LES MUCOCELES SINUSIENNES : ASPECTS DIAGNOSTIQUES ET THERAPEUTIQUES, A PROPOS DE 16 CAS

Abstract

Introduction: The sinus mucoceles are expansive pseudokystic benign tumours, whose wall is the sinus wall at least modified and of which sticky and aseptic contents. Patients and method: Our work is a retrospective study, bearing on 16 cases of sinus mucoceles in the service of ORL of hospital ANTAKI of Marrakech, from January 2000 to December 2006. It was interested in the characters epidemiologic, clinical, radiological, therapeutic and evolutionary of this pathology. Results: The average age in our series is 49 years, with extremes of 25 years and 81 years, and a sex ratio of a unit. The sinusal case histories were noted among four patients. The time with the consultation was 2 months in 48 months. The ethmoido-frontal sinus mucoceles in 12 cases (75% of the cases), were followed by the maxillary mucoceles in 2 cases (12,5 % of the cases) and by the sphenoid sinus mucocele in 2 cases (12,5%). In the ethmoido-frontal form, clinical symptomatology was dominated by the exophthalmia (100%), the tumefaction of the interior angle of the eye (100%) and the cephalus (67%). In the sphenoid form, the cephalus, the fall of vision and the exophtalmy dominated the clinical picture. In the maxillary form, the nasal obstruction associated with rhinorrhea was found among all patients. All the patients underwent an endoscopic visualization in the search of a suspect endonasal lesion. It highlighted a component endonasale of the mucocele in 60%. The diagnosis was marked in all the cases by the tomodensitometry of the sines which highlighted an orbital regional extension, endocranial or endonasal and guided the choice of the way initially and the knowledge of operational difficulties. The marsupialisation by endonasal way under endoscopic guidance was made among nine patients, including five ethmoido-frontal cases of mucocele, two cases of maxillaries mucoceles and two cases of sphenoid mucoceles. The initially combined way was used in seven ethmoido-frontal cases of mucoceles in front of the insufficiency of the gesture of marsupialisation. An anatomopathologic study of the mucocele wall did not objectify malignant lesions. The evolution noted two cases of recidivism. The retreat was 3 years and 10 months. Discussion: the sinus mucocele is an unsual pathology. Diagnosis is radio-clinical. Treatment is surgical. The endoscopic way take more and more place than the conventional surgery.