Frontal Sinus Mucocele Research Articles

巨大前頭洞嚢胞症例に対し経頭蓋法にて手術を施行した経験

副鼻腔嚢胞は,術後性嚢胞を含めると上顎洞嚢胞が最も多く,ついで前頭洞,筋骨洞の順であるといわれる.とくに前頭洞嚢胞は約半数の症例において副鼻腔手術の既往がなく,眼部症状を初発症状とし,鼻症状を欠くため,眼科を受診することが多い.最近,われわれは,眼球突出,複視を主訴とした巨大前頭洞嚢胞を経験したので報告する.症例は69歳,男性.徐々に進行する右の眼球突出と瞼裂低位がみられ,複視,流涙を来すようになり,近医眼科を受診した.術前MRIにて右前頭葉を圧排,右簾骨洞,眼窩に進展した巨大前頭洞嚢胞が確認され,手術目的にて当科紹介となった.手術は両側前頭開頭にて嚢胞切除を行ったが,前頭葉硬膜と嚢胞壁の剥離が困難であり,一部硬膜損傷を来した.嚢胞切除後は一部残存する菲薄化した前頭洞後壁を除去,前頭蓋底と副鼻腔を遮断すべく,頭蓋骨膜弁を挙上,再建を行った.術後,一時的に前頭葉徴候がみられたが,術前に見られた眼症状は消失し,整容的にも満足する結果が得られた.

開頭術を要した側方伸展型の前頭洞嚢胞例

A 30-year-old male complained of nasal obstruction and left upper eyelid swelling. CT scan and MRI revealed a huge mucocele of the left frontal sinus extending into the left orbit and lateral to the left anterior cranial fossa. Severe paranasal sinusitis was also present. Under general anesthesia, a huge mucocele and severe paranasal sinusitis were operated on by craniosurgery through a coronal incision and by endoscopic endonasal sinus surgery respectively. All the paranasal sinuses were packed with polyps, and bone destruction was evident in the left frontal bone and upper wall of the left orbit. The mucocele was removed easily from the dura mata. Dead spaces were packed with fascia and fatty tissue from the femur and with temporal muscle. The patient recovered uneventful by and continues to be well at present.

Isolated Third-Nerve Palsy Associated with Frontal Sinus Mucocele

Isolated third-nerve palsies are seen most commonly with aneurysms, vascular disease, trauma, or neoplasms (1-5). Sinus mucoceles have been known to cause orbital symptoms including proptosis and cranial nerve palsies. Rarely, an oculomotor nerve abnormality may be seen in the setting of mucoceles of the paranasal sinuses. We describe an unusual case of an isolated pupil-sparing third-nerve palsy as the presenting sign of a frontal sinus mucocele. Emphasis is placed on the discussion of sinus mucoceles and their relation to orbital symptoms.

Meningioma of the Frontal Sinus

Meningioma of the frontal sinus is a rare entity. Only nine cases of primary frontal sinus meningioma are reported in the literature. Two cases of frontal sinus meningioma, one primary and one secondary, are herein described. Each patient presented with headache and a frontal mass. Neither patient had fever or signs of meningeal irritation. Computerized tomography (CT) of the paranasal sinuses demonstrated frontal sinus opacification, posterior table bone erosion, and inferolateral displacement of the orbital contents in both patients. One patient underwent preoperative magnetic resonance imaging (MRI) that was officially interpreted as a frontal sinus mucocele and a small epidural abscess. Patients underwent unsuccessful endoscopic decompression for presumed mucoceles. Subsequent MRI in the second patient showed a large intracranial mass with extension into the frontal sinus. Treatment included frontal sinus obliteration and frontal craniotomy for removal of tumor, respectively. Meningioma was confirmed histologically in each patient. Although meningioma of the frontal sinus is rare, thorough evaluation, including MRI, should be considered for frontal sinus opacification in association with posterior table bone erosion.

