Sinus Mucocele Research Articles

Frontal Sinus Mucocele Development in an Adult Patient With Apert Syndrome

Frontal sinus mucoceles may present many years after traumatic injuries or surgical procedures involving the frontal bone, but have been rarely reported after fronto-orbital advancement. We describe a case of frontal sinus mucocele development in a 43-year-old patient with Apert syndrome who underwent fronto-orbital advancement as a child. This was treated with resection and free fibula osteomuscular flap reconstruction. Computer-aided design and manufacturing techniques were used to virtually plan the procedure and guide the osteotomies intraoperatively. Follow-up at 1 year postoperatively revealed no evidence of recurrence.

Przewlekłe zmiany zapalne zatok przynosowych penetrujące do oczodołu i przedniego dołu czaszki w materiale Kliniki Otolaryngologii PUM w latach 2010–2012

Among pathologies of sinuses penetrating to the orbit or anterior cranial fossa the most common changes are mucocele of fronto-ethmoid region and much rarely – polyps.The aim of the study is the overview of the symptoms, diagnosis and treatment of these lesions.7 patients (4 male and 3 female) in the age of 42–83 were treated for the changes penetrating to the orbit or anterior cranial fossa in the years 2010–2012. All the patients had exophthalmos, ocular movement limitation (n=4) and diplopia (n=4). Patients reported head and orbit pain (n=4), nasal obstruction (n=1) from the period of 4 month to 2 years. Three patients had previously sinus operations. The patients underwent CT of paranasal sinuses, and in two case also MRI. In 3 cases pathological changes penetrated to the orbit and anterior cranial fossa, in 4 – only to the orbit. In 6 cases the cause was paranasal sinus mucocele, in 1 – the polyps. Surgery was the method of treatment: external approach (n=6) or FESS (n=1). The frontal sinus obliteration was done in 4 cases. Wound healing was normal, obtained a good functional and cosmetic result. In one case, after the operation of the frontal sinus polyps, there was the development of mucocele.Surgical treatment is an effective procedure in cases of changes penetrating from sinuses to the orbit and cranial fossa.

Endoscopic Treatment of Frontal Sinus Mucoceles with Lateral Extension

To describe a new and useful criterion to identify endoscopically approachable lateral frontal sinus mucoceles. We retrospectively reviewed all patients diagnosed with frontal mucocele with lateral extension who underwent endoscopic sinus surgery (ESS) at the Department of Otorhinolaryngology, San Raffaele Scientific Institute over a 4year period, from January 2008 to March 2012. We analyzed patient charts, pre- and post-operative imaging, operative reports, postoperative periods, and follow-up records. Our series is composed of seven patients, four males and three females, with a mean age of 56years. Symptoms at presentation varied depending on the extent of mucocele growth and orbital and intracranial invasion. Mucocele extension medially to a virtual sagittal plane tangential to the medial side of the ocular globe was also evaluated with computed tomography, to determine the appropriateness and feasibility of an ESS procedure. After pre-operative investigations, patients underwent marsupialization of the mucocele with ESS. Postoperative follow-up ranged from 1 to 4years. At present, all patients remain free of disease, as documented by radiological imaging. In defining endoscopically approachable lesions, it is essential to determine their extension beyond a virtual sagittal plane tangential to the medial side of the ocular globe. The success of the endoscopic procedures described was undoubtedly linked to the localization of the mucocele medial wall. This criterion is more important than the size of the mucocele, and accurate computed tomography evaluation can identify those mucoceles approachable with ESS, even if laterally extended.

Mucous retention cyst of the maxillary sinus-minimally invasive treatment with use of piezosurgery. Case report

Paranasal sinus mucoceles are chronic, benign, mucous filled cystic lesions caused by obstruction of sinus ostia. Mucoceles are usually seen in the frontoethmoidal region. Maxillary sinus retention cysts are rare amongst paranasal sinus mucoceles. We present one such case of a 63-year-old woman, whose maxillary sinus mucocele revealed during radiological examination, was treated with the use of piezosurgery. In this article we also present the beneficial aspects of the ultrasound unit, that allows for precise removal of bone with minimal risk of injury to underlying soft tissues. It allows more successful and more complication-free surgical result for a less experienced surgeon that could be especially beneficial for preparation of the Schneider’s membrane. Furthermore, it gives minimal operative invasion as well as provides less bleeding intra- and postoperative.

