Sinus Mucocele Research Articles

Sinus mucocele leads to unilateral proptosis in an infant patient with cystic fibrosis; a literature review and a case report study

Introduction and Importance: Cystic fibrosis (CF) is a widespread life-shortening recessive genetic disease and can present with sinus mucocele. Sinus mucocele is a rare condition, with limited prevalence data on unilateral proptosis. Case presentation: We present a case of a 19-month-old boy with CF who experienced worsening proptosis and exotropia in his right eye. A brain and orbit MRI revealed diffuse polypoid mucosal thickening, possible dense fungal deposit, deformity of the mid face, especially on the right side, with more prominent bulging of medical and inferior walls of the right lobe, a right ethmoidal mucocele causing ocular globe displacement, medial rectus compression, and optic nerve. An examination of the eye fundus showed disc edema and vascular congestion. Endoscopic sinus surgery successfully drained the mucocele, and treatment with antibiotics and corticosteroids led to symptom improvement and resolution of proptosis within three weeks. Clinical Discussion: Mucoceles represent an uncommon complication associated with CF in pediatric patients. Consequently, any child presenting with this issue should undergo evaluation for CF. Investigating this infrequent condition’s underlying mechanisms and consequences may improve treatment approaches and outcomes for those impacted. Conclusion: Sinus mucocele with unilateral proptosis in CF patients is uncommon, and endoscopic sinus surgery appears to be an effective cure for this complication, even in the pediatric population at high risk, like CF patients.

Sudden Blindness as the Only Symptom Caused by a Small Sphenoid Sinus Mucocele in a Young Child.

Background: Sphenoid sinus mucocele (SSM) represents a relatively rare disease among pediatric population as compared to adults, with a 1% to 3% incidence of all paranasal sinus mucoceles. Since the initial symptoms varied often, SSM caused blindness was scarcely seen. Case Presentation: Here we described an unusual case of small, isolated SSM causing acute visual loss in a 9-year-old girl. The patient first consulted an ophthalmologist for her right blindness. A diagnosis of SSM was suspected indicated by an orbital MRI scan. Thereafter the patient was referred to our department and an endoscopic sphenoidotomy and optic nerve decompression was performed. Surprisingly, her vision was relieved immediately after surgery, followed by dramatic improvement during the postoperative 20-month follow-up period. Conclusion: To our knowledge, a better understanding of SSM in pediatrics is essential for clinicians, including neurologists, ophthalmologists, and otolaryngologists to make early diagnoses and correct treatment by MRI and CT scan. Prompt surgical intervention of endoscopic transnasal sphenoidectomy is a quite safe, effective, and minimally invasive method for patients.

A CASE REPORT OF RECURRENT FRONTAL MUCOCOELE

Background: Paranasal sinus mucocele is the epithelium lined mucus filled sac causing enlargement of sinus wall. It can cause bone erosion and displacement of surrounding structures. Mucoceles usually occur due to infection, inflammation, trauma, previous surgeries, and tumours which can potentially obstruct the sinus ostium. Cranio facial trauma is the commonest cause for mucocele formation. Case report: A 50yr old male patient came with chief complaints of swelling on forehead since 1yr. The patient had history of road traffic accident 13yrs ago for which he underwent facio-maxillary reconstruction along with right eye evisceration. Later he developed a swelling above right eye after 7yrs, which was diagnosed as mucocele and was treated by frontal cranioplasty. Now he came with complaint of swelling on forehead which was gradually increasing in size. MRI-PNS was done showing fluid filled space extending anteriorly from cutaneous plane in the frontal region going posteriorly over the orbit pushing the contents of the orbit inferiorly and medially and extending posteriorly up to orbital apex. Patient underwent endoscopic mucocele drainage and DRAF 3. Right orbital exenteration was done to prevent recurrence. Patient was on follow up since then and no symptoms or signs of recurrence is noted. Conclusion: Facial trauma may be one of the reasons for development of mucocele where sinus drainage pathways are deranged. As in our case trauma not only led to development of mucocele, but new spaces also created by the treatment lead to extensive spread of the mucocele.

Recurrent Frontal Sinus Mucocle—A Novel Management Approach

A mucocele, or collection of mucoid secretion and desquamated epithelium within a paranasal sinus with distension of its walls, is considered a destructive lesion that resembles an expansile cyst. It can erode bone and therefore may extend in to the orbit or the cranium. The frontal sinus experiences the majority incidence, followed by the ethmoid sinus. This case of frontal sinus mucocele presented 8 years after an event of blunt trauma. The individual presented with a nonresolving right frontal head ache, proptosis of right eye and diplopia for the past 6 weeks. This case report emphasizes on the management of a large, chronic mucocele with prompt resolution of signs and symptoms.