40th Annual Scientific Meeting of the American Rhinologic Society, September 17, 1994, San Diego, Calif

Seven patients, who underwent<b>transfrontal augmentation of the endoscopic surgical approach to the sinuses</b>, were described by<b>Stanley E. Thawley, MD, and Alan E. Deddens, MD</b>, St Louis, Mo. The transfrontal component of this procedure uses a standard frontal trephine opening, which is enlarged to accept endoscopes and instruments laterally and superiorly. The results from this preliminary report are encouraging. Patients with chronic frontal sinus disease, pyocele, mucocele, and acute sinusitis have been treated with the<b>(Neel-Lake) modification of the Lynch procedure</b>for 25 years at the Mayo Clinic, Rochester, Minn. Using the intranasal as well as the external approach,<b>Finn R. Amble, MD</b>, and coauthors have used this procedure for 36 patients, all of whom are asymptomatic at 55 months' mean follow-up (22% required revision surgery). Thin silicone rubber (Silastic) sheeting was rolled to stent the nasofrontal orifice routinely. <b>Steven F. Isenberg, MD</b>, Indianapolis, Ind, described the removal of

Endoscopic Surgery for Frontal and Ethmoid Sinus Mucoceles

Seven patients with frontal and ethmoid mucoceles treated by endoscopic sinus surgery were reviewed. Five cases were successfully managed, with two requiring a trephine procedure in combination with the intranasal endoscopic approach. Follow-up ranged from 3 to 33 months with a mean of 17.8 months. The use of endoscopic instruments through a trephine incision is recommended in difficult cases to assure patency of the frontal sinus recess. When a large frontal sinus mucocele extends into the anterior ethmoid, the endoscopic approach becomes ideal. Sinus mucoceles can be handled safely and successfully by endoscopic surgery and may eliminate the need for more traditional external procedures.

A case report of a frontal sinus mucocele treated with a long term insertion of a silicone rubber tube

A case report of a frontal sinus mucocele treated with a long term insertion of a silicone rubber tube

Massive and Multiple Posttraumatic Nasal and Frontal Sinus Mucoceles

Canalis et al. in 19781 defined the term mucocele as “a chronic, expansile, cyst-like lesion of the paranasal sinuses which contains sterile, mucoid secretions and is limited by the mucosa of the affected cavity.” The lesions are lined by pseudostratified low columnar epithelium containing goblet cells. Typically they expand slowly and concentrically and may take many years before they become symptomatic. As they expand, bony erosion occurs, and they can extend outside of their sinus of origin. The location and extent of bony erosion thus determines the clinical findings associated with the mucocele.

Craniofacial Resection for Intracranial Inverting Papilloma and Frontal Sinus Mucocele

Inverting papilloma is a locally aggressive neoplasm; however, intracranial extension is very rare. The authors herein report a case of massive inverting papilloma with intracranial extension and an associated frontal sinus mucocele, causing marked frontal lobe compression. Treatment consisted of combined anterior craniofacial resection. Magnetic resonance imaging provided accurate preoperative differentiation between neoplasm and inflammation. Skull base reconstruction may prove more difficult when there is significant frontal dead space resulting from chronic brain displacement by an associated mucocele. The management of this unusual neoplasm and a review of the literature is presented.

The Pressure Exerted by Mucoceles in the Frontal Sinus: An Experimental Study in the Cat

The pathophysiologic process that results in bone erosion from frontal sinus mucoceles has long been a mystery. Traditionally, bone erosion has been attributed to pressure. However, no scientific evidence has yet been presented to support this hypothesis. To answer this question, seven cats had a mucocele created in one frontal sinus, with the other sinus left as a control. A manometer was inserted into each frontal sinus. Pressure readings were taken over a 7-month period. Pressures on the mucocele side were higher than on the control side and were sufficient to erode bone. Bone was thicker on the mucocele side than on the control side. This study established that mucoceles exert sufficient pressure to erode bone, and that such erosion may be part of a two-stage process.

Endoscopic Sinus Surgery for Mucoceles: A Viable Alternative

At the recent southern sectional meeting of the Triological Society in Naples, Fla, Dr Jordan Josephson and colleagues, Baltimore, Md, presented data indicating the safe and effective application of functional endoscopic sinus surgery in 18 patients with mucoceles of the frontal (11), ethmoid (5), and sphenoid (2) sinuses. Sixteen patients underwent successful endoscopic drainage and marsupialization of the mucocele. Two patients with extensive frontal sinus mucoceles required an additional external surgical procedure. No major intraoperative or postoperative complications were reported. Even though 6 of 18 patients have been followed up for less than 1 year, the authors present a rational and safe approach for the treatment of mucoceles by marsupialization of the mucocele and preservation of the osteomeatal bony framework. Long-term follow up is needed to assess the efficacy of this procedure as it applies to the treatment of sinus mucopyoceles, but preliminary data are encouraging.—

