively new inflammatory sinonasal disease. Prevalence of the disease is reported to be highly different across Asia. A 23-year-old Thai male came to our hospital with left-sided nasal obstruction. Endoscopic examination found a mass originated from the left sphenoethmoidal recess. Incisional biopsy result of the mass indicated an inflammatory process and high level of serum specific IgE to several aeroallergens was found. Based on the biopsy results and other investigations, the diagnosis of AFRS was made and the patient was treated successfully with endoscopic sinus surgery and postoperative systemic/topical steroids. While AFRS is quite common in some regions, the disease is rarely encountered in Thailand and can be presented as a unilateral lesion, mimicking a tumor mass, which could lead to an incorrect diagnosis and inappropriate treatment. Even though AFRS is rarely reported in our country, it still can be found and might be recognized falsely as a neoplastic process. High level of awareness of the disease features could help to minimize inappropriate disease management.

A Prospective, Randomized, Double-Blind Study on the Efficacy of Different Modes of Topical Application of Nasal Anesthetics in the Diagnostic Nasal Endoscopy Procedure.

IntroductionIn the current otorhinolaryngology practice, technology has always been an essential part. Therefore, diagnostic nasal endoscopy (DNE) has become a vital examination in today’s practice. In order to visualize the nasal cavity in a systematic manner without any discomfort to both patient and doctor, the nose should be well anesthetized and decongested.ObjectiveThe study is to compare and evaluate the efficacy of 4% lignocaine-oxymetazoline cotton pledget packing versus topical sprays in the preparation of nasal cavities for DNE.MethodologyThe prospective, randomized, double-blind study was conducted among 246 patients and was divided into two groups. In the first group, the nose was packed with cotton pledgets containing 4% lignocaine-oxymetazoline and another group with 4% lignocaine-oxymetazoline spray. Following DNE, patients and surgeons were questioned on a pre-formed questionnaire to evaluate their experience during the procedure.ResultsIt was observed that the time taken for the pre-endoscopic preparation of the packing group was more than the spray group. A total of 91.9% of the spray group had pain during the pre-endoscopic preparation and more burning and tingling sensation than in the nasal pack (75.6%). A total of 69.9% of the patients among the spray group participants compared to 32.5% of the packing group patients experienced more throat discomfort. In addition, 12% of the packing group had mucosal bleeding during the preparation. A total of 32.5% of the spray group experienced severe pain when compared to 12.2% of the packing group during the endoscopic procedure. Most of the participants from both groups had difficulty visualizing the superior turbinate and sphenoethmoidal recess during the procedure. There was a significant difference seen between both the groups with respect to pain during the pre-endoscopic procedure (p=0.0005), burning/tingling sensation (p<0.0001), throat pain (<0.0001), mucosal bleed (p=0.0003), pain during the procedure (p=0.0001), and discomfort after the procedure (p<0.0001).ConclusionBoth methods of nasal preparation have merits and demerits in terms of discomfort, pain, and visualization of structures. Still, the packing of the nasal cavity with cotton pledgets is better when compared to spraying with 4% lignocaine-oxymetazoline. However, 4% lignocaine-oxymetazoline spray can be used during an emergency situation and with sensitive patients.

Myoepithelial Carcinoma ex Pleomorphic Adenoma: Rare Case Report with Clinicopathologic and Immunohistochemical Features

Abstract Introduction/Objective Myoepithelial carcinoma is identified by nearly exclusive myoepithelial differentiation and evidence of malignancy. It may arise de novo or in preexisting benign tumors including pleomorphic adenoma and benign myoepithelioma. It occurs most commonly in the parotid gland followed by submandibular glands, minor salivary glands, and occasionally in the sublingual gland. Nasopharyngeal origin has been rarely reported. Methods/Case Report An afebrile 19-year-old female presented to the emergency department with persistent facial pressure, otalgia (right side greater than left side), rhinorrhea, and several episodes of epistaxis. One month before, she has been treated with Amoxicillin for three days with no relief, where Augmentin started for her for five days. About four days prior presentation, she was placed on Prednisone and Cefdinir. Over the next several days, she began having throat pain with difficulty swallowing. Routine blood work revealed a leukocytosis of 14.2 with normal differentiation. CT of the neck showed a large soft tissue mass centered at the right nasopharynx. Flexible nasal endoscopy performed bilaterally to reveal the nasopharynx is entirely obstructed with a lobulated mass filling the nasopharynx. On the right side, it extends into the posterior nasal passage filling the sphenoethmoid recess and the posterior floor of the nasal passage. Outpatient biopsy from nasopharynx mass is also performed. Results (if a Case Study enter NA) Mass biopsy reveals a mucinous and chondromyxoid background with mixed epithelial and myoepithelial differentiation. The is squamous metaplasia of myoepithelial cells and prominent mitotic activity and apoptotic activity. Immunohistochemistry was positive for CK5/6, calponin, BCL2, SMA, BerEp4, Sox10, and a proliferative index up to 40%. Based on this information Myoepithelial Carcinoma ex-pleomorphic adenoma of the nasopharynx is the diagnosis. Conclusion Carcinoma ex pleomorphic adenoma is usually a high-grade malignancy. It occurs most commonly in the parotid gland, followed by submandibular glands, minor salivary glands, and occasionally in the sublingual gland. Our case is one of the few cases of myoepithelial carcinoma arising in nasopharyngeal pleomorphic adenoma.

