Frontoethmoidal Mucocele Research Articles

Mucocele of the Paranasal Sinuses: Retrospective Analysis of a Series of Eight Cases.

Paranasal sinus mucoceles are epithelium-lined cystic masses usually resulting from obstruction of sinus ostia. They most frequently occur in the frontal and ethmoid sinuses. The etiology is not clarified, but the most common identifiable cause of mucoceles following functional endoscopic sinus surgery (FESS), trauma, neoplasms, and allergy. The clinical symptoms of mucocele vary and are not specific, the most common being ophthalmic symptoms and headache, impinging on adjacent orbital structures, and causing ophthalmic sequelae such as double vision, commonly followed by orbital swelling, epiphora, proptosis, and ptosis. All patients in this study had frontal and frontoethmoidal mucocele and initially complained of frontal headache and ophthalmic symptoms. Definitive treatment options for paranasal sinus mucoceles include external approaches and endoscopic marsupialization. Objective:The study aimed to identify the etiology, clinical presentation, most common para nasal sinus affected by mucocele, management, and the rate of recurrence in eight cases with mucocele of the paranasal sinuses. Eight patients diagnosed with mucocele of the paranasal sinuses were admitted to our institution between 2014 and 2021. There were two females and six males aged between 14 and 67. Initial symptoms, duration, clinical presentation upon admission, location of the mucocele, type of surgical intervention, and outcome have all been studied. Results: The most common symptoms at diagnosis were orbital involvement, retrobulbar, and frontal headache. Most patients were diagnosed with frontal mucocele (40%), and three were frontoethmoidal mucocele at the time of presentation. The rest of the cases were diagnosed with ethmoidal mucocele (25%). The etiology was identified in four patients and was unclear in the rest. All patients underwent endoscopic sinus surgery. The most identifiable postoperative complication was a headache. The endonasal endoscopic approach is a safe and effective treatment for paranasal sinus mucocele and provides adequate drainage with a low recurrent rate.

Frontoethmoidal mucocele presenting with the appearance of Pott's puffy tumour.

Frontoethmoidal mucocele presenting with the appearance of Pott's puffy tumour.

Longstanding giant frontoethmoidal mucocele with orbital and intracranial extension: challenges of surgical approach in a developing nation

Mucoceles of the paranasal sinuses are expansile, benign mucus filled epithelial lined cystic-like lesion resulting from chronic obstruction to sinus ostia. They erode bony walls by pressure and bony resorption with the frontal and ethmoid sinuses predominately affected. The expansile lesion can involve surrounding structures like the orbit, intracranium or nasopharynx. Diagnosis is based on history, examination and radiological assessment with Computerized tomography scan being the imaging of choice. Surgery is the mainstay of treatment and would require collaboration with the neurosurgeons or the ophthalmologist when it extends to the brain or orbit respectively. It can be done via an external approach, endoscopic approach or a combination of both. If left without intervention, it may cause morbidity and potential mortality due to its proximity to the brain and orbit. We report a rare case in our setting of a 65-year-old male farmer with a painless huge left sided cystic fronto-orbital swelling of 8 years that mimicked a benign orbital tumor. The mass was non-tender and not pulsatile measuring about 20×18 cm with normal visual acuity. Computed tomography (CT) scans of the brain and paranasal sinus revealed a large well-defined non-contrast enhancing homogenous lesion involving the left fronto-ethmoidal sinuses with orbital and intracranial extension as well as inferolateral displacement of the left eye globe. He was reviewed by the ENT surgeons, neurosurgeons and ophthalmologists and subsequently had frontoethmoidectomy via an external approach.

Tổng quan về hình thái lâm sàng và kết quả phẫu thuật nội soi u nhầy xoang trán sàng

Objectives: To describe manifestation of fronto-ethmoid sinus mucocele and results of endoscopic surgery. Methods: The research method was carried out according to PRISMA-ScR guidelines. The PubMed/Medline database was used to search for studies around the world. Results: Out of 1017 search results, there were 21 studies that matched the selection criteria. The results of a review of 21 studies showed that frontal mucocele had 10 studies with 265 cases, followed by fronto-ethmoid mucocele had 9 studies with 108 cases and ethmoidal mucocele had 2 studies with 74 cases. The common types of sinus surgery methods included endoscopic marsupialization, followed by endoscopic frontal recess surgery, Frontoethmoid surgery and Ethmoidectomy. Conclusion: Frontal mucocele were most mucocele, followed by fronto-ethmoid mucocele and the ethmoid mucocele. The methods showed few complications and were effective in treatment mucocele. The choice of the appropriate surgical method should still be individualized. Keywords: Fronto-ethmoid sinus mucocele, endoscopic surgery.