Outcomes of Endoscopic Sinus Surgery in Treating Paranasal Sinus Mucoceles with Orbital Complications

Outcomes of Endoscopic Sinus Surgery in Treating Paranasal Sinus Mucoceles with Orbital Complications

Ethmoid Sinus Mucocele Penetrating the Anterior Skull Base: A Case Report

Sinus mucoceles are nonmalignant cystic tumors lined by non-neoplastic epithelium, typically involving the frontal and ethmoid sinuses. Although it is common for these mucoceles to cause destruction of surrounding bone tissue due to their growth, cerebrospinal fluid leaks resulting from skull base penetration by an ethmoid sinus mucocele have rarely been reported. A 24-year-old male patient presented with right proptosis and right periorbital pain, who underwent bilateral endoscopic sinus surgery 12 years ago. Endoscopic sinus surgery was performed to treat the right ethmoid sinus mucocele, and confirmed the presence of a basal skull defect during surgery. We reconstructed the skull base defect using septal cartialge and free mucosal graft. The symptoms were completely resolved after surgery and no cerebrospinal fluid leakage was noted during follow up period. This case report highlights a rare instance of direct mucocele extension to the skull base.

Posterior Ethmoid Sinus Mucocele Complicated With Oculomotor Nerve Dysfunction.

Posterior Ethmoid Sinus Mucocele Complicated With Oculomotor Nerve Dysfunction.

P.141 Endoscopic transorbital approach to the skull base: a single centre experience

Background: Minimally invasive endoscopic techniques via the transorbital approach (ETOA) have emerged as a promising alternative for addressing skull base tumours. This study aims to showcase our institution’s extensive experience with ETOA, detailing the surgical technique employed and presenting comprehensive patient outcomes. Methods: A retrospective analysis was conducted on data from patients who underwent ETOA within the past five years. Results: Over the study period, 24 ETOA procedures were performed on 21 patients, with an average age of 48.92, 13 of whom were women. The superior orbital corridor was utilized in 95.83% of cases, and in 79.17%, ETOA was complemented by a transnasal approach. Spheno-orbital meningioma accounted for the most common surgical indication (33.33%, n=8), all resulting in vision improvement, followed by lateral frontal sinus mucocele (25%, n=6). The median length of stay was one day, and ETOA achieved the procedure goal in 19 patients. Transient V1 numbness was the primary complication (29.17%, n=7), and 20.83% (n=5) necessitated another surgery. Notably, no mortality was associated with this procedure. Conclusions: Our institution’s experience underscores the notable safety and efficacy potential of ETOA, with 19 out of 21 patients exhibiting positive outcomes, obviating the need for revision surgery in most cases.

Frontal Sinus Mucocele Mimicking Sphenoorbital Tumor

Introduction: The paranasal sinus mucocele is a slow-growing mass that contains mucous. It can grow to vary in size, well-defined border, and fluctuating. Case description: A 51-year-old male with the chief complaint was a mass in his left eye 9 months before. The complaint began with a small swelling and it became bigger. He had no chronic flu-like syndrome previously. He admitted that he had no complaints with his vision or his hearing. The mass is as big as eight centimeters in diameter. The physical examination revealed that his left eye was protruded with left eye acuity was 6/6. He had paresis with an upward gaze in his left eye. At the palpation examination, it was soft, elastic, and fluctuative, well-defined border with bony in its surroundings, and no pain sensation. Discussion: In this case, the frontal sinus mucocele can make the eyeball protrude because of downward development. It does not impair visual function, because it does not disturb the optic nerve. The impairment was difficult to gaze upwardly. Conclusion: Given that the lesion came from the frontal sinus, it could grow outwardly and make the eyeball protrude. Histologically, mucocele had to spread inflammatory cells and macrophages, debris cells, and necrotic mass. Keywords: Frontal sinus; mucocele; sphenoorbital tumor; paranasal sinus.

