Frontal Mucocele Research Articles

Fronto-ethmoidal mucoceles: a study of 25 cases

<p class="abstract"><strong>Background:</strong> Paranasal sinus mucoceles are quite rare and a comprehensive study regarding their incidence, presentations, management and complications is significantly lacking in our geographical area which led to our prospective study. Fronto-ethmoidal mucoceles are the most common expansile lesions of the paranasal sinuses.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of 25 cases of patients presenting with fronto-ethmoidal mucoceles in a tertiary care hospital in Ahmedabad. All patients were managed surgically through endoscopic approach. </p><p class="abstract"><strong>Results:</strong> The study comprised of 25 cases of fronto-ethmoidal mucoceles. The average age of the patients was 47.72 years with a range of 21–75 years. 16 patients (64%) were females. The most common involvement was of frontal sinus (16 cases, 64%). The most common presenting symptom was displacement of eyeball (68% cases). The most common presenting sign was proptosis, present in 68% cases. Endoscopic sinus surgery was the most commonly used modality of treatment of frontal mucocele and fronto-ethmoidal mucoceles (23 cases). In 2 cases combined approach surgery (endoscopic and external) was done.</p><p><strong>Conclusions:</strong> Mucoceles most commonly occur between 4<sup>th</sup> to 7<sup>th</sup> decades of life. In most cases no predisposing factor is identified. The diagnosis is based on the history, physical examination and radiological findings. CT is the preferred imaging modality for mucoceles.Endoscopic endonasal surgery is currently the most commonly used surgical approach. </p>

Mucocele formation after surgical treatment of inverted papilloma of the frontal sinus drainage pathway.

Inverted papillomas (IP) inserted in the frontal sinus and/or recess may be treated by using an endoscopic endonasal or an external approach. There are still few data available on this uncommon localization of IPs. To report our experience in the management of IP of the frontal drainage pathway, to describe a previously unreported specific complication of this surgery, and to discuss the optimal surgical strategy. A retrospective study of the patients at a tertiary care center between 2004 and 2014 who were operated on for an IP with an insertion in the frontal recess and/or the frontal sinus. Clinical charts were reviewed for demographics, clinical presentation, imaging findings, surgical treatment, and outcome. Twenty-seven patients were included. Patients were operated on by using a purely endoscopic approach (Draf procedure; n = 14 [51.9%]) when the IP was inserted in the frontal recess and/or the frontal sinus infundibulum (with a nasoseptal-septoturbinal flap placed on the exposed bone in four patients), or by using a combined endoscopic and open approach (osteoplastic flap procedure; n = 13 [48.1%]) when the IP invaded the frontal sinus beyond the infundibulum. There were two recurrences (7.4%), with a mean follow-up of 40 months (range, 9-123 months). During follow-up, single or multiple iatrogenic frontal mucoceles were observed in 10 patients (37%), with a mean delay of 60 months (range, 27-89 months). These mucoceles occurred both after using endoscopic (n = 3) or combined (n = 7) approaches, and required a surgical treatment in eight patients. No postoperative mucocele was observed in the four patients who had had a septal flap. In our experience, an approach based on the localization of the IP insertion provided acceptable results in terms of the local control rate (92.6%). However, the significant rate of postoperative mucoceles indicated that specific strategies (such as local flaps) still need to be developed to avoid this iatrogenic complication.

Considerations in the management of giant frontal mucoceles with significant intracranial extension: A systematic review.

Giant frontal mucoceles, characterized by significant intracranial and/or intraorbital extension, can present with significant neurologic symptoms. Although typical mucoceles are managed endoscopically, giant mucoceles are often treated with an open or combined approach due to various concerns, including frontal lobe displacement, size, and rapid decompression of the intracranial component. The impact of significant intracranial extension on outcomes is not well described. This review studied key neurologic considerations in the management of giant frontal sinus mucoceles and analyzed outcomes of different management strategies. Systematic literature review by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Thirty-two articles, which represented 85 cases, met inclusion criteria. Neurologic symptoms on presentation ranged from headache (24.7%) and vision loss (12.9%) to extremity weakness (1.2%), frontal lobe syndrome (2.4%), and seizures (4.7%). Twenty-eight patients were treated endoscopically (34.1%), and 54 (65.9%) were treated with an external approach. Twenty-five of the open procedures included a craniotomy. Indications for the open approach included subdural empyema, enucleation, or large anterior table defects. Perioperative antibiotics were not consistently used. No perioperative seizures were reported with any approach. There were six cerebrospinal fluid leaks, all in the patients who underwent open procedures. The overall recurrence rate was 3.5%, with no recurrences reported in patients treated with an open approach. Follow-up ranged from 1 week to 8 years. Giant frontal mucoceles often present with various neurologic symptoms. Both open and endoscopic techniques offer excellent results. Endoscopic management is effective and preferred, except in special circumstances. An interdisciplinary team approach should be used to optimize surgical planning.

