Frontal sinus mucocele in association sage journals. If you or your child develops a soft swelling in the mouth, it may just be a mucocele a harmless cyst. The frontal sinus is the most common location for paranasal sinus mucoceles. Contemporary management of frontal sinus mucoceles springerlink. Paranasal sinus mucocele is a chronic, cystic lesion of the paranasal sinuses that results from obstruction of the draining ostia. Pdf frontal sinus mucoceles can present with a multitude of different symptoms including ophthalmic disturbances. Instead, they grow and slowly invade adjacent orbital tissues. Intradural infection following resection of posttraumatic mucocele in the frontal paranasal sinus. Endoscopic marsupialization of the mucocele is the surgery of choice, even though complicated cases maybe approached by an external route. Obliteration of frontal sinus after carefully removing complete sinus mucosa is an option if mucoceles are recurrent and are not completely marsupialized by the endoscopic approach. Frontoorbital mucocele with intracranial extension. In both cases, cheesy, claylike material was found intraoperatively within the frontal sinus, suggesting a fungus ball.
Late presentation of a mucocele of the frontal sinus. Frontal sinus mucocele with intracranial and intraorbital extension. There is erosion of both anterior and posterior walls of frontal sinus without or minimal intracranial extension. The following uniform classification system was devised to make evaluation and management of frontal sinus mucoceles easier 1. The posterior wall of the frontal sinus was destructed in 6 patients, with one patient additionally showing partial destruction of the anterior frontal sinus wall. Many authors consider lateral localization of frontal mucocele a contraindication to ess 3, 4, 11, 15, and endoscopic management of lateral frontal sinus lesions is rarely mentioned in the literature. There is erosion of both anterior and posterior walls of frontal sinus with a major intracranial extension. Contemporary management of frontal sinus mucoceles. Mucocele extension medially to a virtual sagittal plane tangential to the medial side of the ocular globe was also evaluated to determine the appropriateness and feasibility. Fat was used to obliterate the sinus completely on the right side.
Article information, pdf download for mucoceles of the frontal sinus. Several factors may influence the amount of mucus being produced and your frontal sinus ability to drain. Prolonged expansion of a mucocele can lead to complications such as pain and pressure, eyelid edema, frontal headaches, cranial nerve palsy, and facial deformity from bony remodeling. Ivory exostosis growing from the roof of the frontal sinus. The posterior sinus wall was thinned with scattered areas of bone erosion. We report the use of this novel technique in the management of a frontal sinus mucocele in a 47year old female. Osteomas and mucoceles of the frontal paranasal sinuses in. They are mucoid filled masses and develop after obstruction of the sinus ostium and drainage pattern, which is confirmed by the high incidence of mucoceles in the frontal sinus caused by the variations of the nasofrontal duct. Indeed, recurrence it is a typical complication of both endoscopic endonasal and transcranial approach or as a consequence of facial fracture. Inoffice balloon dilation and drainage of frontal sinus. The ethmoidal sinuses are the next most common 25%, whereas the maxillary and sphenoid sinuses are infrequently involved 2. Frontal sinus mucocele after osteoplastic flap surgery annals of. The anterior wall was nearly absent, and there was bulging of the mucocele into the superior orbit displacing the globe as seen on mr. A possible cause of pneumosinus dilatans richard a.
A mucocele is mucoid secretion trapped within an epithelial lined sinus that has a. Endoscopic sinus surgery for maxillary sinus mucoceles head. Combined external and endonasal approach to fronto. Thank you for your interest in spreading the word about the bmj. In this type the mucocele is limited to the frontal sinus only with or without orbital extension. Acute visual loss secondary to ruptured sinus mucoceles canadian. It develops when the opening of a paranasal sinus becomes obstructed because of trauma, infection, chronic sinusitis, polyps, malignancy, bony tumors, or congenital anomalies. Balloon dilatation of the sinus ostia is a minimally invasive technique that has been licensed for use in chronic sinusitis. A prompt ct orbits and head scan revealed a large left frontal sinus mucocoele that had eroded into the left orbit. True ducts of communication between the frontal sinus and frontal recess are more often absent than present. Endoscopic marsupialization of the mucocele was applied in all 18 patients, while frontal sinus exploration with the osteoplastic flap procedure was performed in one patient and the caldwellluc. Its natural to be a little worried when a new lump or bump forms on your body. The frontal sinus is particularly prone to developing mucoceles, and up to twothirds of all mucoceles occur there.
