Mucocele of the Sphenoid Sinus

Abstract

Mucocele of the paranasal sinuses is a rare disease with slow evolution. It is a benign, encapsulated and destructive formation fi lled with mucous fl uid and tapistrated with respiratory epithelium. Of all the paranasal sinuses, the sphenoid sinus is aff ected in only 1-7% of the cases. We present two cases of mucocele of the sphenoid sinus involving the posterior ethmoidal cells. We consider here their clinical presentation, use of neuroimaging in the diagnosis, surgical care and postoperative results. Both patients presented with a history of persistent headache and in addition, one of them had a paresis of the right oculomotor and abducens nerves. A transnasal endoscopic sphenoidectomy was performed in both patients, in one -with an evacuation of the mucocele and marsupialization, and in the other -with a balloon dilatation of the natural foramen of the sinus. Postoperatively, a complete reversal of the symptoms was observed in both patients. Mucocele of the paranasal sinuses should be considered as a diagnosis in cases of persistent headache with a primarily retrobulbar location and eye symptoms. Computed tomography and magnetic resonance imaging can be used to successfully diagnose the disease. The transnasal endoscopic sphenoidectomy is the therapeutic method of choice which allows evacuation of the mucocele, while the marsupialization allows good drainage and prevents recurrence.

Nasal Sinus Mucoceles Manifesting Ocular Symptoms

“…Headaches caused by sphenoid sinus mucoceles occur primarily in the retrobulbar position in the early stages15 and are usually bilateral and progressive. Discomfort caused by the mucocele can be relieved by the administration of nonsteroidal anti-inflammatory drugs 16.…”

“…Neurophysical examination found that 4 patients presented with oculomotor nerve palsy, 4 patients had optic nerve or abducens nerve palsy, and 1 patient had optic neuropathy, oculomotor nerve palsy, and abducens nerve palsy simultaneously. 14 Headaches caused by sphenoid sinus mucoceles occur primarily in the retrobulbar position in the early stages 15 and are usually bilateral and progressive. Discomfort caused by the mucocele can be relieved by the administration of nonsteroidal antiinflammatory drugs.…”

Headache and rhinosinusitis: A review

“…Uncommon, but serious, complications include meningitis, brain abscess, orbital cellulitis, orbital abscess, and mucocele (10). A mucocele is a benign, but potentially destructive, mucus-containing cyst that can form in any of the sinuses and may present with a progressive headache and cranial nerve palsies due to compression, especially in the sphenoid sinus (55,56).…”

Implications of anatomical variation of the sphenoid sinus for orthognathic surgery: a case report in cone beam computed tomography

“…A recent systematic review showed that the occurrence rate of orthognathic surgery was 38.1% in individuals with bilateral cleft lip and palate (BCLP), 30.2% for unilateral cleft lip and palate (UCLP) 4.4% for isolated cleft palate (ICP), and 1.8% for patients with isolated cleft lip (ICL), after the orofacial cleft repair [12]. The identification of SS'pneumatization in individuals with and without CLP is important to avoid complications in surgical procedures, including hemorrhages, sinus infections, formation of mucoceles and can be from a surgical approach with inadequate planning [8,13]. Also, infections can occur for the intracranial region, representing a higher risk for the individual, such as: subdural abscess; extradural abscess; brain abscess; meningitis; thrombophlebitis or osteomyelitis [14].…”