Oculomotor nerve palsy in isolated sphenoid sinus inflammatory diseases. Systematic review
Abstract
Introduction and objective: isolated inflammatory diseases of the sphenoid sinus include pathologies such as acute bacterial sinusitis, mucocele, and fungal infections. Due to the proximity of the sinus to important vascular and neural structures, its involvement can cause intracranial and orbital complications. Our aim is to evaluate the prevalence of third cranial nerve involvement in these types of lesions. Method: a systematic review of oculomotor nerve involvement in isolated sphenoid sinus lesions was conducted by two independent reviewers using four databases. Results: a total of 151 articles were retrieved in the initial search; ultimately, after applying the inclusion criteria, 16 articles were selected for the systematic review. Discussion/Conclusions: isolated sphenoid sinus lesions usually present insidiously, with retro-orbital headache and changes in visual acuity or cranial nerve palsies. Oculomotor nerve palsy is the most common cranial nerve involvement in isolated sphenoid sinus lesions of non-fungal aetiology. The treatment of choice is sphenoidotomy. Recovery of the palsy has been documented from the first few days up to 8 months after surgery.
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Chen L, Jiang L, Yang B, Subramanian PS. Clinical features of visual disturbances secondary to isolated sphenoid sinus inflammatory diseases. BMC Ophthalmol. 2017;17(1):237. https://doi.org/10.1186/s12886-017-0634-9
El Mograbi A, Soudry E. Ocular cranial nerve palsies secondary to sphenoid sinusitis. World J Otorhinolaryngol Head Neck Surg. 2017;3(1):49–53. https://doi.org/10.1016/j.wjorl.2017.02.001
Prepageran N, Subramaniam KN, Gopala Krishnan G, Raman R. Ocular presentation of sphenoid mucocele. Orbit. 2004;23(1):45–47. https://doi.org/10.1076/orbi.23.1.45.28986
Lee L, Huang C, Lee T. Prolonged visual disturbance secondary to isolated sphenoid sinus disease. Laryngoscope. 2004;114(6):986–990. https://doi.org/10.1097/00005537-200406000-00006
Chen K, Cao Y, Wu J, Xiang H, Huang XF, Chen B. Clinical analysis of sphenoid sinus mucocele with initial neurological symptoms. Headache. 2019;59(8):1270–1278. https://doi.org/10.1111/head.13605
Ibrahim M, Alqunaee M, Najibullah M, Shabbir Z, Azab WA. Isolated sphenoid sinus fungal mucoceles: A rare entity with a high propensity for causing neurological complications. Surg Neurol Int. 2024;15:849. https://doi.org/10.25259/SNI_849_2024
Sturm V, Kordic H, Leiba H, Landau K. Isolated oculomotor nerve palsy related to sinusitis? Int Ophthalmol. 2008;28(4):303–305. https://doi.org/10.1007/s10792-007-9132-z
Lop-Gros J, Gras-Cabrerizo JR, Bothe-González C, Montserrat-Gili JR, Sumarroca-Trouboul A, Massegur-Solench H. Bola fúngica sinusal: análisis de nuestra casuística. Acta Otorrinolaringol Esp. 2016;67(4):220–225. https://doi.org/10.1016/j.otorri.2015.09.005
Thomassin JM, Paganelli A, Michel J, Dessi P. Micosis rinosinusales. En: Enciclopedia médico-quirúrgica. Elsevier Masson SAS; 2016. https://doi.org/10.1016/S1632-3475(16)77694-6
Lee JC, Park SK, Jang DK, Han YM. Isolated sphenoid sinus mucocele presenting as third nerve palsy. J Korean Neurosurg Soc. 2010;48(4):360–362. https://doi.org/10.3340/jkns.2010.48.4.360
Dores LA, Simão MA, Marques MC, Dias Ó. Parésia do nervo motor ocular comum em contexto de sinusite esfenoidal. Acta Méd Port. 2014;27(6):782–786.
Reyes-Rodríguez AA, García-Cázares N, Caballero-Espinoza D, et al. Síndrome de seno cavernoso secundario a mucocele esfenoidal. Rev Mex Oftalmol. 2015;89(3):183–188. https://doi.org/10.1016/j.mexoft.2015.01.004
Vaphiades MS, Roberson GH. Sphenoid sinus mucocele presenting as a third cranial nerve palsy. J Neuroophthalmol. 2005;25(4):293–294. https://doi.org/10.1097/01.wno.0000189829.46763.41
Aeumjaturapat S, Wadwongtham W. Sphenoid sinus mucocele presenting with isolated oculomotor nerve palsy. J Med Assoc Thai. 2001;84(9):1340–1343. https://doi.org/10.5281/zenodo.1034567
Mohebbi A, Jahandideh H, Harandi AA. Sphenoid sinus mucocele as a cause of isolated pupil-sparing oculomotor nerve palsy mimicking diabetic ophthalmoplegia. Ear Nose Throat J. 2013;92(12):563–565. https://doi.org/10.1177/014556131309201210
Akan H, Cihan B, Çelenk Ç. Sphenoid sinus mucocele causing third nerve paralysis: CT and MR findings. Dentomaxillofac Radiol. 2004;33(5):342–344. https://doi.org/10.1259/dmfr/92903178
Tsai RK, He MS, Cheu CL, Sheu MM. Transient third cranial nerve palsy caused by sphenoid sinus aspergillosis. J Neuroophthalmol. 2008;28(3):239–240.