Frontal sinus and its outflow tract

Introduction: The frontal sinus and its outflow tract attracts special concern for the budding otorhinolaryngologists because of its complex location, variation in anatomy and disease processes altering its pathophysiology.The surgical management is challenging and a surgeon must be well aware of its anatomical variation, radiological finding to anticipate the best surgical outcome. Objectives:-To review the frontal sinus and its drainage pathway with respect to anatomy radiology and different surgical methods. Data Analysis:-The FS presents a variety of anatomical variation and multiple pathological situations can direct multiple surgical approaches to deal with them. FR is the area of “surgical bottleneck” with maximum narrowing endoscopically and beginners must know the boundaries of safe work to have an optimal outcome. Chronic rhinosinusitis, frontoethmoidal mucocele and Osteomas are common disease process affecting frontal sinus and there are vast variant of malignant tumors that can affect the area posing special challenge to surgeon, Conclusion:- Different surgical pathologies affect frontal sinuses and its outflow tract which can be managed successfully if surgeon has good knowledge of its relevent anatomy and by use of appropriate surgical tools and individualized approach.

Recurrent of a Giant Fronto-Ethmoidal Mucocele with Orbital Extension: A Case Report

Mucoceles of the paranasal sinuses are benign expansive pseudo-cystic lesions, affecting mainly adults. These rare lesions are usually evolving at low noise and are most often revealed by neurological or ophthalmological complications. We report a case of a recurrent fronto-ethmoidal mucocele with orbital extension. This was a 69-year-old patient with a previous history of endoscopic marsupilization of mucocele by a private practitioner 10 years back, who presented frontal headaches associated with a left-sided forehead swelling and chronic left proptosis evolving for 3 years, in whom clinical examination revealed fluctuant swelling present in the forehead region above the left eye and unilateral left sided proptosis. Cranio-facial computed tomography (CT) and magnetic resonance imaging (MRI) were in favor of a left fronto-ethmoidal mucocele with homolateral intra-orbital extension. The patient was operated by an endoscopic surgical approach. The outcomes were favorable with regression of headaches and resolution of proptosis. The fronto-ethmoidal mucocele, although benign, has an aggressive potential in the absence of treatment either towards the endocranium or the orbit. Imaging plays a crucial role in the diagnosis, preoperative planning and monitoring of mucoceles and CT and MRI should be used as complementary investigations of sino-nasal pathology. Treatment of mucoceles is surgical and recurrences are uncommon. Although the fronto-ethmoidal is a benign lesion, it is may be responsible for complications involving the functional or even vital prognosis. An early diagnosis and treatment allow to improve mucoceles outcomes.

736 Endoscopic-Guided Decompression of an Incidental, Massive, Infected Fronto-Ethmoidal Mucocele: Our Experience

Abstract A 55-year-old man was referred to neurology with worsening headaches and right-hand numbness. An MRI brain demonstrated a hemangioblastoma but also a large right sided frontoethmoidal mucocele. The only sino-nasal symptom the patient had was unilateral nasal obstruction but felt this was well-controlled with a steroid nasal spray prescribed in primary care. Nasendoscopy showed pus emanating from a smooth mass anterior in the nasal cavity. A CT scan showed features of a large, expansile mass extending across both frontal and ethmoid sinuses, lateralising the septum, with dehiscence of the lamina papyracea. The patient underwent image-guided endoscopic sinus surgery to drain the mucocele which was filled with a considerable amount of pus and was seen to have eroded all sinus lamellae. Sinonasal mucoceles are expansile collections of mucous, lined with epithelium, and are thought to be more common in the third and fourth decades (1). They are usually caused by sinus surgery as a result of an obstructed sinuses but can follow trauma, inflammation or occur spontaneously (2). Once identified, surgery is the standard of care to prevent complications from expansion or infection. In this case report, along with imaging and intraoperative photographs, we further describe our approach and experience in managing a large mucocele.

