title: Isolated sphenoid sinus opacification: A systematic review.
abstract: OBJECTIVE
  Unilateral sphenoid sinus opacification (SSO) on imaging is a common incidental radiologic finding. Inflammatory sinus disease is rarely isolated to one sinus cavity therefore SSO raises the potential for neoplastic etiology. The clinical significance of SSO was evaluated and compared to maxillary sinus opacification (MSO).
  
  
  METHODS
  A systematic review of unilateral sinus opacification was performed via Medline (1966-January 12th, 2015) and Embase (1980-January 12th, 2015), limited to English literature and human subjects. Case series of patients treated with radiologic evidence of unilateral sinus opacification either from maxillary or sphenoid sinuses and with pathology results were included. Individual cases were classified as neoplastic, malignant, or a condition requiring surgical intervention (i.e. fungal ball). Exclusion criteria were single case reports, lack of primary data, series of complications, or single pathology series. Case-by-case analysis was performed for both SSO and MSO.
  
  
  RESULTS
  Search strategy revealed 3264 studies. A total of 31 studies including 1581 patients met the inclusion criteria. In these studies, SSO was described in n=1215 (76.9%) and MSO in n=366 (23.1%). For SSO, the final diagnosis was neoplasia 18%, (malignancy in 10.9%). 58.3% of cases required surgical intervention and 13% were inflammatory. For MSO, neoplasia represented 18.3% (malignancy 7.1%), surgical intervention required in 47% of cases and 27.6%. were inflammatory.
  
  
  CONCLUSIONS
  Isolated MSO and SSO is a marker of neoplasia in 18% and malignancy in 7-10% of patients presenting with these radiologic findings. Clinicians should be wary of conservative management given the high incidence of neoplasia and consider a lower threshold for early surgical intervention.
authors.affiliation: Swedish Medical Group, Seattle, WA, United States; Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Knisely
authors.affiliation: Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia. Electronic address: trholmes8@gmail.com.
authors.forename: Timothy
authors.initials: T
authors.lastname: Holmes
authors.affiliation: Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Australia; Sinus and Nasal Specialists of Louisiana, Baton Rouge, LA, United States.
authors.forename: Henry
authors.initials: H
authors.lastname: Barham
authors.affiliation: Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors.forename: Ray
authors.initials: R
authors.lastname: Sacks
authors.affiliation: Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Harvey
mesh_terms: D006801:Humans; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging*; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging*
keywords: Incidental findings; Isolated sinus disease; Isolated sinus opacification; Maxillary; Neoplasia; Radiologic findings; Sphenoid