Trigeminal Numbness After Intracranial Repair of a Spontaneous Meningoencephalocele of the Lateral Wall of the Sphenoid Sinus

A 58-year-old female with an eight-year history of rhinorrhea and a two-day history of subjective fever, chills, and vomiting presented to the emergency department for neurosurgical evaluation. Brain MRI demonstrated herniation of the meninges and portions of the inferomedial right temporal lobe through a defect of the lateral wall of the right sphenoid sinus, extending to the sphenoethmoidal recess and posterior right ethmoid air cells. A right pterional craniotomy was performed where the herniated part of the right temporal lobe, and its associated meninges, were excised. After surgery, she had hypoesthesia at the right maxillary division of the trigeminal nerve. This finding was caused by the proximity of the trigeminal nerve to the dural dissection that we performed at the bone defect. This rare complication has never been described after intracranial surgery. Only eight literature reports have described hypoesthesia or paresthesia of the trigeminal nerve after endoscopic resection of a sphenoid sinus meningoencephalocele. The patient has not had any recurrence of rhinorrhea after a six-month follow-up period.

Vanishing traumatic pneumocephalus – An alarm bell for the surgeon

Pneumocephalus usually occurs because of a bony defect between the intracranial compartments and the paranasal sinus. We present a case of traumatic non tension pneumocephalus with accompanying subdural haemorrhage (SDH) and fractures of the roof of sphenoid sinus.We noticed complete resolution of pneumocephalus with in a day on repeat CT head done on the next day. Significant resolution of SDH was also noted. This was unexpected as usually it takes 2-3 weeks for the complete resolution of non tension pneumocephalus. We assume that fracture in the roof of sphenoid sinus lead to CSF and haemorrhagic leakage through the sphenoethmoidal recess located within the superior meatus. This was unusual as CSF leakage is itself a cause of development of pneumocephalus when intracranial pressure is expected to increases, according to Ball Valve theory. So, the resolution of pneumocephalus was before the development of sufficient intracranial pressure to cause Ball valve effect. Hence, a complete resolution of a significant pneumocephalus and prompt regression of SDH in head injuries, with in few hours, should raise an alarm to exclude the possible association of CSF rhinorrhoea. Keywords: Pneumocephalus, CSF rhinorrhea, Subdural haemorrhage, Sphenoid roof fracture.

Cholesterol Granulomas Nasal Polyp in Sphenoethmoid Recess: An Atypical Aspect in a Common Lesion

Nasal polyp is a non neoplastic lesion of the respiratory mucosa. In few cases, it can be possible to detech the presence of cholesterolgranuloma. We present the case of a 55 year-old patient affected by a nasal lesion, localized in sphenoethmoidal recess, with particular microscopic feature and a review of the literature.

The non-invasive assessment of the sphenoid sinus: a review

&lt;p class="abstract"&gt;The sphenoid sinus with its peculiar mucociliary drainage effected by pathology at the spheno-ethmoidal recess necessitates an intervention, medical or surgical. Role of basic imaging in pre-treatment evaluation is elaborated upon. &lt;/p&gt;

Demographic profile of subjects undergoing sphenoidotomy for sphenoid sinusitis, in a tertiary care centre of Punjab- analysis of 75 subjects