Functional and Esthetic Outcomes of Either Surgically or Conservatively Treated Anterior Frontal Sinus Wall Fractures: A Long-Term Follow-Up

Study Design Retrospective cohort study. Objective Frontal sinus fractures (FSFs) can lead to a range of clinical challenges, including facial deformity, impaired facial sensation, cerebrospinal fluid (CSF) leakage, sinus drainage impairment, chronic sinus pain and mucocele formation. The optimal management approach, whether surgical or conservative, remains a topic of ongoing discussion. The aim of this study was to evaluate and compare the functional and esthetic outcomes of patients with surgically and conservatively treated FSFs. Methods In this retrospective study, patients treated for FSFs at the Karolinska university hospital 2004 to 2020 were identified in hospital records and invited to participate in a long-term follow-up. Sequelae and satisfaction with the esthetic result were assessed trough questionnaires and physical examinations. Results A total of 93 patients were included in the study, with 49 presenting isolated anterior wall fractures and 44 presenting combined anterior and posterior wall fractures. Surgical intervention was performed in 45 cases, while 48 were managed conservatively. Among patients with moderate anterior wall fractures (4-6 mm dislocation), 80% of surgically treated patients compared to 100% of conservatively treated patients expressed satisfaction with their cosmetic outcomes at follow-up ( P = .03). In conservatively treated patients with a forehead impression, the anterior wall fracture dislocation ranged from 5.3 to 6.0 mm ( P < .0001). Approximately 50% of surgically treated patients vs 15% of conservatively treated patients developed impaired forehead sensation at follow-up ( P = .03). Thirty-six percent of surgically treated patients reported dissatisfaction with surgery-related scarring, particularly those who underwent surgery via laceration or bicoronal incision. Conclusions This study suggests that anterior FSFs with a dislocation of 5 mm or less can be effectively managed conservatively with high patient satisfaction, low risk of long-term forehead sensation impairment and without potential development of forehead impression. Bicoronal incision or incision via a laceration may be associated with esthetic dissatisfaction and late sequelae such as alopecia.

Isolated Sphenoid Fungal Sinusitis With Mucocele Mistaken for Chordoma: A Study of Two Unique Cases

Isolated sphenoid fungal sinusitis (ISFS) is a rare condition characterized by fungal infection of the sphenoid sinus. It often presents with non-specific symptoms, which can lead to misdiagnosis. This study presents two unique cases of ISFS with mucocele that were initially misdiagnosed as chordoma based on preoperative radiographic findings. Two cases of ISFS were thoroughly investigated, including clinical examinations, radiological assessments, and surgical explorations. The patients’ symptoms, radiographic findings, surgical procedures, and postoperative outcomes were documented. In both cases, radiographic assessments raised suspicion of chordoma due to bony destruction and soft tissue lesions involving the sphenoid sinus and clivus. However, endoscopic sinus surgery revealed fungal balls and mucoceles, confirming the diagnosis of ISFS. Postoperative pathology confirmed the presence of aspergilloma. The patients recovered well with appropriate treatment. ISFS is challenging to diagnose due to its deep anatomical location and non-specific symptoms. Visual disturbances, particularly affecting the abducens nerve, are common. Sphenoid sinus mucocele, though rare, can be present. Surgical exploration plays a crucial role in establishing an accurate diagnosis and initiating appropriate treatment. ISFS can mimic other skull base lesions, such as chordoma, on preoperative radiography. These cases underscore the value of surgical exploration in reaching an accurate diagnosis and highlight the need for the cautious interpretation of radiological findings in sphenoid sinus lesions to ensure optimal patient care.

Endoscopic surgical management of the fronto-ethmoido-orbital mucopyocele: a case report and literature review

Abstract Frontal sinus mucocele are benign, pseudocystic lesions that derive from the destruction of the sinus ostium, resulting in a continuous accumulation of mucus. The process of mucocele growth leads to a progressive enlargement of the sinus cavity, thickening and erosion of its bone walls until the invasion of surrounding tissues. Mucoceles are more common in the frontal sinuses, while involvement in the sphenoid, ethmoid and maxillary sinus is rare. The frontal sinus floor is divided by the upper orbital wall; thus, an early displacement of the orbit occurs in the growth of the frontal mucocele. This paper presents one of our experiences in endoscopic surgical management of frontal sinus mucopyocele with secondary orbital complications.

Endoscopic endonasal transsphenoidal surgery for unusual sellar lesions: eight cases and review of the literature.

Preoperative imaging for some unusual lesions in the sellar region can pose challenges in establishing a definitive diagnosis, impacting treatment strategies. This study is a retrospective analysis of eight cases involving unusual sellar region lesions, all treated with endoscopic endonasal transsphenoidal surgery (EETS). We present the clinical, endocrine, and radiological characteristics, along with the outcomes of these cases. Among the eight cases, the lesions were identified as follows: Solitary fibrous tumor (SFT) in one case, Lymphocytic hypophysitis (LYH) in one case, Cavernous sinus hemangiomas (CSH) in one case, Ossifying fibroma (OF) in two cases; Sphenoid sinus mucocele (SSM) in one case, Pituitary abscess (PA) in two cases. All patients underwent successful EETS, and their diagnoses were confirmed through pathological examination. Postoperatively, all patients had uneventful recoveries without occurrences of diabetes insipidus or visual impairment. Our study retrospectively analyzed eight unusual lesions of the sellar region. Some lesions exhibit specific imaging characteristics and clinical details that can aid in preoperative diagnosis and inform treatment strategies for these unusual sellar diseases.

