Frontal sinus mucocele with orbital complications: Management by varied surgical approaches

Abstract

A mucocele of a para-nasal sinus is an accumulation of mucoid secretion and desqua-mated epithelium within the sinus with distension of its walls and is regarded as a cyst like expansile and destructive lesion. If the cyst invades the adjacent orbit and continues to expand within the orbital cavity, the mass may mimic the behavior of many benign growths primary in the orbit. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid, and maxillary mucoceles are rare. Floor of frontal sinus is shared with the superior orbital wall which explains the early displacement of orbit in enlarging frontal mucoceles. Frontal sinus mucoceles are prone to recurrences if not managed adequately. Here, we are evaluating different approaches used to manage various stages of frontal mucoceles which presented to us with orbital complications. Three cases of frontal sinus mucocele are discussed which presented to our OPD with different clinical symptoms and all cases were managed by different surgical approaches according to their severity. We also concluded that it is prudent to collaborate with the neurosurgeons for adequate management of such complex mucoceles by a craniotomy approach.

Bilateral Frontal Sinus Mucocele: A Case Report

“…In literature, etiology was attributed to inflammatory process, neoplasm (e.g. osteoma, ossifying fibroma), postoperative complication, allergy, anatomic anomaly, fibrous dysplasia and posttraumatic sequel formation (2,3,6,7). In our case, however, there was not any pathology except for partial stenosis in the frontal recess.…”

“…Rollet (1909) was the first author who used the term mucocele (3). Mucoceles are most commonly located in the frontal sinuses (60%), whereas sphenoid, ethmoid, and maxillary sinus involvement is rare (1,2,3). Frontal sinus mucoceles can develop due to obstruction of ostium by chronic sinusitis, polyp, tumor, trauma or surgical intervention.…”

“…Mucoceles of the paranasal sinuses were first described by Langenbeck (1820) under the name of hydatids. Rollet (1909) was the first author who used the term mucocele (3). Mucoceles are most commonly located in the frontal sinuses (60%), whereas sphenoid, ethmoid, and maxillary sinus involvement is rare (1,2,3).…”

“…Mucoceles are formed as a result of accumulation of mucus and desquamated epithelium that lead to erosion due to increased pressure on the sinus wall. Mucoceles can lead to various complications with expansions in orbita, nasal cavity and intra cranium due to proximity (3,4).…”

“…CT is used for both assessment of regional anatomy and detection of particularly intracranial and intra orbital expansion, and bone erosion. MRI is helpful in differentiating mucoceles from neoplasms (3,5). Treatment of mucoceles is achieved by craniotomy or functional endoscopic sinus surgery.…”