Frontal Recess Mucocele Associated with Osteoma: Case Report

SUMMARY The paranasal sinus mucocele is an epithelized cystic lesion containing fluid and is characterized by non-neoplastic expansion of the paranasal sinus due to its capacity to erode the overlying bone. Etiology of these lesions is still under debate. In this report, we described a case of a patient with frontal recess mucocele, associated with contralateral frontal recess osteoma. A 55-year-old man was admitted to the Department of Otorhinolaryngology of our hospital with the complaints of a headache affecting the fronto-ethmoidal region, left-sided nasal obstruction, and postnasal discharge. Computed tomography (CT) scan of the paranasal sinuses showed a dense bony lesion in the left and a cystic hypodense mass in the right-sided frontal recess. The patient was treated surgically, with a combined endoscopicexternal approach, bilaterally. Histopathological examination showed that the wall of the cyst was mucocele, and the bony formation was osteoma. The frontal recess osteoma is regarded as the primary condition. Thus, better ventilation and drainage of the frontal sinus were reestablished.

Sphenoidal mucocele presenting as acute cranial nerve palsies

Sphenoidal sinus mucoceles are indolent lesions that, when sufficiently large, can compress on the optic canal or superior orbital fissure, rapidly causing loss of vision, optic neuropathy, ptosis, pain, ophthalmoplegia, and diplopia. We herein report a 72-year-old gentleman who presented acutely with Cranial Nerve II, III, and IV palsies secondary to a sphenoidal sinus mucocele that was confirmed on magnetic resonance imaging and successfully treated with endoscopic drainage. This cause of orbital apex syndrome is important for clinicians to know as early diagnosis and treatment is critical in recovering visual potential.

Endoscopic trans(naso)orbital management of supraorbital mucoceles with biliary T‐tube stenting

The objective of this article is to describe our surgical technique for accessing orbital and supraorbital ethmoid sinus mucoceles and the novel application of a biliary T-tube to stent and redirect mucociliary flow into the frontal recess. We describe in technical terms our surgical approach and the use of an 8-Fr pediatric biliary T-tube as a paranasal sinus stent with demonstrative case reports. Four patients have been successfully managed employing the endoscopic trans(naso)orbital approach to access and marsupialize supraorbital and superiorly located orbital mucoceles without egress to the frontal recess. Patency of drainage was maintained by utilizing a flexible, pediatric, biliary T-tube that is inserted via an above (trephination) and below (endoscopic) approach in three patients, and without the need for stenting in one patient (median follow-up, 14.5 months). The presented surgical strategy is safe and effective in accessing and maintaining long-term patency of problematic supraorbital and superiorly located intraorbital mucoceles without communication to the frontal recess.

Frontal sinus mucocele with orbital complications: Management by varied surgical approaches

A mucocele of a para-nasal sinus is an accumulation of mucoid secretion and desqua-mated epithelium within the sinus with distension of its walls and is regarded as a cyst like expansile and destructive lesion. 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. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid, and maxillary mucoceles are rare. Floor of frontal sinus is shared with the superior orbital wall which explains the early displacement of orbit in enlarging frontal mucoceles. Frontal sinus mucoceles are prone to recurrences if not managed adequately. Here, we are evaluating different approaches used to manage various stages of frontal mucoceles which presented to us with orbital complications. Three cases of frontal sinus mucocele are discussed which presented to our OPD with different clinical symptoms and all cases were managed by different surgical approaches according to their severity. We also concluded that it is prudent to collaborate with the neurosurgeons for adequate management of such complex mucoceles by a craniotomy approach.

Ectopic located tooth which obstrcuted the maxillary sinus ostium

A giant mucocele secondary to obstruction of the maxillary sinus ostium with an ectopic tooth. Mucocele secondary to ectopic maxillary tooth is very rare. We present a case of giant mucocele which is caused by obstruction of the maxillary sinus ostium with an ectopic tooth. The patient presented with headache and facial asymmetry. CT of the paranasal sinuses revealed an ectopic maxillary tooth, obstructing the maxillary sinus ostium and a mucocele of the maxillary sinus that erodes bony walls. The ectopic tooth was removed with Caldwel-Luc approach and the mucocele was marsupialized to the middle meatus with endoscopic sinus surgery. Ectopic maxillary tooth should be kept in mind as rare cause of paranasal sinus mucoceles.

Mucocèles de l’enfant : présentations cliniques et modalités thérapeutiques

Paranasal sinuses mucoceles are extremely rare in children and adolescents. The objective of this study was to assess their clinical presentations and the contribution of endoscopic surgery in their management. we retrospectively reviewed 11 children with paranasal sinus mucoceles who were managed during a period of 15 years (1995-2009). The mean age was 11.8 years with a sex ratio of 2.66. One patient had a history of nasal polyposis surgery. The symptomatology was dominated by ophthalmological complains. The ethmoïd sinus was the main localization. Orbital extension was found in eight cases, pyomucocele in one case. The surgical management was endoscopic (nine cases), and by an external approach (two cases). Two cases of recurrence were assessed. The mean follow-up was 22.3 months. Paranasal sinuses mucocele is exceptional in children. Cystic fibrosis is the main etiologic factor. The symptoms depend on the location and size of the mucocele. The treatment is surgical and most authors prefer the endoscopic approach.

