Combined Endoscopic Endonasal and Transcranial Approach To a Recurrent Frontal Sinus Mucocele

Abstract

The frontal mucocele remains a disease difficult to treat even in the era of functional endoscopic sinus surgery (FESS). Indeed, recurrence it is a typical complication of both endoscopic endonasal and transcranial approach or as a consequence of facial fracture. The modern endoscopic endonasal approach to the frontal sinus allows the marsupialization of the pathology in all those cases in which the mucocele is reached via the route of nasal drainage and is optimal when the location of the mucocele is medial. After infection or as a result of their invasion and growth, mucoceles of the frontal sinus can give rise to intracranial and orbital complications. The most versatile and used transcranial approach is considered the Sinus Fat Obliteration (SFO). We describe the case of a 47 years old patient who under went FESS and OFSO for bilateral recurrence of mucocele within a mega-frontal-sinus. The lesion reached the left supra orbital region with erosion of the roof of the ipsilateral orbit. The endoscopic approach, in our experience, it is necessary in the forms of mucocele complicated by orbital medial and superior extension. Instead, in the presence of a mega-frontal-sinus, of a lateral extension of the mucocele as well and the clinical history of relapses of the disease is also indicated the transcranial surgical approach. The Sinus Fat Obliteration (SFO) minimizes the risk of complications with no need for a postoperative neurointensive unit stay compared to the intervention of cranialization. In fact the patient object of this work had a regular postoperative course and was discharged on the sixth day with excellent aesthetic results.