The Relationship Between Destruction Sites and Clinical Findings in Diffuse Paranasal Sinus Mucoceles.

This study aimed to investigate that complicated mucoceles of paranasal sinuses and their clinical presentation, complications of relations with size, destructions areas, extension limits in affected patients. A retrospective review was performed on patients who were diagnosed and treated as paranasal sinus mucoceles at ENT department from 2002 to 2013 years. Patients' demographic data, mucoceles location, symptoms, surgical approach and complications were evaluated. The study group included 9 male and 10 female patients with a mean age of 45,0 years (range, 12-76 years). This case series include fronto-ethmoidal complex (52,6%), followed by frontal (26,3%), maxillary (15,7%) and sphenoid sinus mucoceles (5,2%). Endoscopic sinus surgery (ESS) was performed on 11 patients (57.8%); endoscopic procedures included marsupialization through an infundibulotomy, associated with an anterior ethmoidectomy and maxillary sinus antrostomy. Four patients (21%) underwent an external surgical procedure. 8 patients (42%) were treated by a combination of both endoscopic and external approaches such as trephination of the anterior wall of the frontal sinus, osteoplastic flap approach, Caldwell-Luc operation, anterior craniotomy and Lynch procedure. Complications occurred only in 2 cases (10.5%). The majority of patients with extensive paranasal sinus mucoceles exhibited ophthalmologic and intracranial symptoms. A satisfactory outcome can be achieved after surgical treatment of both endoscopic and external approaches.

Prelacrimal Recess Approach in Unilateral Maxillary Sinus Lesions: What Is the Impact and Efficacy?

Background and Objectives: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients' quality of life is frequently overlooked, and surgical lines of treatment are numerous. The aim of the study was to assess the comparative efficacy of endoscopic middle meatal antrostomy with the endoscopic prelacrimal recess approach, combined with middle meatal antrostomy in the treatment of unilateral chronic maxillary sinus lesion. Materials and Methods: Thirty patients with unilateral chronic maxillary sinus lesions enrolled in the study at Alahsa hospital. Patients were divided into two groups: 15 treated through a middle meatal antrostomy and 15 treated via a combined middle meatal antrostomy and prelacrimal recess approach. Demographic and clinical information of the patients, including the medical history, CT scan findings, diagnosis, recurrence, and complications, were gathered and analyzed. Pre- and postoperative clinical findings were graded utilizing the Lund-Kennedy Endoscopic Scoring System. Results: The enrolled patients varied in age from 18 to 56, with 60% being male and 40% being female. Antrochoanal polyp, maxillary sinus mucocele, and unilateral allergic fungal sinusitis were among the pathological diagnoses. The follow-up period averaged 14.3 months. Following surgery, two patients in Group II encountered nasal discomfort, which included synechia and epiphora. The success rate for preserving a patient's disease-free condition was 86.7%. A statistically significant difference in disease-free incidence was observed among the patients in group II. In group I, recurrence was identified in 26.7% of the patients. The postoperative symptoms diminished considerably, and the VAS score was reduced substantially. In Group II patients, however, there was no significant difference in scarring. Clinically significant differences were observed in the mean total Lund-Kennedy Endoscopic scores when compared to their preoperative values. Conclusions: Achieving endoscopic access to the sinus's anterior, lateral, inferior, and inferomedial regions is facilitated by operating via the prelacrimal recess, which is the most advantageous approach. This approach facilitates rapid mucosal healing by maintaining the integrity of the nasolacrimal duct and mucosal covering. The specific pathology, surgical objectives, surgeon expertise, and equipment accessibility influence the choice of endoscopic surgical technique.

