Unilateral Sphenoidal Mucocele with Nasal Polyposis - A Typical Presentation

Abstract

Mucoceles of the sphenoid sinus act as benign lesions and can result in bony erosion from within its confinity of the sinus to the intracranial and orbital spaces 1. Disease restricted to the sphenoid sinus is rare and often manifests with nonspecific or subtle signs and symptoms. Early and accurate diagnosis of sphenoid sinus disease may thus be difficult. Otolaryngologists must have a thorough knowledge of the spectrum of sphenoid sinus disease and the radiologic characteristics to manage these patients properly 2. The increased use of endoscopy in routine examination and advances in techniques of imaging this area will result in the more frequent diagnosis of these lesions 3. We herewith report a 26-year, female patient, who presented with left-sided nasal obstruction with headache confined to the frontal and occipital region for 6 months. Diagnostic nasal endoscopy showed multiple, pale polyps filling the left nasal cavity with the normal right nasal cavity. Non-contrast Computed tomography of the nose and paranasal sinuses showed, left pansinusitis with? left sphenoidal mucocele showing heterogeneous density. The patient underwent left Functional endoscopic sinus surgery with polypectomy. Intra-op showed fungal debris filling the sphenoid and polyps noted in the frontal, ethmoidal and maxillary sinus. KOH was positive for fungal elements. With regular follow up, no evidence of recurrence to date. Variable nonspecific symptoms and the complex anatomy of the sphenoid sinus tend to delay the diagnosis resulting in a poor prognosis. Keywords: Mucocele, Sphenoid, Polypoidal