Sinus mucocele are normally located in the frontal, ethmoid and occasionally in the maxillary sinus cavities and can cause immense discomfort, pain, affect your breathing pattern, nasal obstructionand and in severe cases cause bone deterioration. Such a lapse of time makes the establishment of the cause of mucocele formation in the frontal sinus difficult and short term evaluation of the surgery for their eradication uncertain. The first page of the pdf of this article appears above. Combined external and endonasal approach to fronto. Osteomas and mucoceles of the frontal paranasal sinuses in. Fat was used to obliterate the sinus completely on the right side. Frontoethmoid mucocele with or without orbital extension type 3.
The authors describe a patient with frontal giant mucocele involving the orbit, the ethmoid, and intracranial portion of the dura. The intracranial mucocele occurs as a complication of obstruction of sinus drainage caused by osteoma, but it is often diagnosed preoperatively as an intracranial or intracerebral cyst because of the rarity of these combined lesions in neurosurgical practice. Frontal sinus mucocele in association sage journals. Although mucocele of the frontal sinus was not dealt with as a problem in therapeutics in authoritative medical literature earlier than the eighteenth century, this pathologic condition must have existed in ancient times. There is erosion of both anterior and posterior walls of frontal sinus with a major intracranial extension. Inoffice balloon dilation and drainage of frontal sinus. Weber et al 20 advocated that osteoplastic frontal sinus surgery with fat obliteration is very useful and successful in patients in whom frontal sinus cannot be.
If left untreated, they can erode the thin sinus wall causing lifethreatening complications such as meningitis. Indeed, recurrence it is a typical complication of both endoscopic endonasal and transcranial approach or as a consequence of facial fracture. Mucoceles in paranasal sinuses definition and etiology. Prolonged expansion of a mucocele can lead to complications such as pain and pressure, eyelid edema, frontal headaches, cranial nerve palsy, and facial deformity from bony remodeling. It develops when the opening of a paranasal sinus becomes obstructed because of trauma, infection, chronic sinusitis, polyps, malignancy, bony tumors, or congenital anomalies. True ducts of communication between the frontal sinus and frontal recess are more often absent than present. Fortunately this was accessible endoscopically, and the patient healed very nicely, and as can be seen in the video, both the frontal sinus and mucocele. The frontal sinus was successfully cannulated, dilated and drained. Frontal sinus mucocele with intracranial and intraorbital.
Several factors may influence the amount of mucus being produced and your frontal sinus ability to drain. Endoscopic marsupialization of the mucocele is the surgery of choice, even though complicated cases maybe approached by an external route. Late presentation of a mucocele of the frontal sinus. The main cause of acute frontal sinusitis is mucus buildup due to sinus inflammation.
The modern endoscopic endonasal approach to the frontal sinus allows the marsupialization of the pathology in all those cases in. Mucocele extension medially to a virtual sagittal plane tangential to the medial side of the ocular globe was also evaluated to determine the appropriateness and feasibility. It is most commonly the result of either facialhead trauma or previous sinus surgery that was done poorly or incorrectly. There is erosion of both anterior and posterior walls of frontal sinus without or minimal intracranial extension. In another patient with a frontal sinus mucocele, a small piece of bone was found obstructing the nasofrontal duct at surgery. Obliteration of frontal sinus after carefully removing complete sinus mucosa is an option if mucoceles are recurrent and are not completely marsupialized by the endoscopic approach. A case report leslie timothy koh1, katherine pollaers2 and chris rataphol dhepnorrarat2 abstract fibrous dysplasia is an uncommon developmental anomaly of bone wherein normal bone marrow is. A possible cause of pneumosinus dilatans richard a. To describe a new and useful criterion to identify endoscopically approachable lateral frontal sinus mucoceles. We present a case of right maxillary mucocele without an identifiable cause, which is reported due to its rarity and delayed management. Paranasal sinus mucocele is a chronic, cystic lesion of the paranasal sinuses that results from obstruction of the draining ostia. Cultures showed small amounts of mixed bacteria, and the contents of the mucocele were. The posterior sinus wall was thinned with scattered areas of bone erosion.
Endoscopic sinus surgery for maxillary sinus mucoceles head. Symptoms, which depend on the site of involvement and the direction and extent of expansion, include pain, facial swelling or. A 73yearold man, with no medical history of note, presented with a 4week history of an isolated leftsided ptosis and associated periorbital and retroorbital discomfort. To define the natural history, clinical signs, treatment and the modalities of medium and longterm followup of patients operated for sinus mucocele. Article information, pdf download for mucoceles of the frontal sinus. Patients and method retrospective study of all patients operated for sinus mucocele between january 1993 and december 2009 n 68. Endoscopic treatment of frontal sinus mucoceles with.