In-office drainage of a frontoethmoidal mucocele with non-axial proptosis: an alternative to operating-room drainage

Mucocele of the paranasal sinus is a cystic lesion with accumulation of mucus within the sinus walls, which is capable of expansion. The frontal sinus is most commonly involved, whereas ethmoidal, sphenoid, and maxillary mucoceles are rare. The floor of the frontal sinus is shared with the superior orbital wall, which explains orbital displacement in enlarging frontal mucoceles. This article presents a case of a spontaneous right frontoethmoidal mucocele with non-axial proptosis in a 26-year-old male patient who was referred by an ophthalmologist to our ENT (ear, nose, throat) clinic for a biopsy to rule out a sinonasal malignancy. An intranasal endoscopic approach was done to obtain a tissue biopsy in a clinic setting, which turned out to be a both diagnostic and therapeutic procedure with complete resolution of symptoms.

Extended endoscopic frontal nasal sinus surgery in management of chronic and recurrent frontal sinus diseases

BackgroundThe anatomical variation of the frontal sinus and its intimate relation to the skull base and orbit makes its surgery demanding. The extended endoscopic frontal sinus surgery allows wide better drainage and preventing the recurrence of the disease. Fourteen patients underwent EEFSS from May 2017 to May 2019. These patients are nine patients presented by chronic recurrent frontal sinusitis, three patients presented by chronic recurrent fronto ethmoidal mucocele and two patients with chronic recurrent external frontal fistula. Draff III done for ten patients of them and Draff IIB done for four patients of them. This study is designed for evaluating the efficacy of the extended endoscopic frontal sinus surgery (E E F S S) in management of chronic and recurrent frontal sinus diseases.ResultsThe neo opening of the restored frontal sinus was remained opened with Draff III with high success rate; two patients from four patients with Draff IIb were with closed nasofrontal duct. The main follow-up was 12 months; the patients were followed up post-operatively for many office visits without any other manifestations.ConclusionThe chronic recurrent frontal sinus diseases can be treated successfully with extended endoscopic frontal sinus surgery (E E F S S). The extended endoscopic frontal sinus surgery (Draff III) provides good results with low morbidity and less post-operative care.

Delayed Presentation of Onodi Cell Mucocele with Optic Neuropathy: A Rare Case and Literature Review.

A mucocele of a paranasal sinus is a mucus filled cystic mass lined by epithelium filling the involved sinus whose ostium is obstructed. While frontoethmoidal mucoceles are common, Onodi cell mucoceles are less frequently seen. Due to its anatomic proximity to optic nerve, it can lead to devastating visual complications. A 29year old female presented with progressive loss of vision in right eye since 20days leading to complete loss of vision since 12days without any nasal complaints. Endoscopy showed fullness in right spheno-ethmoidal region. Computed Tomography scan revealed a mucocoele of the right Onodi air cell causing compression of intracanalicular part of right optic nerve. Despite urgent surgical decompression of mucocele, vision could not be restored. Poor visual acuity at presentation may be associated with bad prognosis. Hence, a high index of suspicion followed by appropriate imaging (CT scan and/or MRI nose and paranasal sinus) is crucial for early diagnosis in case of unexplained progressive diminution of vision, even in setting of no nasal complaints.

Mucopyocele: An Entity Infrequently Reported as a Complication of Functional Endoscopic Sinus Surgery.

Paranasal sinus mucocele or mucopyocele development after functional endoscopic sinus surgery is an infrequent phenomenon. The risk of mucocele development after endoscopic surgery for nasal polyposis or for chronic rhinosinusitis with nasal polyposis increases with greater preoperative Lund-Mackay score, with suboptimal post-operative management and with infrequent follow up post-surgery. We are reporting a case of bilateral fronto-ethmoidal mucocele developing secondary to FESS, its management and a brief literature review.

Boxing Match Gone Awry- A Punch over the Head Leading to Eccentric Proptosis in a Child

The most common ocular pathologic conditions in amateur boxing are sub conjunctival haemorrhage, lid injuries, cataract, pupil deformation, angle abnormalities and retinal tear. Proptosis due to frontoethmoidal mucocele in young is one of the least common complications seen in boxers. Here, we discuss a rare case of unilateral eccentric proptosis of right eye in a child after he was punched over the right side of the head during a boxing match. He came with complaints of swelling of upper eyelid. Examination revealed right sided eccentric proptosis with restricted ocular movements and defective vision. Computed Tomography (CT) of orbit showed a well-defined isodense lesion with smooth margins arising from the frontal sinus, extending inferiorly to anterior ethmoidal sinus which caused mass effect over right eye and ocular muscles which resulted in displacement of the eye ball. Otolaryngologist’s opinion was obtained. Functional Endoscopic Sinus Surgery (FESS) was done. Postoperatively vision improved with no proptosis and eyeball returned to its normal position.

