Maxillary sinus pneumocele causing orbital displacement

Abstract

Pneumoceles of the maxillary sinus were first described by Noyek and Zizmorl in 1674. A 35year-old man noted right cheek pain during a trans-Atlantic flight. The pain resolved during descent but recurred intermittently during the following 6-month period. The pain was exacerbated by sneezing, and he eventually noticed a cystic mass in the canine fossa during Valsalva’s maneuver. Plain radiographs showed an extensively pneumatized maxillary antrum. A Caldwell-Luc approach was curative.l Since that original description, one sphenoid sinus and eight additional maxillary sinus pneumoceles have been reported.2-8 It is theorized that an abnormal one-way valve between the nasal cavity and the affected sinus allows chronic air trapping, an intrasinus pressure dysequilibrium, and subsequent hyperpneumatizati0n.l Wolfensberger and Herrmanng were the first to document this trapvalve hypothesis in a patient with a pneumocele. They documented elevated maxillary sinus pressure in the pneumocele compared with the uninvolved maxillary sinus during a transoral puncture using a trocar, Luer’s lock, and whole-body plethysmography. During Valsalva’s maneuver, both antral pressures increased, but only the pressure in the pneumocele remained elevated on termination of the maneuver. g CASE REPORT