The Diagnostic Challenge of Distinguishing Temporal Lobe Encephaloceles from Sphenoid Sinus Mucoceles

Introduction: Temporal lobe encephaloceles are rare malformations defined as brain parenchyma herniation through a skull base structural defect into adjacent structure such as sphenoid sinus, while sphenoid sinus mucoceles are expansive cystic lesions caused by mucus buildup and thinning of the sinus wall, mostly involving the frontal and ethmoid sinus. Both illnesses may present similar clinical symptoms, such as neurological symptoms, nasal and ophthalmologic symptoms. However, misdiagnosis of temporal lobe encephaloceles can have significant clinical implications, as the best treatment plans vary depending on the disease. Case report: A 27-year-old healthy man who presented with seizure and loss of consciousness in public gave a history of head trauma 13 years back. Upon physical examination, the patient had normal cranial nerve function, and no cerebellar or meningitis signs. Rigid nasoendoscopy showed unremarkable findings. A computed tomography scan revealed an expanded left sphenoid sinus likely mucocele with a left temporal lobe encephalomalacia. Further investigations with brain magnetic resonance imaging (MRI) discovered temporal lobe encephalocele and transcranial repair of sphenoid encephalocele was arranged. Conclusion: Imaging results interpreted incorrectly may result in significant clinical ramifications. Distinguishing between both diseases with a complete investigation including MRI scan is crucial for appropriate management and treatment planning.

Frontal Sinus Mucopyocele Presenting as Purulent Discharge in the Frontal Region Following a Neglected Frontal Fracture: A Case Report and Literature Review

Mucoceles are progressive growths of encapsulated mucus capable of eroding and destroying adjacent bone structures and compressing neighboring organs. They are caused by the presence of mucous cells from the sinus membrane in an undrained space. These mucoceles can become infected, leading to the formation of a mucopyocele. They may manifest many years after the initial trauma to the facial bones, especially those involving the frontal sinuses. The discovery is either fortuitous or secondary to imaging: Computed tomography (CT), magnetic resonance imaging, carried out during an etiological assessment of symptoms such as frontal pain, proptosis, diplopia, nasal obstruction, rhinorrhea. Rarely, purulent discharge through a frontal cutaneous fistula may be the initial sign of a frontal sinus mucocele or mucopyocele. We report a case of mucopyocele of the frontal sinus presenting in the form of purulent discharge at the frontal level following a neglected frontal fracture and present our therapeutic approach.

A case report of a mucocele

Frontal sinus mucoceles can present with a multitude of symptoms including ophthalmic disturbances. In benign conditions, they tend to expand by eroding the surrounding bony walls that displace and destroy structures through pressure and bony resorption. It becomes inflamed and filled with pus (pyocele) or a combination of both (mucopyocele). Due to its expansile nature, mucocele is important for diagnosis. Frontal mucoceles are benign and curable. Early recognition and management are important, as they can cause local, orbital, or intracranial complications. The purpose of this paper is to report a case of mucocele and emphasize the importance of radiological imaging, especially CT-Scan and MRI, in supporting the diagnosis of frontal sinus mucocele, detecting invasive processes to surrounding tissues and their extension to the intraorbita/intracranial, planning before surgery/biopsy, and evaluating the results of therapy.

Management of paranasal sinus mucoceles (fronto-ethmoid mucocele)

Paranasal sinus mucoceles are quite rare and benign but expansile masses. Most commonly frontal and ethmoid sinuses are involved, maxillary and sphenoid sinues are involved in descending order of frequency. Early recognition and timely management of Paranasal sinus mucocele is very important as it can cause local, orbital and cranial complications which led to our prospective study. This was prospective study of five patients at tertiary care at BMC Sagar from May 2021 to April 2022, after our ethics committee approval. Proper history was taken. Otorhinolaryngological and ophthalmological examination was done. Computed tomography was preferred mode of imaging. All cases were managed surgically through endoscopically. Our study was compromised of five patients. Out of them two were females and three were mens. Mean age of patient was 54.2. In our study most common symptom was periorbital swelling and displacement of eyeball. Most common sign was proptosis. Most common sinus involved were frontoethmoid. Paranasal sinus mucoceles usually occur at 3rd to 7th decade of age group with almost equal sex ratio. Computed tomography is preferred mode of imaging. Endoscopic endonasal surgery is currently most commonly used surgical method for this. Paranasal sinus mucocele has good outcome if treated timely. Early recognition and management is very important as it can cause local, orbital and cranial complications.

Maxillary Sinus Mucocele With Fungal Ball.

Mucocele is a benign, expansile, and oppressive lesion, more common in the frontal and ethmoid sinus and less in the maxillary sinus. Sinus mucocele mainly causes cheek swelling pain and nasal obstruction. In some cases, the paranasal mucocele grows large enough to compress periorbital structures and lead to impaired vision. Generally, mucocele is full of simple mucus, but pathogens can be found if co-infected, which means a poor prognosis. Functional endoscopic sinus surgery is an effective treatment for this disease. Here, the authors report a case that a mucocele occurred in the maxillary sinus, and a fungal ball was also found during the operation, which is a result of Paecilomyces farinosus co-infection.