Sphenoidotomy is performed to open up the sphenoid sinus and resolve symptoms of sinus infection. Since the sphenoid sinus is hemmed with several important structures, including carotid artery that supplies blood to the brain, optic nerve, brain and cavernous sinus, there are full chances of injuries to any of these structures during the surgery.
For instance, laterally, the sphenoid sinus is surrounded by the carotid artery and optic nerves. The ethmoid sinus makes anterior border of the sphenoid sinus. The pituitary gland and the brain are located superiorly to the sphenoid sinus. Sphenoidotomy is therefore a challenging operation requiring extraordinary surgical skills. If the infection is not treated in time, it may spread to the artery and brain.
Different approaches, such as transseptal, transnasal, transantral and transethmoidal, can be adopted for sphenoidotomy depending on symptoms of sinus infection. In transethmoidal approach, the procedure is performed through the anterior wall’s ethmoid portion. Transethmoid sphenoidotomy is performed to treat chronic sphenoid disorder accompanied by ethmoid diseases. The procedure is simultaneously executed with an external ethmoidectomy. The transethmoid sphenoidotomy may cause an injury to nasolacrimal duct, CSF rhinorrhea and / or orbital trauma.
The transnasal sphenoidotomy is done through the anterior wall’s nasal part. The transnasal sphenoidotomy approach is used for isolated sphenoid sinus disorders. The sphenoidotomy performed through the sphenoethmoidal recess or transnasally is safe and relatively easy. The transseptal approach is rarely used. Popularity of the intranasal sphenoidotomy grew with launch of endoscopic instruments and techniques.
The procedure helps in treating thickening of the mucosa and / or opening up the blocked natural ostium. If mucosal disorder is severe, there is a cyst or polyps are obstructing the sinus function, the cyst / polyps shall also be removed and medication shall be administered to treat other symptoms of sinus infection. To treat inflammation of the sphenoid sinus, drainage canals can be widened.
However, sphenoidotomy may cause some complications, such as bleeding from the posterior nasal artery, a branch of the sphenopalatine artery. Damage to the optic nerve is also possible. Cerebrospinal fluid leak may develop. An injury to the carotid artery is another major risk. Sphenoidotomy may fail due to two main reasons: the surgeon did not enter the sphenoid sinus unintentionally or intentionally, and the surgeon used secondary scarring for closing the sinus after entering it.