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Sinus Sphenoidalis

The two sphenoidal sinuses (or sphenoid) contained within the body of the sphenoid vary in size and shape; owing to the lateral displacement of the intervening septum. They are rarely symmetrical. When exceptionally large they may extend into the roots of the pterygoid processes or great wings, and may invade the basilar part of the occipital bone. Each sinus opens into the roof of the nasal cavity via apertures on the posterior wall of the sphenoethmoidal recess directly above the choana. The apertures are located high on the anterior walls of the sinuses themselves. Because only thin shelves of bone separate the sphenoidal sinuses from the nasal cavities below and hypophyseal fossa above, the pituitary gland can be surgically approached through the roof of the nasal cavities by first passing through the anterioinferior aspect of the sphenoid bone and into the sinuses, followed by entry through the top of the sphenoid bone into the hypophyseal fossa. If a fast-growing tumor erodes the floor of the sinus, the vidian nerve could be in danger. If the tumor spreads laterally, the cavernous sinus and all its constituent nerves could be in danger.