Frontal Mucocele Masked as Upper Lid Abcess- A Case Report

Frontal mucocele is not commonly masked as upper lid abscess.A 72-year-old Chinese man with underlying hyperthyroidism complained of left upper eyelid swelling of 6 months duration. The swelling had persisted and worsen when intravenous antibiotic was changed oral type. Visual acuity on presentation was hand motion and reverse relative afferent pupillary defect was present. Because the swelling was large and resulted in mechanical ptosis and ophthalmoplegia, a CT imaging was performed, which showed huge left frontal mucocele eroding the supereromedial orbital rim. The left globe was displaced inferolaterally but there was no extension into brain parenchyma. Fundus examination showed pale optic disc with dull macula. Old laser marks were seen at peripheral fundus. Referral to ortholaryngologist was made and endoscopic sinus surgery and evacuation of mucopyocoele was done. Culture and sensitivity of the fluid showed no organism. He recovered well postoperatively with additional two weeks of antibiotics. We highlight the necessity of surgical drainage of mucocele, following a course of antibiotic.

感染性粉瘤として治療され皮膚瘻を形成した前頭洞嚢胞の 1 例

感染性粉瘤として治療され皮膚瘻を形成した前頭洞嚢胞の 1 例

Frontal Mucocele following Previous Facial Trauma with Hardware Reconstruction.

Mucoceles are cysts that can develop after facial bone fractures, especially those involving the frontal sinuses. Despite being rare, mucoceles can result in serious delayed sequelae. We present a case of a frontal mucocele that developed two years after extensive facial trauma following a motor vehicle crash (MVC) and review the emergency department (ED) evaluation and treatment of mucocele. Early recognition, appropriate imaging, and an interdisciplinary approach are essential for managing these rare sequelae of facial trauma.

BILATERAL FRONTAL SINUS MUCOCELE: A CASE REPORT

Paranasal sinus mucoceles are cyctic lesions that occur as a result of accumulation of mucoid secretion and desquamated epithelium, leading to distension by growing in an expansile and destructive manner within the sinus wall. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid, and maxillary mucoceles are rare. However, bilateral frontal sinus involvement is rather rare. If the cyst invades the adjacent orbit and continues to expand within the orbital cavity, the mass may mimic the behavior of many benign growths primary in the orbit. Here, we present a case with frontal mucocele involving bilateral sinuses. It was manifested with proptosis and exophthalmia of the left eye in a forty year-old male patient. Paranasal computed tomography scan and magnetic resonance imaging revealed an image consistent with mucocele. We performed intranasal frontal sinusectomy via endoscopic approach. No orbital and intranasal complication developed at the end of the surgery. We report here that endoscopic drainage, performed by experienced hands, could be preferred surgical approach in rare case of bilateral frontal mucocele case.

Frontal Mucocele Presenting with Subcutaneous Cystic Swelling: An Unusual Case Report

ABSTRACT Paranasal sinus mucocele is slowly expanding cystic lesions leading to sinus expansion, bony erosion and extension into the orbit, cranial cavity or into subcutaneous tissue. Mucoceles most commonly involve the frontal and ethmoidal sinuses. We describe a frontal mucocele presenting with forehead subcutaneous cystic mass which was successfully managed by endoscopic sinus surgery and by external approach (frontal trephination). How to cite this article Chauhan B, Gupta M. Frontal Mucocele Presenting with Subcutaneous Cystic Swelling: An Unusual Case Report. Clin Rhinol An Int J 2015;8(3):130-132.

Frontal mucocele in the developing sinus

Abstract We report the first paediatric case of mucocele formation in a developing frontal sinus with no known associated lesions. A 10-year-old girl presented with a 12-month history of left frontal pain with no response to nasal steroid and antibiotics. CT-imaging revealed a left frontal mucocele enclosed by bone covering the sinus ostium, despite no prior history of trauma or surgery. The patient underwent image guided endoscopic sinus surgery with successful relief of symptoms. The rarity and non-specific symptoms of frontal mucoceles may result in misdiagnosis and delayed treatment, why this pathology should be considered in children with persistent frontal pain.