Mucocele formation under pedicled nasoseptal flap

The pedicled nasoseptal flap has become an indispensible tool for the reconstruction of skull base defects. This flap is easily harvested, provides a large surface area of vascularized tissue, and has few reported complications. We describe the case of a 60-year-old man who underwent endoscopic, endonasal transsphenoidal surgery with septal flap reconstruction who developed a sphenoid sinus mucocele postoperatively. We also have reviewed the literature for similar findings and discuss this complication in the setting of pituitary surgery and endoscopic skull base repair. Although likely a rare occurrence, mucocele formation after septal flap reconstruction should be recognized and monitored with postoperative nasal endoscopy and radiologic imaging. Reoperation or mucocele drainage may be necessary if symptomatic or in cases of rapid enlargement.

Dev frontal piyomukosel

Giant mucoceles of the frontal sinus are rare but their recognition is important in the differential diagnosis of proptosis and fronto-orbital lesions. We describe a patient with frontal giant mucocele with intracranial as well as orbit and ethmoid sinus involvement. A 53-year-old male was admitted with headache, right exophthalmos and ophthalmoplegia. Computed tomography and magnetic resonance imaging demonstrated a giant frontal sinus mucocele with extension into the left anterior cranial fossa and orbit. The mucocele was treated with a transcranial and endoscopic transnasal approach.

Paranasal Sinus Mucocele

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. While ophthalmologic symptoms are most common, patients also report rhinological or neurological complaints. The close proximity of paranasal sinus mucoceles to the orbit and skull base predisposes the patient to significant morbidity. Computed tomography displays a non-enhancing homogenous mass with expansion of bony walls. Magnetic resonance imaging reveals variable intensity of T1-weighted images and a hyperintense mass on T2-weighted images. Histopathologically mucoceles have features of respiratory mucosa with areas of reactive bone formation, hemorrhage, fibrosis, and granulation tissue. Surgical excision is the standard treatment with trends towards endoscopic techniques.

Śluzowiak zatok sitowych penetrujący do oczodołu i przedniego dołu czaszki – opis przypadku

Paranasal sinus mucocele is the cystic formation lined by inflammatory changed mucoperiosteum. This is slow-growing pathology with a tendency to bone erosion. The symptoms are dependent on the direction of the penetration, and are as follows: increasing headaches, deformations of frontal or orbital region, ophthalmic manifestations such as lacrimation, decreased visual acuity, exophthalmos, ocular movement limitation, diplopia. The most common location of the mucocele is fronto-ethmoid region. The most useful diagnostic tests are a magnetic resonance imaging (MRI) and a computed tomography (CT) which show the progress of the disease and bone destructions. Surgery is the only method of treatment (external approach or FESS). This paper reports the case of a 74-year-old woman with ethmoid mucocele penetrating into the orbit, frontal sinus and anterior cranial fossa with compression of frontal lobe of the brain. The patient underwent CT and MRI and was treated with endoscopic intranasal marsupialization of the cyst. There are no clinical signs of disease recurrence 7 months after surgery. The endoscopic surgical management in treatment of sinus mucocele is a good alternative to the operation from external approach because of its low invasiveness, low complication risk, rapid healing and good therapeutic effects.

Erste Erfahrungen in der endonasalen Chirurgie mit einem neuen 3D-Chipendoskop

Endoscopic surgery for treatment of nasal, paranasal and anterior skull base pathologies is an established treatment modality. Available rigid endoscopes with angled views provide a 2-dimensional view with restriction of depth perception. In this study we report about our first experience with a new 3D-Chipendoscope in surgery at the nose, paranasal sinuses und anterior skull base. 30 patients were enrolled in this study with chronic rhinosinusitis, inverted papilloma, frontal sinus mucocele, frontal sinus osteoma, chronic dacryocystitis and pituitary adenoma. All patients were subjected to standard endonasal endoscopic surgery using 3D-endoscopes. Surgery was performed by the use of the 3D-endoscope in all patients. The operative handling of the 3D-endoscopes was user friendly in regard to design and weight of the endoscopes. The problem of fogging during endoscopic surgery diminishing the quality of view was not observed. Blood crusts on the endoscope tip however was able to changed the 3D-view to a 2D-view. To close positioning of the 3D-endoscopes to the surgical field reduced image quality. The visualisation of the frontal sinus was limited. 3D-endoscopic surgery is an interesting development in endonasal surgery of pathologies at the nose, paranasal sinuses and anterior skull base.