Frontal sinus mucocele with intracranial and intraorbital extension. The overall prognosis for frontal sinus mucoceles is good with likelihood of cure, and a low incidence of recurrence. Frontal sinus mucopyocele facial plastic surgery jama. The frontal sinus is the most common location for paranasal sinus mucoceles.
A mucocele of paranasal sinuses is a collection of mucus within an epithelial lined sinus whose outflow tract is permanently obstructed. The lynch incision has been the standard external approach employed by surgeons to access frontal mucocele. Ghaed1 idiopathic expansion of a paranasal sinus containing air and without an associated mass has been termed pneumosinus dilatans 1. Jul 22, 2017 fortunately this was accessible endoscopically, and the patient healed very nicely, and as can be seen in the video, both the frontal sinus and mucocele cavities were healed completely by 2 months. Isolated fungus ball mimicking mucocele or frontal sinus. The most frequent complaints recorded were frontal headaches, eye probl. In the paranasal sinus computerized tomography, a mucocele. Frontal mucoceles occur due to accumulation of inspissated mucus and desquamated epithelium, whenever there is obstruction to the outflow of the frontal sinuses. Osteoma of the frontal sinus complicated by intracranial. A prompt ct orbits and head scan revealed a large left frontal sinus mucocoele that had eroded into the left orbit. Frontal sinus mucoceles may have different sizes and configurations.
If you or your child develops a soft swelling in the mouth, it may just be a mucocele a harmless cyst. Pdf frontalsinusmucoceleafterosteoplasticflapsurgery. Microscope was used to scrape out the mucosa completely from the frontal sinus. Maxillary sinus mucocele is a benign cyst formation that originates within the sinus and is lined by. A mucocele is mucoid secretion trapped within an epithelial lined sinus that has a. The anterior wall was nearly absent, and there was bulging of the mucocele into the superior orbit displacing the globe as seen on mr. Dec 20, 2012 however, not all frontal sinus mucocele are considered approachable through ess alone 3, 4. Here the mucocele is found involving the frontal and ethmoidal sinuses with or without orbital extension. The records of 56 patients presenting with mucoceles andor pyoceles have. Frontal sinus mucopyocele presenting as a subcutaneous. The posterior wall of the frontal sinus was destructed in 6 patients, with one patient additionally showing partial destruction of the anterior frontal sinus wall. Endoscopic treatment of frontal sinus mucoceles with lateral. Combined endoscopic endonasal and transcranial approach to. Mucocele erodes the anterior wall of the frontal sinus.
The frontal mucocele remains a disease difficult to treat even in the era of functional endoscopic sinus surgery fess. Frontal sinus mucoceles causing proptosistwo case reports. The pathologic features of mucocele are not really specific. Expansion of the totally opacified right compartment of the frontal sinus showing rather high attenuation value contents. Balloon sinuplasty for an acute frontal sinus mucocele. The frontal sinus is particularly prone to developing mucoceles, and up to twothirds of all mucoceles occur there. Endoscopic marsupialization of the mucocele was applied in all 18 patients, while frontal sinus exploration with the osteoplastic flap procedure was performed in one patient and the caldwellluc.
Although, for control of recurrences longterm followup is recommended 3. Mucoceles of the paranasal sinuses are benign, chronic, expanding lesions that characteristically develop because of obstruction of the sinus ostium. The mucocele was seen to be eroding the anterior table and the floor of the frontal sinus medially. Ct shows a right frontal sinus mass with extension. Frontal sinus mucocele after osteoplastic flap surgery.
The most common site for a mucocele is the frontal sinus. Acute visual loss secondary to ruptured sinus mucoceles canadian. Generally arising from the ethmoid or frontal sinuses, orbital mucoceles are mucous or fluid filled cysts which can displace the eye. Its natural to be a little worried when a new lump or bump forms on your body. Paranasal sinus mucocele radiology reference article. Limited to the frontal sinus with or without orbital extension type 2. The ethmoidal sinuses are the next most common 25%, whereas the maxillary and sphenoid sinuses are infrequently involved 2. We present two cases of isolated frontal sinus fungus ball which preoperatively were suspected to be either a tumour or a mucocele. A sinus mucocele is a pocket or pockets of trapped mucous within one or more of the sinuses. Pdf frontal sinus mucoceles can present with a multitude of different symptoms including ophthalmic disturbances. Sinus mucoceles treatment houston tx sinus mucoceles. In the case reported we performed, as suggested by many authors, a transcranial approach that allowed a wide exposition of the frontal sinus, a safer removal of the mucocele and an easier obliteration of the sinus using both subcutaneous abdominal fat and pericranial flap in order to isolate the surgical cavity from the intracranial space and.
