The sphenoid sinus, the neglected nasal sinus.

O. E. Van Alyea stated that "The sphenoid sinus is the most neglected of the nasal sinuses." It is neglected by disease because of its location, by the physician because of its subtle symptoms when diseased, and the surgeon because of its inaccessability. An accurate knowledge and understanding of the anatomy of the area help the physician diagnose and manage problems in this area. Eleven cases are used to illustrate the wide spectrum of pathologic conditions in and about the sphenoid sinus. Only two of the patients were asymptomatic. All of the others had deep-seated, retrobulbar headaches. Eight of 11 patients had cranial nerve involvement. The optic nerve was involved in six cases. The abducens nerve was involved in five of 11 cases and the maxillary nerve in four of 11 cases. Initial roentgenographic examination must include lateral and submental vertex views. The newer techniques of angiography, polytomography, and computerized tomography aid in determining the extent of the pathologic condition and the treatment approach.