Role of navigation system in functional endoscopic sinus surgery

<p class="abstract"><strong>Background:</strong> Functional endoscopic sinus surgery (FESS) is a challenging procedure for otorhinolaryngologists. Navigation can reassure the surgeon’s judgement and enhance surgical performance and prevent complication. The study done with aim of comparison between FESS with navigation and conventional FESS and explore other indication of navigation in endoscopic sinus surgery in difficult clinical scenario.</p><p class="abstract"><strong>Methods:</strong> This is a cross-sectional study on patients with sino-nasal disease. 100 patients in whom the ability to identify surgical site is assumed to be compromised by various conditions like previous surgery, massive/ recurrent polyposis, front oethmoidal mucocele, frontal, sphenoid sinus disease were included in the study. Patients were randomly allocated into two groups, group A (50 patients) FESS with navigation and group B (50 patients) conventional FESS. Pre-operative preparation time, intraoperative time, blood loss (Fromme–Boezzaart scoring), surgeon satisfaction, patient satisfaction (SNOT-20), complications were documented on a preformed, pretested proforma. Equipments used were –StealthStation S7 system, CD for recording intraoperative findings. </p><p class="abstract"><strong>Results:</strong> Preoperative preparation time duration was applicable for group A only. Intraoperative time was slightly and insignificantly higher in group A. Blood loss according to Fromme-Boezzaart scoring had lesser scoring values in group A and difference among gradings was statistically insignificant. Surgeons satisfaction and confidence was statistically significant higher in group A. The SNOT-20 score values were lower and insignificant in group A.</p><p class="abstract"><strong>Conclusions:</strong> FESS with navigation is more convenient to surgeon, appears to be safer tool.</p>

Fronto-ethmoidal Mucocele with Frontal Sinus Destruction

Fronto ethmoidal mucocele is a benign but expansive pseudo cyst due to mucous secreting nature of fronto-ethmoid sinus. A rare presentation of frontoethmoidal mucocele was reported. Our subject a 61 years old female presented with frontoethmoidal mucocele of unusually large size and two in number which developed over 2 years. Two masses one above left supra-orbital region and next on forehead was noted along with diplopia and non-axial proptosis in left eye due to swelling. Similar findings were found on CT scan and diagnosis was confirmed during surgery. Endoscopic marsupialisation of fronto-ethmoid pyocele with incision & drainage of isolated pyocele in the frontal bone was performed under general anaesthesia. A puncture wound in the posterior table of frontal sinus which might have resulted in CSF rhinorrhoea was dealt at the same setting. Keywords: Fronto-ethmoidal mucocele, diplopia, two mucocele, CSF rhinorrhoea

External Frontoethmoidectomy in the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Introduction: External Frontoethmoidectomy is an open surgical procedure employed to remove disease from the frontal and ethmoidal sinuses. Pathologies in the para nasal sinuses can be managed endoscopically, however, the limited availability of skilled man power in endoscopic sinus surgeries, and the dearth of its instruments in this region, remains a challenge in most tertiary health care centres in Nigeria, thus promoting the use of external approach to manage sinus diseases. Method: This was a retrospective study of 10 patients who had Frontoethmoidectomy over a 6 year period, from January 2012 to December 2017.Their medical records were retrieved from operating theatre, and Ear, Nose and Throat ward. Information retrieved included their age, gender, presenting complain, indication for surgery and length of hospital stay. Results were presented in tables and figures. Results: Among the 10 patients, there were 7 males and 3 females, 6 (60%) were aged 10-19 years. The indications for surgery was Fronto-ethmoidal mucocele in 3 patients and frontal mucocele in 2 patients, frontal sinusitis with intracerebral abscess in 1 patient, pan sinusitis with sinu-cutaneous fistula in 1 patient, potts puffy tumor in 1 patient, fronto-ethmoidal abscess, and fronto-ethmoidal osteoma in 1 patient each. Nasal obstruction was the commonest complain 7(70%), followed by frontal headache 4(40%).The average hospital stay among the patients was 6 days. Conclusion: External fronto-ethmoidectomy has remained the mainstay of treatment for frontal and ethmoidal sinus pathologies in this region, despite the advent of endoscopic sinus surgery. Early presentation for specialist otorhinolaryngological management can reduce morbidity and mortality.