The left frontal sinus was also completely opacified. Many authors consider lateral localization of frontal mucocele a contraindication to ess 3, 4, 11, 15, and endoscopic management of lateral frontal sinus lesions is rarely mentioned in the literature. Mucocele was meticulously separated from the periorbita and complete removal was ascertained. An interesting bit of writing indicating this is the description by. The authors describe a patient with frontal giant mucocele involving the orbit, the ethmoid, and intracranial portion of the. The sinus walls were expansile without intrasinus calcification. Frontoorbital mucocele with intracranial extension. The anterior wall of frontal sinus was also eroded but the posterior frontal table was intact. Mucoceles of the paranasal sinuses are benign, cystlike, expansile lesions lined with a secretory respiratory mucosa of pseudostratified columnar epithelium 1, 2. The average interval between the primary insult to the frontal sinus and surgical confirmation of the frontal sinus mucocele was seven and onehalf years. In this type the mucocele is limited to the frontal sinus only with or without orbital extension. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Instead, they grow and slowly invade adjacent orbital tissues. The frontal sinus floor which was forming the medial orbital roof was eroded and the wall of mucocele was abutting the eyeball figure 4.
Ivory exostosis, growing from the roof of the frontal sinus into the orbital and cranial cavities, removed through an osteoplastic opening in the cranium by mr. We report the use of this novel technique in the management of a frontal sinus mucocele in a 47year old female. The prognosis for frontal sinus mucoceles is good with likelihood of cure, and a low incidence of recurrence. Frontal sinus mucocele after osteoplastic flap surgery annals of. It may expand and erode the surrounding structures such as bones and cerebral parenchyma.
Finger, md description orbital mucocele can occur when sinus mucoceles cannot naturally drain through the nose. The diagnoses consisted of frontal sinus mucocele n 4, chronic frontal sinusitis n 1, potts puffy tumor after frontoethmoid fracture n 1, and recurrent inverting papilloma n 4. Treatment of frontal sinus disease represents one of the most challenging aspects of endoscopic sinus surgery. It usually occurs in a very specific area in the sinuses. Isolated frontal sinus fungus ball is a rare cause of frontal sinus disease. Endoscopic sinus surgery for maxillary sinus mucoceles. Intradural infection following resection of posttraumatic mucocele in the frontal paranasal sinus. Frontal sinus mucocele in association with polyostotic fibrous dysplasia. Balloon dilatation of the sinus ostia is a minimally invasive technique that has been licensed for use in chronic sinusitis.
We present a rare case of intracranial mucocele associated with frontal sinus osteoma in a patient suffering from generalized convulsion. Pdf frontal sinus mucocele with intracranial and intraorbital. We would like to alert the clinicians to this diagnosis that can be easily misdiagnosed. In both cases, cheesy, claylike material was found intraoperatively within the frontal sinus, suggesting a fungus ball. The communication then is directly through an ostium 11. Immediate ct scan was done which revealed a frontal sinus pyomucocele of size measuring 5. Mucoceles of the frontoethmoidal sinuses radiology. Combined endoscopic endonasal and transcranial approach to a. They are mucoid filled masses and develop after obstruction of the sinus ostium and drainage pattern, which is confirmed by the high incidence of mucoceles in the frontal sinus caused by the variations of the nasofrontal duct. Frontal sinus mucoceles are epitheliumlined mucuscontaining sacs that are capable of bony expansion causing a spectrum of ophthalmological symptoms. Giant mucocele of the frontal sinus is a rare pathology of benign entity caused by retention of mucous secretions in the sinus. Patient with proptosis of his right eye and displacement of the globe inferiorly.
Thank you for your interest in spreading the word about the bmj. Contemporary management of frontal sinus mucoceles springerlink. His pupils were spared, his eye movements were not restricted and he was not proptosed. Frontal sinus mucocele drainage may be an exception to the rule because in many instances, the expansion of the mucocele widens the frontal sinus recess and renders surgical drainage technically undemanding. Contemporary management of frontal sinus mucoceles. They are mucoid filled masses and develop after obstruction of the sinus ostium and drainage pattern, which is confirmed by the high incidence of mucoceles in the frontal sinus caused by the variations of the nasofrontal duct 6, 9.
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