PMC6537237_01
Preoperative coronal CT scan, showing an enlargement of the right sphenoid sinus with overdevelopment and opacity of the lateral recess. Thickening and sclerosis of the bone surrounding the right sphenoid sinus, the pterygoid process (white arrow) and the orbital apex (white arrowhead) can be observed. Focal interruption of the foramen rotundum (CNV2) (small star) and of the sphenoidal lateral recess wall is also present (black arrow).
10.1177_2050313X19852885-fig1.jpg
PMC6537237_01_10.1177_2050313X19852885-fig1.jpg
fig1-2050313X19852885
Contrast-enhanced maxillofacial MRI and CT scans were performed (Figures 1 and (2).
Preoperative (a) coronal and (b) axial gadolinium-enhanced T1-weighted MRI shows soft tissue protruding through the breach in the lateral recess wall of the sphenoid sinus (black arrowhead), invading the right internal pterygoid muscles, the masticatory fossa (double small star) and the pterygopalatine fossa (single small star) and infiltrating the II (CNV2) (black arrow) and III (CNV3) (white arrow) trigeminal branches. Endocrianially, the tissue extended into the cavernous sinus surrounding the Gasser ganglion (double angled arrow). The cavernous carotid artery appears unobstructed. The MRI show marked hypointense signal on (c) axial T2-weighted into the lateral recess of the sphenoid sinus with inflamed mucosa at periphery (white arrow).
10.1177_2050313X19852885-fig2.jpg
PMC6537237_01_10.1177_2050313X19852885-fig2.jpg
fig2-2050313X19852885
Contrast-enhanced maxillofacial MRI and CT scans were performed (Figures 1 and (2).
Intraoperative view during endoscopic sinus surgery shows an erosion of lateral recess wall of the right sphenoid sinus (white arrow).
10.1177_2050313X19852885-fig3.jpg
PMC6537237_01_10.1177_2050313X19852885-fig3.jpg
fig3-2050313X19852885
After careful haemostasis, a Merocel sponge was positioned in the right nasal fossa (Figure 3).
Axial gadolinium-enhanced T1-weighted MRI after 12 weeks of therapy shows good pneumatization of the right surgical cavity and a sharp decline in contrast enhancement of the lateral recess of right sphenoid sinus (white arrow), masticatory fossa (double small star) and pterygopalatine fossa (single small star). A similar decrease can be appreciated in phlogistic alterations of the Gasser ganglion and the cavernous sinus (double angled arrow).
10.1177_2050313X19852885-fig4.jpg
PMC6537237_01_10.1177_2050313X19852885-fig4.jpg
fig4-2050313X19852885
Thus, antifungal therapy was discontinued and at the present time, 11 months after surgery, the patient is still symptom-free (Figure 4).