Mishra A, Patel D, Munjal VR, Patidar M. Isolated sphenoid sinus mucocele with occular symptoms: A case series. Indian J Otolaryngol Head Neck Surg. 2022;74(S2):1109–1112. https://doi.org/10.1007/s12070-020-02176-2
Kataria R, Gupta S, Chopra S, Bagaria H, Sinha VD. Mucocele of the sphenoid sinus: A rare cause of reversible 3rd nerve palsy. Ann Indian Acad Neurol. 2012;15(2):158–160. https://doi.org/10.4103/0972-2327.95006
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:71. https://doi.org/10.1136/bmj.n71
El Mograbi A, Soudry E. Ocular cranial nerve palsies secondary to sphenoid sinusitis. World J Otorhinolaryngol Head Neck Surg. 2017;3(1):49–53. https://doi.org/10.1016/j.wjorl.2017.02.001
Prepageran N, Subramaniam KN, Gopala Krishnan G, Raman R. Ocular presentation of sphenoid mucocele. Orbit. 2004;23(1):45–47. https://doi.org/10.1076/orbi.23.1.45.28986
Lee L, Huang C, Lee T. Prolonged visual disturbance secondary to isolated sphenoid sinus disease. Laryngoscope. 2004;114(6):986–990. https://doi.org/10.1097/00005537-200406000-00006
Chen K, Cao Y, Wu J, Xiang H, Huang XF, Chen B. Clinical analysis of sphenoid sinus mucocele with initial neurological symptoms. Headache. 2019;59(8):1270–1278. https://doi.org/10.1111/head.13605
Ibrahim M, Alqunaee M, Najibullah M, Shabbir Z, Azab WA. Isolated sphenoid sinus fungal mucoceles: A rare entity with a high propensity for causing neurological complications. Surg Neurol Int. 2024;15:849. https://doi.org/10.25259/SNI_849_2024
Sturm V, Kordic H, Leiba H, Landau K. Isolated oculomotor nerve palsy related to sinusitis? Int Ophthalmol. 2008;28(4):303–305. https://doi.org/10.1007/s10792-007-9132-z
Lop-Gros J, Gras-Cabrerizo JR, Bothe-González C, Montserrat-Gili JR, Sumarroca-Trouboul A, Massegur-Solench H. Bola fúngica sinusal: análisis de nuestra casuística. Acta Otorrinolaringol Esp. 2016;67(4):220–225. https://doi.org/10.1016/j.otorri.2015.09.005
Thomassin JM, Paganelli A, Michel J, Dessi P. Micosis rinosinusales. En: Enciclopedia médico-quirúrgica. Elsevier Masson SAS; 2016. https://doi.org/10.1016/S1632-3475(16)77694-6
Lee JC, Park SK, Jang DK, Han YM. Isolated sphenoid sinus mucocele presenting as third nerve palsy. J Korean Neurosurg Soc. 2010;48(4):360–362. https://doi.org/10.3340/jkns.2010.48.4.360
Dores LA, Simão MA, Marques MC, Dias Ó. Parésia do nervo motor ocular comum em contexto de sinusite esfenoidal. Acta Méd Port. 2014;27(6):782–786.
Reyes-Rodríguez AA, García-Cázares N, Caballero-Espinoza D, et al. Síndrome de seno cavernoso secundario a mucocele esfenoidal. Rev Mex Oftalmol. 2015;89(3):183–188. https://doi.org/10.1016/j.mexoft.2015.01.004
Vaphiades MS, Roberson GH. Sphenoid sinus mucocele presenting as a third cranial nerve palsy. J Neuroophthalmol. 2005;25(4):293–294. https://doi.org/10.1097/01.wno.0000189829.46763.41
Aeumjaturapat S, Wadwongtham W. Sphenoid sinus mucocele presenting with isolated oculomotor nerve palsy. J Med Assoc Thai. 2001;84(9):1340–1343. https://doi.org/10.5281/zenodo.1034567
Mohebbi A, Jahandideh H, Harandi AA. Sphenoid sinus mucocele as a cause of isolated pupil-sparing oculomotor nerve palsy mimicking diabetic ophthalmoplegia. Ear Nose Throat J. 2013;92(12):563–565. https://doi.org/10.1177/014556131309201210
Akan H, Cihan B, Çelenk Ç. Sphenoid sinus mucocele causing third nerve paralysis: CT and MR findings. Dentomaxillofac Radiol. 2004;33(5):342–344. https://doi.org/10.1259/dmfr/92903178
Tsai RK, He MS, Cheu CL, Sheu MM. Transient third cranial nerve palsy caused by sphenoid sinus aspergillosis. J Neuroophthalmol. 2008;28(3):239–240.
Mishra A, Patel D, Munjal VR, Patidar M. Isolated sphenoid sinus mucocele with occular symptoms: A case series. Indian J Otolaryngol Head Neck Surg. 2022;74(S2):1109–1112. https://doi.org/10.1007/s12070-020-02176-2
Kataria R, Gupta S, Chopra S, Bagaria H, Sinha VD. Mucocele of the sphenoid sinus: A rare cause of reversible 3rd nerve palsy. Ann Indian Acad Neurol. 2012;15(2):158–160. https://doi.org/10.4103/0972-2327.95006
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:71. https://doi.org/10.1136/bmj.n71
Rodríguez-García, A., Manzanares López-Rendo , C., Martín-González , A., Clement-Alonso , L., Sara Fernández-Cascón , S., & Martín-Sigüenza , G. (2025). Oculomotor nerve palsy in isolated sphenoid sinus inflammatory diseases. Systematic review. Revista ORL, 16(4), e33655. https://doi.org/10.14201/orl.33655
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