Paranasal sinus mucocele: endoscopic marsupialization and surgical outcome

AbstractWe report 10 cases of paranasal sinus mucoceles with/without orbital/intracranial extension who presented to the Otolaryngology Department at the University Kebangsaan Malaysia Medical Center (UKMMC). The clinical presentation, pathophysiology, and the endoscopic and combined endoscopic craniofacial approaches in mucocele removal are discussed. The authors recommend the endoscopic transnasal approach as the main surgical treatment for paranasal mucoceles and highlight its outcome.

Osteoplasty Flap Technique for Repair of Latent (30-Year) Post-Traumatic Frontal Sinus Mucocele: Case Report and Review of the Literature

Mucoceles are benign, slow-growing lesions defined as mucus-filled pseudocystic formations. Paranasal mucoceles predominantly affect the frontal sinus (60% to 65%), followed in frequency by the ethmoidal (20% to 30%), maxillary (10%), and sphenoid (2% to 3%) sinuses. Mucoceles usually arise because of sinus ostium obstruction, preceded by infection, fibrosis, inflammation, trauma, surgery or tumors such as osteomas. Mucoceles arising from the frontal sinus present with a variety of clinical signs, including decreased visual acuity, visual field abnormalities, proptosis, ptosis, periorbital swelling, displacement of the globe, restricted ocular movements, and choroidal folds. We describe a case of orbital involvement from a mucocele of the frontal sinus 30 years after the initial trauma, with a review of the published data concerning the etiology, diagnosis, and treatment planning.

Paralysie partielle du III isolée d’origine sinusienne chez un enfant : à propos d’un cas

We report a case of unilateral mydriasis associated with sphenoid sinusitis and mucocele in a child. An 11-year-old girl with a history of unilateral mydriasis was referred for ophthalmologic examination. She complained of a mild headache over the past four days. The right pupil was dilated and nonreactive to light. The left pupil was normal and reactive. There was no ptosis or other focal neurological deficit. She was orthotropic. Visual acuity in both eyes, ocular motility and fundi were normal. Magnetic resonance imaging (MRI) showed a sphenoid sinus mucocele with sphenoiditis. The diagnosis was partial third nerve palsy without ophthalmoplegia. Treatment with antibiotics was initiated and led to complete resolution of the mydriasis. Sphenoid sinus mucoceles are relatively rare. Failure to diagnose and treat can lead to serious neurologic sequellae such as third nerve palsy, compressive optic neuropathy, cavernous sinus thrombosis, meningitis or brain abscess. Head imaging by reconstructed CT and MRI can lead to the diagnosis of mucocele. Isolated unilateral mydriasis as a sign of third nerve palsy may be caused by a slowly enlarging lesion. In a child with isolated unilateral mydriasis, head MRI should be performed to rule out a compressive lesion of the oculomotor nerve.

Cystic fibrosis presenting as bilateral maxillary mucoceles in an infant

Abstract A six months old male presented to our Otolaryngology Department with a long -standing history of chronic nasal congestion and difficulty of breathing. The child was initially treated with nasal steroids without improvements. On follow up investigations, bilateral sinus mucoceles were seen on CT scan. The diagnosis of cystic fibrosis was confirmed by the chloride sweat test and the child was taken to the operating room for functional endoscopic sinus surgery and marsupialization of mucoceles. The child's brother was then investigated and diagnosed with CF.

Sinus mucocele: Natural history and long-term recurrence rate

To define the natural history, clinical signs, treatment and the modalities of medium- and long-term follow-up of patients operated for sinus mucocele. Retrospective study of all patients operated for sinus mucocele between January 1993 and December 2009 (n=68). Demographic data, symptoms, medical imaging findings, surgical treatment and results were recorded. The mean age of patients in this series was 53 years (range: 27-82 years, sex ratio: 3/2). The most common site was fronto-ethmoidal. Fifty-one patients (75%) had a history of sinus surgery, essentially for nasal polyposis. Only 15% of mucoceles occurred spontaneously. Presenting symptoms, in decreasing order of frequency, were facial pain or headache (38%), ocular or orbital complications (28%), while 20% of patients were asymptomatic. Surgery was performed by endonasal endoscopic sinus surgery (n=57, 84%) or via a combined, transfacial and endonasal approach, associated with navigation after January 2003. The mean follow-up was 7 years (range: 4 months-16 years). During this follow-up period, 23.5% of patients developed recurrence or a second mucocele after a mean interval of 4 years. This study demonstrates the high recurrence rate of mucocele, particularly in multi-operated patients with chronic sinusitis. Long-term, regular, clinical and radiological follow-up is necessary to detect asymptomatic lesions prior to the onset of complications.