Author(s)
Caroline Rieger, MD
Timothy DeKlotz, MD
Affiliation(s)
Medstar Georgetown University Hospital
Abstract:
Introduction: Isolated sphenoid sinus disease (ISSD) is a relatively infrequent diagnosis with potential neurovascular and cranial repercussions. Indistinct symptoms such as generalized headaches and facial pain may make clinical diagnosis difficult. Intervention varies depending on the etiology and may range from antibiotic therapy to surgical intervention to prevent injury to nearby critical neurovascular structures. We present a case of unilateral abducens nerve palsy in the setting of isolated sphenoid sinusitis secondary to compression of Dorello’s canal from an Aspergillus mycetoma. Methods: Case report and literature reviewResults: An 83-year-old female presented to the emergency department with a severe generalized headache, unilateral diplopia and right lateral rectus palsy. She reported two similar episodes over the preceding nine months, lasting approximately four days, with resolution of symptoms in the interim. MRI obtained to rule out ischemic causes demonstrated complete opacification of the right sphenoid sinus with extension up to the posterior fossa dura in the region of Dorello’s canal. She was referred to Otolaryngology and underwent an endoscopic sphenoidotomy with removal of an aspergilloma. Post-operatively, the patient’s headaches immediately resolved with complete resolution of diplopia and lateral rectus palsy three weeks later. Conclusion: Involvement of the sixth cranial nerve in isolated sphenoid sinus disease is unusual. A high index of suspicion for ISSD is warranted given the potential for devastating complications. Endoscopic sphenoidotomy with removal of the associated lesion is one viable surgical option to prevent permanent disability in select pathology.