title: Isolated sphenoid sinus disease - a retrospective analysis.
abstract: OBJECTIVE
  To evaluate the etiology, symptoms, signs, imaging, surgical findings and outcomes of isolated sphenoid sinus disease (ISSD).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary university based referral center.
  
  
  METHODS
  All 8 patients aged 17-63, managed surgically in the department of ENT and Head and Neck Surgery at St. John's Medical College and Hospital, Bangalore from 2006 to 2008 for ISSD. Demographic data, presenting signs and symptoms endoscopic and imaging findings, surgical management, surgical pathology and clinical outcomes were investigated in the above patients.
  
  
  RESULTS
  Of the 8 cases of ISSD, 5 were male; 3 were female, with an age range of 17-63 years. The most common presenting symptom was headache (7 patients [87.5%]), followed by nasal obstruction and recurrent URTI (5 cases [62.5%]). Imaging included CT and/or MRI studies in all cases. Sphenoid sinus pathology was varied and included 5 (62.5%) inflammatory cases, 1 (11.1%) cerebrospinal fluid fistula and 2 (22.2%) cases of sphenoid sinus neop;asms. Of the inflammatory cases 2 (40%) had isolated polyps in the sphenoid sinus [sphenochoanal polyps] and 3 (60%) had fungal sinusitis. Treatment was surgical, endoscopic transnasal sphenoidotomy under general anesthesia in all 5 patients with inflammatory ISSD Two patients with sphenoid sinus tumors underwent endoscopic biopsy.
  
  
  CONCLUSIONS
  ISSD is rare. A high index of suspicion is required for diagnosis, which should be an active process and not one of exclusion. Both diagnostic nasal endoscopy and CT imaging are essential for diagnosis. The direct approach to the sphenoid sinus, transnasal endoscopic sphenoidotomy without ethmoidectomy is safe and effective. With early and adequate surgery we were able to avoid the morbidity associated with ISSD.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, St. Johns Medical College and Hospital, Bangalore, 560 034 India.
authors.forename: B V
authors.initials: BV
authors.lastname: Manjula
authors.forename: Arun B
authors.initials: AB
authors.lastname: Nair
authors.forename: A M
authors.initials: AM
authors.lastname: Balasubramanyam
authors.forename: Shantanu
authors.initials: S
authors.lastname: Tandon
authors.forename: Ravi C
authors.initials: RC
authors.lastname: Nayar
keywords: Headache; Sinusitis; Sphenochoanal polyp; Sphenoid sinus; Sphenoidotomy