Extensive paranasal sinus mucoceles: a 15-year review of 82 cases

Lee, Ta‐Jen; Li, Shang-Pei; Fu, Chia‐Hsiang; Huang, Chi‐Che; Chang, Pi-Yueh; Chen, Yiwei; Chen, Chiang-Wen

doi:10.1016/j.amjoto.2008.06.006

Cited by 58 publications

(67 citation statements)

References 25 publications

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“…Prostaglandins and collagenases aid in osteolysis and further enhance the expansile nature of the cysts [1][2][3]. Except in the case of pyeloceles, they are generally benign and slow growing with the potential, through mass effect, to cause local morbidity upon neighboring structures [1,4,5].…”

Section: Discussionmentioning

confidence: 99%

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Paranasal Sinus Mucocele

Capra

Carbone

Mullin

2012

Head and Neck Pathol

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Paranasal sinus mucoceles are epithelium-lined cystic masses usually resulting from obstruction of sinus ostia. They most frequently occur in the frontal and ethmoid sinuses. While ophthalmologic symptoms are most common, patients also report rhinological or neurological complaints. The close proximity of paranasal sinus mucoceles to the orbit and skull base predisposes the patient to significant morbidity. Computed tomography displays a non-enhancing homogenous mass with expansion of bony walls. Magnetic resonance imaging reveals variable intensity of T1-weighted images and a hyperintense mass on T2-weighted images. Histopathologically mucoceles have features of respiratory mucosa with areas of reactive bone formation, hemorrhage, fibrosis, and granulation tissue. Surgical excision is the standard treatment with trends towards endoscopic techniques.Keywords Paranasal sinus mucocele Á Magnetic resonance Á Computed tomography Á Blindness Á Ophthalmologic Á Optic neuropathy Á Cranial neuropathy Á Osteolysis Á Inflammatory infiltrate HistoryA 54-year-old female with a history of cataracts was referred by an ophthalmologist to the Otolaryngology Clinic for acute worsening of visual acuity and diplopia in the right eye. Symptoms began 5 months prior and were described as a 'white curtain' in her vision. Her ophthalmologic exam showed proptosis and chemosis of the eye and her visual acuity ipsilaterally was 20/100 (baseline 20/25). The optic disc was pink and healthy on exam. Cranial nerves III, IV, V, and VI were intact, with only minimal impairment of extraocular muscle movement. Radiographic FeaturesA non-contrast computerized tomographic (CT) scan of the head and orbits showed a 4.4 cm 9 4.2 cm 9 3.3 cm well-circumscribed expansile mass in the right ethmoid sinus. The medial orbital wall was expanded with evidence of mass effect upon the medial rectus muscle and optic nerve (Fig. 1). Nuclear magnetic resonance images (MRI) of the head with and without contrast demonstrated a hyperintense mass on T2-weighted images (WI) and a hypointensity on T1WI. The MR fluid attenuation inversion recovery (FLAIR) sequence suggested proteinaceous fluid (Fig. 2). TreatmentThe mass was emergently decompressed through an endoscopic approach in the operating room. Resistance to retropulsion of the right eye resolved immediately and the patient's visual acuity returned to baseline within 24-h of surgery.

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Section: Discussionmentioning

confidence: 99%

“…Paranasal sinus mucoceles most commonly occur in the third or fourth decades of life with a slight male predilection [3,5]. The frontal sinus is most commonly affected followed by the ethmoid sinuses, with reports suggesting 70-90 % of mucoceles occur in these locations.…”

Section: Discussionmentioning

confidence: 99%

Paranasal Sinus Mucocele

Capra

Carbone

Mullin

2012

Head and Neck Pathol

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“…It allows to differentiate and to assess any extension into the orbit or intracranial compartment, but, unfortunately it can't study bone detail. 14,15 Its indications are in complement of the CT scan in case of diagnosis doubt in CT scan between mucocele and other tumors or inflammatory lesions, in case of sphenoid location and in endocranial or orbital extension.…”

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confidence: 99%

“…16 The usual signal characteristics are a low intense T1 and a high intense T2 but any combination of signal intensity may be seen depending on the presence of blood products or the degree of hydration of the contents. 5,14,17,18 The appearance consisted of hyperintense signal on both T1 and T2 type images, corresponding to more hydrated secretions, which are also high in protein content.…”

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confidence: 99%

Imaging of Paranasal Sinus Mucoceles

Marrakchi¹,

Nefzaoui²,

Chiboub³

et al. 2016

Otolaryngol Open J

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Introduction: Mucoceles are cystic masses developing after obstruction of the sinus ostium. The symptoms are not specific. Computed Tomography scan (CT scan) and Magnetic Resonance Imaging (MRI) confirm the diagnosis. Objectives: We herein review the radiologic characteristics of mucoceles in CT scan and MRI. Materials and Methods: We report a retrospective study of 43 patients diagnosed with paranasal sinuses mucoceles. CT scans were performed for all patients, but MRI was carried out only in selected cases. Results: Our study was constituted of 27 males and 16 females with a mean age of 47 years. The CT scan appearence of mucoceles were in all cases as a well circumscribed expansile sinus mass with an effect on the neighbor bone structure. This mass was hypodense in 26 cases, isodense in 14 cases and hyperdense in 3 patients. The paranasal sinuses most frequently affected in our series were the fronto-ethmoidal sinuses. The most affected bone eroded was the lamina papiracea. Intracranial extension was seen in four cases. CT scan allowed to predict the cause of mucoceles in some cases and to provide information about anatomic variants. MRI was realized for 15 patients in addition to the CT scan. It allowed to study the extension of mucoceles to the neighboring organs especially orbital and endocranial ones. Conclusion: The presentations of mucoceles on imaging are quite variable. CT scan provides precious information about the location, bone erosion and extension of the mucoceles. MRI is indicated in some cases especially in cases of orbital or cranial extension.

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“…Spontaneous remittance of pain and swelling is rather unusual. In a retrospective study by Lee et al, 3 82 cases with intracranial or intraorbital extension of sinus mucoceles were reported; headache was documented in only 1 case and eye pain in 3 cases. Obeso et al 4 reported craniofacial pain in 10 of 72 patients (14%) operated on for 81 mucoceles; 2 patients were diagnosed as having trigeminal neuralgia.…”

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confidence: 99%