Frontoethmoid Mucocele causing Unilateral Proptosis

Introduction
 Mucoceles occur most frequently in the frontal and ethmoidal sinuses, without gender prevalence. Presenting symptoms can include facial pain, headache, nasal obstruction, diplopia, decreased visual acuity, orbital globe displacement, facial swelling and meningitis, depending on the anatomic area involved. The gold standard in terms of diagnostic precision is computed tomography scan.
 Case Report
 The present study describes case of frontoethmoidal mucocele with orbital involvement that was treated by transnasal endoscopic approach obtaining good outcomes, demonstrating safety and efficacy of this surgical approach.
 Conclusion 
 Transnasal endoscopic management of mucoceles is preferred due to minimal trauma and less morbidity.

Fronto Ethmoidal Mucocele Associated with Type 4 Kuhn Cells.

A mucocele is an epithelial lined mucous containing sac completely filling the sinus and capable of expansion. We report a case with unilateral frontoethmoidal mucocele in relation with type IV Kuhn cell. A 26 year old man came to theENT department at SDUMC, Tamaka, Kolar, presenting complaints of proptosis of left eye since 3 years. After detailed examination and investigations patient was Diagnosed to have mucocele of left frontoethmoidal region. Intraoperatively we found a rare picture of type IV kuhn cells completely seated in the frontal sinus. After externally assisted modified Lothrop's approach, marsupialization of mucocele was donein the nasal cavityand symptoms of the patient relieved. We state that, in cases of frontoethmoidal mucocele, externally assisted modified Lothrop procedure offers an alternative for endoscopic management of frontoethmoidal mucocele for the complete clearance of disease.

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>

Extended applications of the endoscopic modified Lothrop procedure.

The endoscopic modified Lothrop procedure is mainly used for refractory frontal sinusitis. However, we have used it as an access procedure to facilitate treatment for an extended range of additional frontal sinus pathologies. A retrospective review of patients who underwent the endoscopic modified Lothrop procedure for 'alternative' frontal sinus pathologies was conducted. Patient data were reviewed. The main outcome parameter measured was signs of recurrence. Twelve patients (6 males, 6 females) from a 7-year study period, with a mean age of 45.2 years (range, 16-78 years), were analysed. The surgical indications included frontoethmoidal mucoceles, cerebrospinal fluid leaks within the frontal sinus, cystic fibrosis, frontal sinus osteoma, frontal sinus ossifying fibroma and frontal silent sinus syndrome. The mean follow-up period was 33.3 months. There were no known recurrences. We have used the endoscopic modified Lothrop procedure for a range of frontal sinus pathologies, safely and effectively, with no peri-operative complications.

Combined external and endonasal approach to fronto-ethmoidal mucocele involving the orbit

PurposeTo present a technique to improve the surgical treatment of frontal sinus mucocele and its recurrence. MethodsNine procedures performed on eight patients by a team of ENT and Ophthalmic orbital surgeons. Data collected included patient demographics, surgical details, pathological findings and complications. The surgical technique involved an external approach via the upper eyelid skin crease combined with an internal approach with a rigid 4 mm endoscope described below. Following evacuation of the mucocele the sinus was anastomosed to nasal cavity with insertion of silicon stent. All patients had preoperative and postoperative CT scans of the orbit and paranasal sinuses. ResultThere were nine operations on eight patients (six males, two female patients, mean age of 57.25: range, 15–71). Two patients had inverted papillomas. All patients presented with non-axial proptosis and diplopia. The mean follow up period was 38.7 months (range 11–99). The only intraoperative complication noted was a cerebrospinal fluid (CSF) leak in a patient with a post traumatic mucocele. Post-operative complications included lid scarring in 2 patients. One of the patients had a fistula overlying the affected sinus at presentation. Both patients underwent dermis fat grafting as a second stage procedure and responded well. One patient presented with asymptomatic superior oblique weakness that could be attributed to trauma to the superior oblique intra operatively. There was no case of recurrence of mucocele in our series. One of the inverted papillomas had an early recurrence (within 6 months) that required repeat surgery. ConclusionFronto nasal anastomosis restores the anatomy and reduces the chance of recurrence in our experience. The final cosmetic result is excellent and the patient's satisfaction is high.