Unilateral Frontal and Ethmoidal Mucoceles of the Paranasal Sinuses in a Seventy-Four-Year-Old Man

Introduction: Mucoceles of the paranasal sinuses are relatively rare. A very busy otolaryngology department does not have more than a few cases each year. Bilateral, multiple, and multiloculated cases are extremely unusual. Case Presentation: We report a 74-year-old man with two separate mucoceles in left ethmoid and frontal sinuses with pansinusitis. After marsupialization of mucoceles and functional endoscopic sinus surgery, the symptoms of the patient relieved. Conclusions: Surgeons should consider the possibility of existence of other mucoceles when they find a large downstream sinus mucocele obstructing the ostia of upstream sinuses on computed tomography scans.

Frontal Mucocele Presenting As a Subcutaneous Giant Mass

Giant mucocele of the frontal sinus is a rare pathology lesion presenting with massive cosmetically unacceptable bony swelling in the frontal region. Most of the patients complain primarily of the ophthalmic symptoms. However, the present case reminds us that frontal mucocele is one of the differential diagnoses for a subcutaneous mass on the forehead.Authors report an unusual case of frontal mucocele in a 64years old Iranian male who presented with painless slowly progressive subcutaneous swelling of ten-year duration on the forehead. Endoscopic marsupialization, decompression of the mucocele, removal of the sinus mucosa and widening of ostium was performed.The case is discussed and the pertinent literature is reviewed.

Outcomes of frontal mucoceles treated with conventional endoscopic sinus surgery

Conclusion: Conventional endoscopic sinus surgery (CESS) is useful for frontal mucoceles. A patient with short anterior–posterior distance and bone thickening may need an axillary flap, Draf type IIb, or Draf type III procedure. Objective: To present outcomes of frontal mucoceles treated with CESS and predict risk factors for poor outcomes to help define surgical indications. Methods: A consecutive clinical series was reviewed retrospectively. The authors performed CESS without agger nasi resection (Draf type IIa) for 13 frontal sinus mucoceles in 12 patients between October 2011 and July 2013. Patient age, sex, blood eosinophil count, history of operation and co-existence of acute infection were compared. For the condition of the frontal sinus, anterior–posterior distance and width of frontal recess, bone thickening of the frontal recess, bone absorption due to continuous pressure by mucocele and anatomy of the frontal recess was noted. Results: All operations were done without a navigation system. The post-operative course was uneventful in all 12 patients, and all symptoms gradually receded. Among 13 mucoceles, one frontal sinus (7.7%) closed during follow-up.

Frontal Sinus Violation and Management of Complications

Introduction: Frontal sinus violation often occurs incidentally during a craniotomy. There is an assortment of operative techniques that have been employed to manage this. A delayed complication can be frontal sinusitis or mucocele formation. Our objective was to review the published literature and our experience of frontal sinus complications after craniotomy with frontal sinus violation.

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

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.

Challenges in exophthalmia management: Frontal mucocele

Challenges in exophthalmia management: Frontal mucocele

Unusual case of frontal mucocele presenting with forehead ulcer

Paranasal mucoceles are benign slow-growing paranasal sinus lesions, which usually develop following the obstruction of the sinus ostiu. They most frequently occur in the frontal sinus. Frontal mucoceles are expansive lesions usually causing visual clinical signs and symptoms such as diminution of vision, visual field defects, diplopia, orbital swelling, retroorbital pain, displacement of eye globe, ptosis, and proptosis. When the frontal mucocele extends intracranially, it can manifest with meningitis, meningoencephalitis, intracranial abscess, seizures, or cerebrospinal fluid fistula. Very rarely it can cause forehead swelling. We report an 80-year-old woman presenting with a forehead skin ulcer and painless subcutaneous forehead induration. Histopathologic examination revealed mucin deposition and inflammation. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans showed a mass originating from the frontal sinus with frontal bony defect and frontocutaneous fistula. Surgical excision of the mass confirmed the mucocele diagnosis. In this article, we present a case of frontocutaneous fistula and skin ulcer, which is an unexpected complication of frontal mucocele. We propose that in the case of a localized non-healing ulcerated forehead skin lesions, mucocele should be considered in the differential diagnosis.