Background: The demographic profile of patients with Sphenoiditis undergoing surgical intervention, in the state of Punjab was studied. The emphasis was on the age, gender and clinical presentation in this prospective study.Methods: There were 75 patients of sphenoethmoidal recess pathology with sphenoditis, who were selected from the Rhinology clinics of Otorhinolaryngology and head Neck services of Dayanand Medical College and Hospital Ludhiana , in a period one and a half years (November 2002 to October 2004). All patients were taken up for Functional endoscopic sinus surgery of the sphenoid sinus surgery with sphenoidotomy.Results: The age range of subjects with sphenoiditis was between 12 years to 70 years. The mean age was 38.13 years. The maximum number of patients were in 19-30 years age group and the minimum in 31-40 years age group. Males outnumbered the females by a ratio of 1.7:1. The most common was posterior nasal drip (69.33% cases) behind the Eustachian tube and the least common complaint was diplopia (5.33% cases. Ocular involvement was observed in 32%. The right eye was more frequently involved (17.33%) as compared to the left (12%).Conclusions: Patients with Sphenoid sinusitis were seen in the broad age range from 19 to 30 years with a male predominance. Posterior nasal discharge behind the Eustachian tube, rather than the typical occipital ache was the primary complaint .Right sided eye involvement with ptosis and lateral rectus palsy were commonly noted.

Postoperative complications and quality of life in patients with pituitary adenoma

Pituitary adenomas (PAs) are tumors that arise from the cells of the anterior pituitary gland. PAs are the most common tumors to occur in the sella area and the third most common intracranial neoplasm in surgery. Due to developments such as microscopy and neuroendoscopy, the curative effect of PA surgery continues to improve. However, postoperative complications may still occur. PA surgery can result in iatrogenic trauma, which is a primary cause of cerebrospinal fluid (CSF) rhinorrhea. PA surgery can affect the posterior pituitary gland, causing decreased antidiuretic hormone secretion and increased urine output, which can lead to hyponatremia. The nasal cavity and sphenoid sinuses may also be damaged during PA surgery, causing the sphenoethmoidal recess to be blocked. This increases the risk of infection. The purpose of this study was to analyze quality of life in PA patients post-resection, and to provide references for the development of early targeted risk assessment programs and intervention measures. We selected patients who underwent neuroendoscopic transnasal PA resection at the Affiliated Hospital of Nantong University between January 2017 and October 2019. These patients' hospital records were retrospectively obtained, including details of any postoperative complications. The patients were followed up by telephone 12 weeks following discharge, and we used the EuroQol 5 Dimensions (EQ-5D) health scale to assess the patients' quality of life. At follow-up 3 months after discharge, 68 people (41.72%) had experienced at least one common complication, including 7 cases of infection (4.29%), 56 cases of hypopituitarism (34.36%), 18 cases of CSF rhinorrhea (11.04%), 28 cases of diabetes insipidus (17.18%), and 25 cases of hyponatremia (15.34%). Patients that experienced complications reported having more serious problems on the dimensions of the EQ-5D descriptive system (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) than patients without complications. The scores of patients with complications on the EQ-5D visual analog scale (EQ-VAS) were lower than that of patients without complications. Postoperative complications are negatively associated with quality of life in PA patients. Actively preventing common complications could therefore improve these patients' quality of life and reduce their burden of disease.

An unusual presentation of sphenochoanal polyp

&lt;p class="abstract"&gt;Sphenochoanal polyp is a rare entity. Isolated polyps arising from mucosa covering the anterior wall of the sphenoid sinus or sphenoethmoidal recess extending till oropharynx is extremely rare. We aim to report a rare case of sphenochoanal polyp with a slender, unusually long stalk which extended till nasopharynx leading to a large bulky polypoidal mass extending till oropharynx. Due to its posterior location, sphenochoanal polyps are often diagnosed late as they can be easily missed in clinical examination. We intend to emphasize the combined use of diagnostic nasal endoscopy and computed tomography imaging in patients presenting with unilateral or bilateral nasal obstruction, snoring and recent onset of sleep disturbances. Treatment includes endoscopic excision of polyp and cauterization of the base of the stalk. Widening of the sphenoid sinus ostium is done when necessary. Early and complete removal and regular follow up is essential to prevent complications.&lt;/p&gt;

Nasal polyps and rhinosinusitis.

