Extensive cholesteatoma of the sphenoid sinus

A 38-year old female was admitted to the ENT-specialist due to nasal discharge und sneeze attacks for several weeks. Other complaints, especially other rhinological or neurological symptoms were negated.

30 °-endoscopy revealed no pathological findings. Conservative treatment failed, so a CT-Scan was initiated where an extensive mass in the sphenoid sinus was seen with displacement of the surrounding bony structures.

A videoendoscopic sinus surgery was performed for further investigation and paste-like masses were seen in the sphenoid sinus, which were similar to the matrix of a cholesteatoma. Other differential diagnoses were excluded by histological and microbiological examination. Further operations were performed for removal of frontal wall of sphenoid sinus, posterior septum and remnants of the matrix of the cholesteatoma. Removal of the perimatrix was not possible due to extensive destruction of bony structures at the roof of the sphenoid sinus as well as the canal of the internal carotid artery. 2 years after first diagnosis there were no radiological signs for further expansion of the lesion.

Although there are several case reports about cholesteatomas in paranasal sinuses, this case is unique because of its localization and extension. A complete resection is not possible due to the risk of a life-threatening hemorrhage, so the therapy include wide drainage and cleaning, intensive mucosal care with nasal brush as well as frequent endoscopical and radiological follow-up examinations.

Publication History

Publication Date:
23 April 2019 (online)