A case of exuberant pneumatization of the left sphenoid sinus into the pter
ygoid process and floor of the middle cranial fossa is presented. The fact
that pneumatization of the sphenoid sinus is frequently atypical is of clin
ical import because there is an intimate relationship between the contents
of a hyperaerated sinus and adjacent vital facial and cranial structures. I
t is imperative that clinicians determine the location and extent of the wa
lls of the sphenoid sinus and its relationship to adjacent vital structures
whenever endoscopic sinus surgery is contemplated to avoid morbid conseque
nces during surgery.