Nasosinusal polyposis revealing maxillary sinus mucocele

Abstract

Mucocele is a benign pseudo-cyst formation that rarely develops in the maxillary sinus. Mucocele is secondary to various conditions having in common an inflammation and an obstruction of the sinus ostium. The latter may be primary but it is often secondary to a trauma, tumor, chronic inflammation. Diagnosis is based on imaging. CT scan is essential for assessing osseous changes and for planning endonasal surgery under endoscopic control. MRI allows to specify the relations of mucocele. Therapeutic management of these mucoceles should be based on mucocele marsupialization performed at the same time as the treatment of the local factor involved. We report the case of a 21-year old man with no pathological history presenting with bilateral nasal obstruction associated with anosmia. Clinical examination showed exquisite pain in the anterior maxillary sinus wall, bilateral nasal sinus polyposis and swelling at the level of the hard palate. CT scan of the facial skeleton showed a well-defined homogeneous hypodense mass with no enhancement, involving the entire left maxillary sinus associated with regular bone lysis of its walls and a bilateral opacification of ethmoid cells and nasal cavities. The patient underwent endonasal surgery and functional ethmoidectomy associated with intranasal middle meatus antrostomy allowing the marsupialization of the mucocele. The postoperative course was uneventful and not associated with recurrence.