New Operative Approach to the Frontal Base

Lesions in the frontal base have been conventionally approached extra- and intradurally through a bilateral frontal craniotomy. However, when the lesion is large or deeply situated, wider retraction of the bilateral frontal lobes is required to obtain a sufficient operative field. The authors describe a new operative approach to dumbbell-shaped tumors in the frontal base, consisting of en bloc osteotomy of the bilateral orbital roofs and frontal sinus. This procedure, which is a modification of the transbasal approach described by Derome, is termed the "extensive transbasal approach." Successful applications of this procedure in three patients with frontal base tumors, two with frontal base fractures, one with a frontal arteriovenous malformation, and one with a frontal sinus mucocele are described. Also, the advantages of this approach over other, conventional operative approaches are discussed.

前頭葉を圧排していた巨大なる前頭洞嚢腫

A case of frontal sinus mucocele is reported. A 72-year-old man, complained of swelling of the upper eyelid. Examination revealed the presence of a cyst in the frontal sinus. The frontal sinus was opened by Killian's method and the frontal sinus mucocele was removed. The wall of frontal sinus was partially destroyed and the dural surface was widely exposed. Two days after the operation, computed tomography showed evidence of space occupying lesions severely pressing the frontal lobe. However, the patient did not complain of psychiatric symptoms and there was no presence of suspected meningitis. This means that the mucocele grew very slowly. The patient completely recovered and there has been no trouble after the operation.

Indications for and Avoidance of Complications in Endoscopic Sinus Surgery

At the Spring Meeting of the American Rhinologic Society in Palm Beach, Fla, Vijay Anand, MD, New York, reviewed his indications and methods for avoidance of complications in endoscopic sinus surgery. His four indications are ethmoiditis, fungal sinusitis, recurrent sinusitis, and biopsy of tumor. Contrasted with this, he recommends not using the procedure for recurrent pansinusitis, tumor resections, and frontal sinus mucocele. To avoid complications, Dr Anand advocates a good preoperative evaluation with a careful diagnostic endoscopic examination. The preoperative planning includes a coronal computed tomographic scan that is reviewed with the radiologist. Special areas of concentration during surgery include local anesthesia and hemostasis. A knowledge of anatomy is absolutely essential. Immediately after the operation, vision and eye movements need to be evaluated. An ophthalmologic consultation is recommended for any eye dysfunction identified. Likewise, if a cerebrospinal fluid leak is suspected, neurosurgical consultation is essential.

Frontal Sinus Mucopyocele in Cystic Fibrosis

This report summarizes the treatment of two patients with cystic fibrosis and frontal sinus mucopyocele. The first patient, an 18-year-old boy, had a 1-year history of a proptosis of the left eye. The second patient, a 28-year-old woman, had a 3-month history of intermittent diplopia. In both cases, the frontal sinus mucocele was diagnosed by computed tomographic scans; both were successfully treated with an osteoplastic flap and fat obliteration of the frontal sinus. When a patient with cystic fibrosis presents with a history of unilateral proptosis, diplopia, or frontal headaches, a paranasal sinus mucocele should be suspected.

The Iron Rim Sign

A chronic cystic cerebral hematoma occurred in the frontal lobe and mimicked both clinically and radiographically a frontal sinus mucocele. A rim seen on multidirectional tomography and unenhanced computed tomography was presumed to be composed to calcium. However, electron microscopic analysis revealed the rim to be composed almost entirely of iron from hemosiderin breakdown products. This is the first such report of an "iron rim" that we could find in the literature.

Mucoceles of the frontal sinus: causes and treatment.

