Fungal Sinusitis Clinical Trial
Official title:
(Value of Endoscopic Sphenoid Nasalization in Management of Allergic Fungal Sinusitis Involving Sphenoidal Sinus)
To study the outcome of different two endoscopic sphenoid procedure for management of allergic fungal sphenoidal sinusitis : sphenoidotomy versus sphenoid nasalization with posterior septectomy .
Fungal rhinosinusitis classified into invasive and noninvasive subtypes. Phenotypes of
noninvasive fungal rhinosinusitis occur in immunocompetent subjects and include: local fungal
colonization, fungal ball, and allergic fungal rhinosinusitis. Subtypes of invasive fungal
rhinosinusitis include acute invasive fungal rhinosinusitis, chronic invasive fungal
rhinosinusitis and granulomatous invasive rhinosinusitis.
The estimated incidence of sphenoid sinusitis is only 2.7% of all nasal sinus infections,
also the diagnosis of sphenoid sinus fungal infection is sometimes difficult. Clinical signs
are often non specific and nasal endoscopy can be strictly normal.Early diagnosis is
therefore difficult and diagnosis is often delayed with headache that may sometimes persists
for several years before diagnosis of the disease.
In most cases of sphenoid sinusitis, enlargement of the obstructed sinus ostium is sufficient
to provide drainage of retained secretions and reestablish mucociliary clearance.According to
Simmen and Jones, a type I sphenoidotomy entails identification of the ostium without further
intervention; a type II sphenoidotomy entails enlargement of the ostium upward to the level
of the cranial base, and inferiorly to one-half of the sinus height; and a type III
sphenoidotomy involves widening the ostium to its most lateral extent.
Eloy et al in 2017 stuited that,In more extensive sphenoid sinus surgery is reserved for
cases where in the disease process is extensive or previous surgery has failed. In some cases
sphenoid nasalization in which bilateral extended sphenoidotomy is necessary. In this
procedure, the posterior aspect of the nasal septum is resected, along with the sphenoid
rostrum, the intersinus septum, and other intrasphenoid partitions, creating a common cavity
with a broad drainage pathway . It also allows access to the lateral recesses of this sinus.
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