Rhinosinusitis is defined as inflammation of one or more of the paranasal sinuses and affects approximately 12% of the population. Acute rhinosinusitis is defined as symptoms that last < 12 weeks, and chronic rhinosinusitis (CRS) is defined as symptoms that last > 12 weeks. CRS is divided into three groups: CRS with nasal polyps (CRSwNP), CRS without nasal polyps (CRSsNP), and allergic fungal rhinosinusitis. Nasal polyps are inflammatory outgrowths of paranasal sinus mucosa caused by chronic mucosal inflammation and are present in 20% of patients with CRS. Nasal polyps typically present with nasal congestion, nasal obstruction, and anosmia or hyposmia, and occur more frequently in patients with persistent asthma, aspirin-exacerbated respiratory disease (AERD), CRS, and cystic fibrosis. The sinus cavities are lined with pseudostratified ciliated columnar epithelial cells interspersed with mucous goblet cells. Cilia continuously sweep the mucous toward the ostial openings and are important in maintaining the proper environment of the sinus cavities. The frontal, maxillary, and anterior ethmoid sinuses drain into the ostiomeatal unit of the middle meatus. The posterior ethmoid sinuses and superior sphenoid sinuses drain into the sphenoethmoid recess of the superior meatus. Most acute sinus infections are caused by viruses, and, therefore, it is not surprising that the majority of patients improve within 2 weeks without antibiotic treatment. A bacterial infection should be considered if symptoms worsen or fail to improve within 7-10 days. Combining an intranasal corticosteroid with an antibiotic reduces symptoms more effectively than antibiotics alone. Topical nasal steroids are the treatment of choice for nasal polyps. They significantly decrease polyp size, nasal congestion, and rhinorrhea, and increase nasal airflow. Short courses of oral steroids may be needed to reduce polyp size, followed by maintenance therapy with topical steroids. Surgery is reserved for patients in which polyps cause severe obstruction or recurrent sinusitis and for patients for whom medical therapy has failed. Aspirin desensitization may decrease the requirement for polypectomies and sinus surgery in patients with AERD.

Extraoral anatomy in CBCT – a literature review. Part 1: Nasoethmoidal region

Cone beam computed tomography has become a widely used imaging technique for dental indications. Depending on the selected size of the field of view, anatomical structures outside the dentomaxillary complex become visible. As a consequence, the clinician must be able to interpret also those anatomical regions. In this article, the anatomy of the nasoethmoidal region is presented based on a literature review. The nose is characterized by the nasal septum and the superior, middle, and inferior conchae. The turbinates may be pneumatized (concha bullosa), mainly the middle concha. The ethmoid bone has a complex morphology (ethmoid labyrinths) and contributes with its perpendicular plate to the nasal septum. Other structures of the septum include the vomer and the septal cartilage. The nasal meatuses stabilize the airflow and direct the inhaled air to the nasopharynx via the choanae. The middle nasal meatus, which is also a part of the so called ostiomeatal complex, serves as the major drainage area (semilunar hiatus) of the paranasal sinuses, i.e., maxillary sinus, anterior ethmoid cells, and frontal sinus. Posterior ethmoid cells empty into the superior meatus and the sphenoid sinus drains into the sphenoethmoidal recess, located above the superior concha. The nasolacrimal duct that is running along the middle portion of the lateral nasal wall opens into the inferior nasal meatus.

Intractable Epistaxis: Looking Beyond the Usual Sites

Intractable epistaxis is a challenge to manage and often requires multiple interventions, both medical and surgical. After anterior and posterior packing, many options exist on how to manage the patient. We performed a retrospective chart review of patients who presented to a private ear, nose, and throat practice with intractable epistaxis from January 2010 until July 2015.The clinical notes were reviewed, noting the demographic characteristics of the patients and the treatment plan that followed. In particular, we determined the site of bleeding that was documented. Of the 17 patients with intractable epistaxis identified, 5 had the site of bleeding documented and were included in the study. The documented areas that may have contributed to bleeding included the nasal olfactory region (n=3), nasal inferior meatus (n=1), and sphenoethmoid recess (n=1). After resuscitation and hematologic investigation, nasal endoscopy should be considered in patients with intractable epistaxis.

Primary Osteosarcoma of Sphenoid and Ethmoid Sinus in a 17Year Female: Case Report.

Primary osteosarcoma of sphenoid and ethmoid sinus present as a challenge in head neck cancer. A 17year female presented with left sided hemifacial pain, headache with nasal discharge. Clinico-radiological finding showed mass in sphenoethmoid recess spreading to adjacent structures. Endoscopic resection was done. Histopathological diagnosis was osteosarcoma of sphenoid and ethmoid sinus. Adjuvant chemotherapy administered. Osteosarcomas of sphenoid and ethmoid sinus are aggressive tumors with variable clinical features warranting high clinical suspicion.