Frontal sinus mucopyocele facial plastic surgery jama. The modern endoscopic endonasal approach to the frontal sinus allows the marsupialization of the pathology in all those cases in. The main cause of acute frontal sinusitis is mucus buildup due to sinus inflammation. Four mucoceles extended into the orbit, one was confined to the frontal sinus and two eroded the posterior wall of the frontal sinus, invading the anterior cranial fossa. Frontal sinus mucoceles may have different sizes and configurations. Mucoceles of the paranasal sinuses are benign, chronic, expanding lesions that characteristically develop because of obstruction of the sinus ostium. Isolated fungus ball mimicking mucocele or frontal sinus. The communication then is directly through an ostium 11. Symptoms, which depend on the site of involvement and the direction and extent of expansion, include pain, facial swelling or. The frontal sinus was successfully cannulated, dilated and drained.
Frontal sinus mucocele after osteoplastic flap surgery. Sinus mucocele are normally located in the frontal, ethmoid and occasionally in the maxillary sinus cavities and can cause immense discomfort, pain, affect your breathing pattern, nasal obstructionand and in severe cases cause bone deterioration. To define the natural history, clinical signs, treatment and the modalities of medium and longterm followup of patients operated for sinus mucocele. We present a rare case of intracranial mucocele associated with frontal sinus osteoma in a patient suffering from generalized convulsion. Combined endoscopic endonasal and transcranial approach to. The diagnoses consisted of frontal sinus mucocele n 4, chronic frontal sinusitis n 1, potts puffy tumor after frontoethmoid fracture n 1, and recurrent inverting papilloma n 4.
Frontal sinus mucocele with intracranial and intraorbital. If left untreated, they can erode the thin sinus wall causing lifethreatening complications such as meningitis. Jul 22, 2017 fortunately this was accessible endoscopically, and the patient healed very nicely, and as can be seen in the video, both the frontal sinus and mucocele cavities were healed completely by 2 months. The frontal sinus floor which was forming the medial orbital roof was eroded and the wall of mucocele was abutting the eyeball figure 4. Giant mucocele of the frontal sinus is a rare pathology of benign entity caused by retention of mucous secretions in the sinus. Frontal sinus mucoceles causing proptosistwo case reports. It is most commonly the result of either facialhead trauma or previous sinus surgery that was done poorly or incorrectly. Isolated frontal sinus fungus ball is a rare cause of frontal sinus disease. The intracranial mucocele occurs as a complication of obstruction of sinus drainage caused by osteoma, but it is often diagnosed preoperatively as an intracranial or intracerebral cyst because of the rarity of these combined lesions in neurosurgical practice. Patients and method retrospective study of all patients operated for sinus mucocele between january 1993 and december 2009 n 68. Dec 20, 2012 however, not all frontal sinus mucocele are considered approachable through ess alone 3, 4. Ct shows a right frontal sinus mass with extension.
To describe a new and useful criterion to identify endoscopically approachable lateral frontal sinus mucoceles. The most common site for a mucocele is the frontal sinus. Expansion of the totally opacified right compartment of the frontal sinus showing rather high attenuation value contents. The left frontal sinus was also completely opacified. In another patient with a frontal sinus mucocele, a small piece of bone was found obstructing the nasofrontal duct at surgery. Pdf frontal sinus mucocele with intracranial and intraorbital.
Balloon sinuplasty for an acute frontal sinus mucocele. Patient with proptosis of his right eye and displacement of the globe inferiorly. An interesting bit of writing indicating this is the description by. Mucocele erodes the anterior wall of the frontal sinus. The first page of the pdf of this article appears above. Frontal sinus mucoceles are epitheliumlined mucuscontaining sacs that are capable of bony expansion causing a spectrum of ophthalmological symptoms. Ghaed1 idiopathic expansion of a paranasal sinus containing air and without an associated mass has been termed pneumosinus dilatans 1. Treatment of frontal sinus disease represents one of the most challenging aspects of endoscopic sinus surgery. The overall prognosis for frontal sinus mucoceles is good with likelihood of cure, and a low incidence of recurrence. Limited to the frontal sinus with or without orbital extension type 2.
Paranasal sinus mucocele radiology reference article. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. It usually occurs in a very specific area in the sinuses. Although, for control of recurrences longterm followup is recommended 3.
