Penetrating Sphenoid Sinus Injuries in Children: A Comprehensive Literature Review.

Abstract

Penetrating foreign bodies in the pediatric sphenoid sinus are exceptionally rare and pose significant diagnostic and surgical challenges due to the sinus's proximity to critical neurovascular structures. We present the case of an 11 year-old boy who sustained a penetrating injury from a 7 mm bullet that entered through the floor of the frontal sinus, traversed the ethmoid sinus, and lodged in the right sphenoid sinus near the carotid canal and optic nerve. Initial assessment revealed hemodynamic stability and no active bleeding or neurological deficits. Non-contrast computed tomography precisely localized the metallic foreign body and confirmed an intact surrounding neurovascular architecture, with no intracranial injury. A multidisciplinary team opted for functional endoscopic sinus surgery to minimize risks to adjacent structures. The bullet was successfully extracted under endoscopic guidance without any complications. Postoperative recovery was uneventful, with no evidence of infection, nor cerebrospinal fluid leak, nor neurological sequelae. This case underscores the pivotal role of advanced imaging in guiding surgical planning and the efficacy of minimally-invasive endoscopic techniques in pediatric sinonasal trauma. The absence of intraoperative complications highlights the importance of interdisciplinary collaboration, anatomical knowledge, and early intervention to mitigate risks of infection or increasing surrounding fibrosis. delayed neurovascular injury might be avoided. While isolated pediatric sphenoid sinus foreign bodies remain rare, this report reinforces the value of tailored imaging protocols, endoscopic proficiency, and collaborative care in optimizing outcomes. Future studies should focus on standardizing management strategies and exploring emerging technologies to enhance precision in this anatomically-complex population.