Acute Visual Loss Caused by Onodi Cell Mucopyocele

최진수,김기식,김보성 대한비과학회 2010 Journal of rhinology Vol.17 No.2

Acute visual loss caused by an infected mucocele in an Onodi cell is extremely rare. The Onodi cell is a pneumatized posterior ethmoid cell located laterally and superiorly to the sphenoid sinus and closely related to the optic nerve. Therefore, a mucocele affecting the Onodi cell that has encroached on the adjacent sphenoid bone forming the optic canal can rarely present with visual loss. We describe a rare case of retrobulbar optic neuritis caused by an infected mucocele in the Onodi cell. A 54-year-old male complained of headache and visual loss in his right eye. A computed tomography scan and magnetic resonance image demonstrated a mucocele occupying the Onodi cell on the right side. Surgical treatment with an endoscopic sinus approach was performed, resulting in improvement of visual acuity. A lesion in an Onodi cell may be associated with ocular symptoms even if the lesion is isolated or small. Imaging studies should be considered for the differential diagnosis because early diagnosis and prompt surgical treatment for mucocele are needed for recovery of visual function.

시력 소실을 동반한 Onodi Cell의 진균 감염 1예

정진혁,김태헌,유한석,이윤정 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.9

The Onodi cell, which is a posterior ethmoid cell that gets pneumatized far laterally and to some degree superiorly to the sphenoid sinus, is intimately associated with the optic nerve. The problem with most cases of Onodi cells is that acute visual loss may occur in association with a compression to the optic nerve by a mucocele of an Onodi cell. We report, with a review of literature, a case of fungal infection in Onodi cells with acute visual loss in a 71 year-old female patient, who was treated by endoscopic sinus surgery with electrical drill and steroid therapy.

오노디 세포내 곰팡이 덩이에 의한 시신경병증 1예

한영수,양찬민,신재호,박인기,Young Soo Han,Chan Min Yang,Jae Ho Shin,In Ki Park 대한안과학회 2014 대한안과학회지 Vol.55 No.3

Purpose: To report a rare case of optic neuropathy caused by a fungal ball in an Onodi cell. Case summary: A 63-year-old female was referred to our clinic with relapsed visual loss and ocular pain in the right eye. She had been diagnosed as optic neuritis 14 days before and given pulse steroid therapy. She recovered to normal but relapsed 7 days before. In medical referral there was no suspected multiple sclerosis but only a few inflammation in the paranasal sinuses. On our initial examination, best corrected visual acuity was counting finger at 10 cm in the right eye, and 1.0 in the left eye, along with relative afferent pupillary defect in the right eye. The fundoscopic examinations disclosed disc swelling; nearly total visual field defect was observed on visual field examination and visual evoked potential test revealed decreased amplitude at P100 wave in the right eye. Clinical impression was relapsed optic neuritis. After the administration of pulse steroid therapy, her disc swelling was decreased and visual acuity was recovered to 0.6, however, visual acuity was exacerbated to 0.4 in 2 weeks. We checked outside brain magnetic resonance imaging (MRI) and the result showed optic neuropathy caused by a fungal ball in an Onodi cell. The patient was referred to otorhinolaryngologist and fungal ball was removed by endoscopic sinus surgery. 3 weeks after surgery the patient's visual acuity was 0.9, no disc swelling was found and visual evoked potential was recovered to normal. Conclusions: An Onodi cell lesion should be considered in the differential diagnosis of optic neuritis, identified by imaging studies and promptly removed by surgery for visual recovery. J Korean Ophthalmol Soc 2014;55(3):426-431

한국인에서 오노디 세포의 유병률에 대한 영상학적 연구

이승주,강용경,이은섭,김지선 대한이비인후과학회 2015 대한이비인후과학회지 두경부외과학 Vol.58 No.12

Background and Objectives The Onodi cell is the posterior-most ethmoid air cell that lies superior to the sphenoid sinus, and has intimate relationship with the optic nerve. The aim of this study was to evaluate Onodi cell prevalence, protrusion and bony dehiscence of the optic nerve in Korean population using computed tomography (CT). Subjects and Method A retrospective analysis was performed on 129 Korean patients who consecutively underwent CT between January 2014 and December 2014. The presence of Onodi cells and protrusion and bony dehiscence of the optic nerve were analyzed using 3-dimensional CT images. Results A total of 70 males and 59 females were studied. Onodi cells were present in 61 (47.3%) patients but in 88 CT slides (34.1%); this consisted of 27 Onodi cells found bilaterally (44.3%), 18 on the right side only (29.5%), and 16 on the left only (26.2%). Of the total 61 patients with Onodi cells, the optic nerve protrusion and dehiscence were present in 34.4% and 23.8% of the studied CT slides. There was no statistically significant relationship between the presence of Onodi cells and protrusion and bony dehiscence of the optic nerve. Conclusion In our study, Onodi cells were found in almost half of the patients. This prevalence is higher than previously reported in the literature. In patients with Onodi cells, the optic nerve protrusion and dehiscence were present in about 1/3 and 1/5 of the total slides, respectively. Therefore, the identification of these cells is essential prior to endoscopic sinus and skull base surgery to prevent potential complications.