The records of 56 patients presenting with mucoceles and/or pyoceles have been reviewed. The most frequent complaints recorded were frontal headaches, eye problems, postnasal discharge, frontal sinus tenderness, and fluctuant swellings of the forehead. Roent-genographic studies demonstrated a high incidence of orbital roof erosion and anterior frontal sinus table erosion. Posterior frontal sinus table erosion and osteomyelitis were also demonstrated. In about half of the cases there was x-ray evidence of clouding of the frontal sinus. In one third of the patients a soft tissue mass could be demonstrated in the frontal sinus. Osteomas were reported in the frontal sinus in four cases. Surgery employed included the Macbeth osteoplastic procedure, the Goodale osteoplastic operation, the Lynch-Howarth operation, the radical frontal sinuseetomy with sinus collapse, and a local incision of a small mucocele. Analysis of the results indicates that the collapse operation had the greatest success, with only one recorded failure. Surgical revision of nine failures successfully eradicated the disease. The most frequent predisposing factors to mucocele formation were previous frontal sinus infection, previous surgery involving the frontal sinus including neurosurgical procedures that violated the sinus, external trauma to the sinus, long standing nasal allergy, and osteomas in the nasofrontal area of the sinus. The average interval between the primary insult to the frontal sinus and surgical confirmation of the frontal sinus mucocele was seven and one-half years. Such a lapse of time makes the establishment of the cause of mucocele formation in the frontal sinus difficult and short term evaluation of the surgery for their eradication uncertain. It would appear that the ultimate relief of the condition will lie in the hands of the surgeon.

Review of skull base surgery in a Nigerian teaching hospital

There is dearth of information on skull base surgery in Nigerians. This study was conducted to determine types of skull base lesions describe surgical approaches to the lesions and determine outcome of surgical management of the lesions over the study period. We retrospectively reviewed the case notes of the patients who underwent skull base neurosurgical procedures between January 2001 and June 2007 in our centre. We obtained information on demography, clinical presentation, diagnosis, cranial computerised tomography findings, type of surgery, intraoperative findings and outcome of surgical management at the time of discharge from the hospital. Brain tumours were diagnosed in 28 patients, head injuries in 9 patients and one patient each had anterior encephalocele and frontal sinus mucocele. Eighteen patients had frontal craniotomy, three patients had temporal craniotomy and two patients had lateral rhinotomy in addition to bifrontal craniotomy. Two patients had frontoorbitotomy while retrosigmoid craniectomy was performed in one patient. Thirty three patients showed significant postoperative improvement at discharge. Brain tumour was the most common indication for skull base surgery in our centre. These tumours were mainly located in the anterior cranial fossa. Frontal craniotomy was the most common surgical approach. Non-availability of modern neurosurgical facilities confined us to the use of mainly traditional approaches. The availability of these facilities will assist in improving our management outcome in the future.

Adenocarcinoma of the prostate presenting as a frontal sinus mucocele.

The LaryngoscopeVolume 79, Issue 3 p. 458-469 Article Adenocarcinoma of the prostate presenting as a frontal sinus mucocele† Richmond Jay Brownson M.D., Richmond Jay Brownson M.D. St. Louis, Mo.Search for more papers by this author Richmond Jay Brownson M.D., Richmond Jay Brownson M.D. St. Louis, Mo.Search for more papers by this author First published: March 1969 https://doi.org/10.1288/00005537-196903000-00012Citations: 4 † Supported in part by National Institute of Health Training Grant 5 T1 5190. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume79, Issue3March 1969Pages 458-469 RelatedInformation

Pathogenesis of mucocele of the frontal sinus. As a pneumatization anomaly of the sinuses

Pathogenesis of the mucocele was discussed on the basis of the author's pneumatization theory. The construction of the pneumatic cavities are considered to be divided into two parts, i.e. the canal and the antrum. The Euchstachian tube, the nasofrontal duct and the bronchus correspond to the canal part of the pneumatic cavity.From the study on the development of the bronchi and the alveoli, the author concluds that the canal part (bronchus) may become atrophic, if the antrum (alveoli) enlarges (emphysema), and on the other hand, the canal part may become hypertrophic and dilate (broncuiectasis), if the antrum becomes apneumatic.This mechanism can be applied to the relationship of the frontal sinus and its duct. Therefore, in the large frontal sinus the duct may become narrowed and then obliterated.However, roentgenological study of 12 cases of frontal sinus mucocele indicates that the mucocele of the frontal sinus does not occur only in the large frontal sinuses, but also in the moderate large sinuses, by which the over development of the anterior ethmoidal sinuses were confirmed. Over development of the anterior ethmoidal sinuses might cause the constriction of the nasofrontal duct The author emphasises that as one of the etiological factors of mucocele of the frontal sinus the over development of the frontal sinus and the ethmoidal sinus, namely the pueumatization anomaly of the paranasal sinuses, should be considered.