Complications ophtalmiques des mucocèles rhino-sinusiennes

Abstract

A nasosinus mucocele is a pseudocystic process filled with mucus arising within the sinus. Despite its benign histology, potential ophthalimic risks are related to mass effect and expansion to the orbit by bone destruction with compression of optic nerves. We describe mechanisms of ophthalimic involvement in patients with paranasal sinus mucoceles, radiological appearance, treatment and prognosis of this disease. We report 5 cases of paranasal sinus mucocele with ophthalmic complications seen between January 2007 and December 2011 on the ENT and MFS service of La Rabta University hospital. The reason for consultation was: unilateral proptosis in 4 patients, diplopia in 2 patients and medial canthal swelling in 3 patients. Facial computed tomography showed a mucocele in the frontal sinus in two patients, in the ethmoid-frontal sinuses in two patients and in the ethmoid-maxillary sinuses in one patient. We found erosion of the orbital walls and displacement of the globe in all cases, extra-axial proptosis in one case, compression of the extraocular muscles in 4 cases and stretching of the optic nerve in three cases. All patients were treated initially with antibiotics then surgery. The postoperative course was uneventful with no recurrence. It is necessary to diagnose mucoceles as early as possible and plan surgical excision before growth of the mass irreversibly compromises visual function.