Incidence and Types of Sphenoethmoid Cell in Patients with Chronic Paranasal Sinusitis

Chung, Seung-Kyu,Kim, Hyo Yeol,Yoon, Seong-Won Korean Rhinologic Society 1998 Journal of rhinology Vol.5 No.2

Isolated Oculomotor Nerve Palsy Caused by Onodi Cell Sinusitis

구철효,김민헌,박동준,이은정 대한이비인후과학회 2023 대한이비인후과학회지 두경부외과학 Vol.66 No.7

Onodi cell sinusitis is a rare cause of isolated oculomotor nerve palsy. The sphenoid sinus andOnodi cell mucocele or invasive fungal sinusitis are often associated with multiple cranial-nerve symptoms simultaneously. However, isolated cranial nerve palsy due to simple sinusitisis rare. Sinus disease associated with cranial nerve palsy is difficult to diagnose based on pa-tient history or physical examination alone; CT and MRI help in correctly assessing these le-sions. Here we report a case of Onodi cell sinusitis observed in a patient who presented withisolated oculomotor nerve palsy. The patient underwent endoscopic sinus surgery and recov-ered completely at 2 months postoperative.

Evaluating the effects of Onodi cells and accessory septa on sphenoiditis using a sinus navigation system

전석원,김주연,최동규,권재환 대한이비인후과학회 부산,울산,경남 지부회 2020 임상이비인후과 Vol.31 No.2

Background and Objective: Onodi cells (OCs) and accessory septa (AS) may displace the sphenoid sinus causing sphenoiditis. To assess the impact of anatomic variations related to the sphenoid sinus (SS) on the prevalence of sphenoid sinusitis using computed tomography analysis. Materials and Methods: This was a retrospective analysis of high-resolution computed tomography (HRCT). 233 HRCT studies of the paranasal sinus obtained between July 2015 and April 2017 were enrolled. Sinus navigation system was used to evaluate OC and AS in HRCT planes. SSs were divided into 2 groups based on the presence of sphenoiditis. Results: Among all SSs included (n=466) in this study, 35 were associated with sphenoiditis (S+) and 431 were not (S- ). The prevalence of OC in S+ group was 31.43%, while the prevalence of OC in S-group was 47.80%. The distribution of OC type according to the classification scheme described by Wada et al, namely, optic canal, sella, and infrasella OC was 63.63%, 27.27%, and 0.09% in S+ group and 56.80%, 40.29%, and 0.03% in S-group, respectively. The prevalence of AS in S+ group was 77.14. Conversely, the prevalence of AS in S- group was 71.46%. Conclusion: There was no significant difference in the prevalence or characteristics of OCs and AS between patients with and without sphenoiditis. Future studies including a greater number of HRCTs that also evaluate other risk factors for sphenoiditis may be needed. Lastly, sinus navigation system is useful not only as a surgical tool, but as a tool for evaluating CT images as well.

한국인에서의 오노디 세포의 발생률과 시신경과의 관계 분석

권정훈,한승윤,구형본,강명신,이진,이재훈 대한이비인후과학회 2022 대한이비인후과학회지 두경부외과학 Vol.65 No.6

Background and Objectives It is important to identify variations of paranasal sinuses dur- ing sinus surgery. The Onodi cell (OC), a variant of the paranasal sinuses, is the most posteri- or ethmoid cell with a close relationship with the optic nerve (ON). The purpose of this study is to evaluate the prevalence of OCs and analyze the relationship of OCs with ON in Koreans. Subjects and Method This retrospective study utilized CT images of 526 slides from 263 Korean adults. The prevalence of the OCs and the degree of indentation of the ON within the OC was determined using binary logistic regression analysis. Results The OCs were observed in 37.3% of 263 subjects and in 27.6% of 526 slides. The OCs are found more frequently in males than in females (p=0.01), and also more frequently inthe right side than in the left side (p=0.001). Binary logistic regression analysis revealed thatthe ON protrusion in female was 0.339 times lower than in male and 1.052 times higher withthe increased age. The ON protrusion within the OC in the postsellar type was 10.214 times higher than that in the presellar. Conclusion The OCs were observed in 37.3% of the Koreans. The protrusion of the ON within the OCs increased in male and in the postsellar type of the sphenoid sinus.

Investigation of the prevalence and main features of skull-base anomalies and characteristics of the sphenoid sinus using cone-beam computed tomography

Akbulut Aslıhan,Demirel Oğuzhan,Orhan Kaan 대한구강악안면외과학회 2022 대한구강악안면외과학회지 Vol.48 No.4

Objectives: This study aimed to define the prevalence and characteristics of skull base anomalies and the features of sphenoid sinus pneumatization (SSP). Materials and Methods: Five hundred cone-beam computed tomography scans were evaluated retrospectively for the presence of fossa navicularis magna (FNM), canalis basilaris medianus (CBM), sphenoid emissary foramen (SEF), and/or Onodi cells (OC). Patterns of the SSP and sphenoid sinus mucosa dimensions (SSMD) were also recorded. Results: The prevalence of FNM, CBM, SEF, and OC was 26.0%, 22.4%, 47.4%, and 18.4%, respectively. Two hundred sixty-two (52.4%) sellar-type SSP were defined, followed by post-sellar 191 (38.2%), pre-sellar 31 (6.2%), and conchal 16 (3.2%) types. The frequency of SSMD less than 1 mm, 1-3 mm, and greater than 3 mm was 40.6%, 38.4%, and 21.0%, respectively. An SEF was detected more frequently in females, while SSMD greater than 3 mm was more frequent in males. An FNM was more prevalent in the 18-29 and 30-39 age groups and SEF was significantly less fre-quent in patients over 60 years of age compared to other age groups. A sinus mucosa larger than 3 mm was more common in the younger than 18 year group. The frequency of post-sellar-type pneumatization was lower in patients younger than 18 years. Conclusion: Skull-base anomalies are common and may be detected incidentally during imaging procedures. The sphenoid sinus, its variations, and pneumatization patterns should also be taken into consideration in imaging procedures performed for various purposes.