Answer to Sometimes a Headache is Really a Headache!!

Correct answer is A. The symptoms describe in the patient clearly suggest the presence of a pituitary tumor. Older adults are more likely to be diagnosed with this type of tumor, but it can occur at any age. Women are more likely to develop these tumors than men. The absence of libido and onset of lactation without pregnancy clearly suggests there is an endocrine disorder, confirmed by the CT scan. Transsphenoidal approaches to the pituitary are the most common approach to removing a pituitary tumor. The corridor includes entering the nostril, passing through the nasal cavity, exiting the choana and entering the nasopharynx, then punching through the sphenoid sinus to reach the pituitary bed. Compare the drawing (A) with the dissection (B). The choana is the exit way of the posterior nasal cavity to reach the nasopharynx. No other sinus cavity needs to be compromised using the transsphenoidal approach to perform a hypophysectomy.

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Answer to this question is based on material presented in lectures 10 of the Head and Neck Dissection Review Series.