Chronic Sinusitis with Frontal Mucocele: A Case Report

Purpose: To describe a type IIIa frontal mucocele in a case of diffuse nasal polyposis. To discuss the clinical presentation, diagnostic and treatment modalities. Study Design: A case report including radiological, histopathological analysis and review of literature. Methods: A case report from a tertiary care centre. Histopathologic and radiological details are reviewed. Results: This case report presents a 59-year-old male who came to us with fronal headaches and nose blocks of 6 months’ duration. Clinical examination revealed bilateral nasal polyposis. Plain CT scan of paranasal sinuses revealed a circumscribed lesion with erosion of inner table of left frontal sinus amidst pan sinus haziness. We addressed the condition by combined FESS with eyebrow incision frontal craniotomy. Histopathological examination revealed a mucocele. Conclusion: In combined approach, eyebrow incision minimal frontal craniotomy remains the optimal option for visualisation of entire sinus, especially in laterally placed frontal mucoceles; while FESS helps in maintaining physiological drainage and proper follow-up.

Frontal Mucocele following Contralateral Orbitopterional Craniotomy for Optic Nerve Sheath Meningioma: A Short Report

ABSTRACT Unilateral skull base craniotomy provides reasonable exposure for orbital tumors, especially involving optic nerve sheath lesions. Such a surgical approach requires disturbance of sanctity of rhinological spaces, inviting unusual complications. The authors report contralateral mucocele formation 4 years after such a craniotomy performed for optic nerve sheath meningioma. How to cite this article Mohindra S, Mohindra S, Gupta B, Gupta K. Frontal Mucocele following Contralateral Orbitopterional Craniotomy for Optic Nerve Sheath Meningioma: A Short Report. Clin Rhinol An Int J 2013;6(3):121-123.

English

The paranasal sinus mucocele is an epithelized cystic lesion containing fluid and is characterized by non-neoplastic expansion of the paranasal sinuses due to its capacity to erode the overlying bone. Etiology of these lesions is still under debate. In this report, we describe a case of frontal mucocele associated with proptosis and diplopia. A 56 year old male patient was admitted to our hospital in the department of Otorhinolaryngology with chief complaints of left sided nasal obstruction, double vision, swelling in the left eye and headache, all since 3 months. CT scan of the paranasal sinuses revealed a left sided dense hypoechoic mass with destruction of floor of the frontal sinus with intra orbital extension. All other laboratory examinations were within physiological limits. The patient was treated surgically by external approach. An incision was put in the left supra-orbital region and a bone window was created to access the frontal sinus and the mass identified and excised in-toto. Dermal fat graft was harvested the thigh and grafted into the recess. Histopathological examination of the mass revealed the mass to be a mucocele.

Contemporary management of frontal sinus mucoceles: A meta-analysis

To analyze trends in the surgical management of frontal and fronto-ethmoid mucoceles through meta-analysis. Meta-analysis and case series. A systematic literature review on surgical management of frontal and fronto-ethmoid mucoceles was conducted. Studies were divided into historical (1975-2001) and contemporary (2002-2012) groups. A meta-analysis of these studies was performed. The historical and contemporary cohorts were compared (surgical approach, recurrence, and complications). To study evolution in surgical management, a senior surgeon's experience over 28 years was analyzed separately. Thirty-one studies were included for meta-analysis. The historical cohort included 425 mucoceles from 11 studies. The contemporary cohort included 542 mucoceles from 20 studies. More endoscopic techniques were used in the contemporary versus historical cohort (53.9% vs. 24.7%; P = <0.001). In the authors' series, a higher percentage was treated endoscopically (82.8% of 122 mucoceles). Recurrence (P = 0.20) and major complication (P = 0.23) rates were similar between cohorts. Minor complication rates were superior for endoscopic techniques in both cohorts (P = 0.02 historical; P = <0.001 contemporary). In the historical cohort, higher recurrence was noted in the external group (P = 0.03). Results from endoscopic and open approaches are comparable. Although endoscopic techniques are being increasingly adopted, comparison with our series shows that more cases could potentially be treated endoscopically. Frequent use of open approaches may reflect efficacy, or perhaps lack of expertise and equipment required for endoscopic management. Most contemporary authors favor endoscopic management, limiting open approaches for specific indications (unfavorable anatomy, lateral disease, and scarring). N/A.