The mucocele was seen to be eroding the anterior table and the floor of the frontal sinus medially. Combined endoscopic endonasal and transcranial approach to a. Frontal sinus mucocele drainage may be an exception to the rule because in many instances, the expansion of the mucocele widens the frontal sinus recess and renders surgical drainage technically undemanding. Finger, md description orbital mucocele can occur when sinus mucoceles cannot naturally drain through the nose. Mucoceles in paranasal sinuses definition and etiology. The average interval between the primary insult to the frontal sinus and surgical confirmation of the frontal sinus mucocele was seven and onehalf years. Microscope was used to scrape out the mucosa completely from the frontal sinus. Mucoceles of the paranasal sinuses are benign, cystlike, expansile lesions lined with a secretory respiratory mucosa of pseudostratified columnar epithelium 1, 2. 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. The most frequent complaints recorded were frontal headaches, eye probl.
Generally arising from the ethmoid or frontal sinuses, orbital mucoceles are mucous or fluid filled cysts which can displace the eye. In the case reported we performed, as suggested by many authors, a transcranial approach that allowed a wide exposition of the frontal sinus, a safer removal of the mucocele and an easier obliteration of the sinus using both subcutaneous abdominal fat and pericranial flap in order to isolate the surgical cavity from the intracranial space and. Were there developmentally no ostium, there could be no cell. The frontal mucocele remains a disease difficult to treat even in the era of functional endoscopic sinus surgery fess.
The records of 56 patients presenting with mucoceles andor pyoceles have. Immediate ct scan was done which revealed a frontal sinus pyomucocele of size measuring 5. Frontal mucoceles have been classified into 5 types depending on its extent. Ivory exostosis, growing from the roof of the frontal sinus into the orbital and cranial cavities, removed through an osteoplastic opening in the cranium by mr. Sinus mucoceles treatment houston tx sinus mucoceles. Pdf frontalsinusmucoceleafterosteoplasticflapsurgery.
The authors describe a patient with frontal giant mucocele involving the orbit, the ethmoid, and intracranial portion of the. Frontal sinus mucocele in association with polyostotic fibrous dysplasia. Mucoceles of the frontoethmoidal sinuses radiology. The authors describe a patient with frontal giant mucocele involving the orbit, the ethmoid, and intracranial portion of the dura. A 73yearold man, with no medical history of note, presented with a 4week history of an isolated leftsided ptosis and associated periorbital and retroorbital discomfort. Frontal sinus mucopyocele presenting as a subcutaneous. Osteoma of the frontal sinus complicated by intracranial. In the paranasal sinus computerized tomography, a mucocele. We present a case of right maxillary mucocele without an identifiable cause, which is reported due to its rarity and delayed management. Frontal mucoceles occur due to accumulation of inspissated mucus and desquamated epithelium, whenever there is obstruction to the outflow of the frontal sinuses.
Frontoethmoid mucocele with or without orbital extension type 3. Cultures showed small amounts of mixed bacteria, and the contents of the mucocele were. His pupils were spared, his eye movements were not restricted and he was not proptosed. They are mucoid filled masses and develop after obstruction of the sinus ostium and drainage pattern, which is confirmed by the high incidence of mucoceles in the frontal sinus caused by the variations of the nasofrontal duct 6, 9. The pathologic features of mucocele are not really specific.
Weber et al 20 advocated that osteoplastic frontal sinus surgery with fat obliteration is very useful and successful in patients in whom frontal sinus cannot be. Endoscopic sinus surgery for maxillary sinus mucoceles. Although mucocele of the frontal sinus was not dealt with as a problem in therapeutics in authoritative medical literature earlier than the eighteenth century, this pathologic condition must have existed in ancient times. A mucocele of paranasal sinuses is a collection of mucus within an epithelial lined sinus whose outflow tract is permanently obstructed. Mucocele was meticulously separated from the periorbita and complete removal was ascertained. The lynch incision has been the standard external approach employed by surgeons to access frontal mucocele. We would like to alert the clinicians to this diagnosis that can be easily misdiagnosed. Endoscopic treatment of frontal sinus mucoceles with. Endoscopic treatment of frontal sinus mucoceles with lateral. Here the mucocele is found involving the frontal and ethmoidal sinuses with or without orbital extension.
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