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A CT scan showed a 3.5 Â 2.5 cm sized ovoid mass on the right ethmoid sinus. The lateral wall of the mucocele was eroded; however, the medial wall was calcified. CT = computed tomography.
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Rationale:Mucocele is a disease lined primarily by epithelium, and occurs mainly when the sinus ostium is obstructed.Patient concerns:We report a case of a 37-year-old man who presented with painless proptosis of the right eye and diplopia.Diagnoses:The preoperative finding was mucocele of the ethmoid sinus.Interventions:We performed endoscopic sin...
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... 37-year-old man presented with painless proptosis of the right eye present over the previous 2 months. He had a history of nasal trauma 7 years earlier. The patient was aware that a mass was visible on previous computed tomography (CT) scan, but he was not treated appropriately as the lesion was asymptomatic. His vision was normal, but extraocular muscle movement in the right eye was more restricted in the horizontal plane than in the left eye, especially in the medial direction (Fig. 1A). On CT scan, a 3.5 Â 2.5 cm sized mass was visible in the right ethmoid sinus along the right orbit. The medial rectus muscle was compressed by a nasal cavity mass (Fig. 2). On magnetic resonance imaging (MRI), a 3.4 Â 2.6 Â 3.4 cm sized oval shaped mass in the ethmoid cavity showed a high signal intensity on T2-weighted images (WI) (Fig. 3A, B) and intermediate signal intensity on T1WI (Fig. 3C, D). The mass pushed the right lamina papyracea laterally, resulting in thinning of the right medial rectus muscle and medial orbital wall (Fig. 3). The patient underwent endoscopic sinus surgery. The operation started with uncinectomy, and the whitish bony shell of the mucocele was seen (Fig. 4A). After uncapping the anterior portion of the mucocele, yellowish thick mucus escaped from the mucocele cavity (Fig. 4B). We did not touch the epithelial lining of the medial orbital wall, which showed a Stankiewicz positive sign, which differed when the eye was pressed and not pressed (Fig. 4C, D). During 1-year follow-up, he has shown improvement of proptosis and eye movement compared with his initial presentation (Fig. ...
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... Mucoceles dos seios paranasais são formações císticas benignas com acúmulo de conteúdo mucoso que normalmente decorrem de uma obstrução do óstio do seio nasal acometido (Capra, 2012;Thompson, 2012). O seio nasal mais acometido é o frontal, com cerca de 60% dos casos de mucocele, em seguida temos o etmoidal, sendo sua forma etmoidal anterior mais frequente do que a localizada mais posteriormente (Kim, 2017;Liu et al., 2015). ...
Mucoceles são formações císticas que podem ocorrer em variadas topografias na cavidade nasal, principalmente e na região do seio frontal e das células etmoidais, levando a uma clínica decorrente de seu efeito compressivo local e apresenta a cirurgia como a principal forma de manejo terapêutico. O objetivo deste relato de caso é descrever o quadro clínico de um jovem do sexo masculino com uma mucocele em região de células etmoidais posteriores que abriu sua clínica de sintomas simulando os achados de uma neurite óptica, levando a apresentar uma clínica de perda visual do lado direito. Após seu tratamento inicial com corticoide não apresentar resultados clínicos, o exame de imagem foi capaz de identificar a descrição radiológica clássica de uma mucocele, transformando o diagnóstico e tratamento do paciente. Como conclusão, sugere-se que o caso apresentado seja uma referência no processo de construção de hipóteses diagnósticas dentro de um pensamento em neurite óptica, levantando sempre a necessidade de pensar em mucocele, e reiteramos que o tratamento cirúrgico é o de escolha no manejo desses pacientes.
... The most common symptoms of patients with frontoethmoid sinus mucoceles are headache, swelling or facial asymmetry and ophthalmic symptoms, such as visual disturbance, proptosis and diplopia (13). In the case of local complication, frontoethmoid mucoceles are often associated with a palpable mass in the superonasal and medial canthal region (14). ...
... As most cases of symptomatic mucocele have erosion of the bony sinus wall, the obliteration of the sinus should not be considered (9). Kim et al. note that minimally invasive surgery to remove ethmoid mucoceles with orbital complications is relatively straightforward and avoids the complications associated with these lesions (13). In cases where intranasal treatment presents difficulties, it is possible to use an external route or a combined approach with external treatment under endoscopic control (5). ...
Paranasal sinus mucoceles are benign cystic masses filled with mucous content. Mucoceles are locally destructive, causing pressure on sinus walls with their resorption, allowing them to spread on adjacent structures causing local, orbital or intracranial complications. They are most commonly found in frontal sinuses.
The aim of this report is to present case of oculo-orbital complications of frontal sinus mucocele, with focus on treatment using combined surgical approach.
A 75-year old female patient with frontal sinus mucocele which led to destruction of orbital roof and occurrence of complications in form of orbital cellulitis and palpebral abscess was successfully treated with a combination of external frontoethmoidectomy and endoscopic sinus surgery. After initial incision of the upper eyelid abscess with drainage of purulent content, modified external frontoethmoidectomy was performed using preformed defect of orbital roof. Finally, using endoscopic sinus surgery, natural drainage of anterior group of paranasal sinuses was achieved.
Various endoscopic and open approaches have been described in mucocele treatment. In this case we showed that the combined surgical approach in the treatment of frontal sinus mucoceles with destruction of sinus floor and appearance of oculo-orbital complications, provides an effective treatment and allows natural drainage of anterior group of sinuses.
... [3] Mukoselin içindeki mukusun enfekte olması sonucu (mukopiyosel) etraf dokularda süpüratif komplikasyonlara da neden olabilmektedir. Klasik sinüzit semptomları olan baş ağrısı ve yüz ağrısı semptomlarının yanı sıra mukoselde proptozis, gözde yer değişikliği, görmede azalma, diplopi gibi orbital komplikasyonlar [4,6,8,10,11] ve beyin apsesi, epidural apse, subdural apse, menenjit gibi kraniyal komplikasyonlar görülebilmektedir. [5,12] Ayrıca çok büyük boyutlara ulaştığında yüzde şekil bozukluğu yaratarak kozmetik sorunlara yol açabilmektedir. ...
... İyatrojenik durumlar inverted papillom, nazal polip ve kronik sinüzit nedeniyle yapılan endoskopik sinüs cerrahileri sonrası meydana gelmektedir. [2][3][4][5][6][7][10][11][12] Verillaud ve ark. [15] inverted papillom nedeniyle ameliyat ettikleri 27 hastanın 10'unda (%37) iyatrojenik olarak frontal mukosel geliştiğini saptamışlardır. ...
... T2 ağırlıklı serilerde hiperintens ve T1 ağrılıklı serilerde izo/hipo-intens görünüm 132 KBB Uygulamaları mukosel için tipiktir. [1,2,4] Bilgisayarlı tomografi ve MRG ile radyolojik inceleme sonucu hem mukoselin tanısı konulabilmekte; hem orbita, frontal sinüs arka duvarı ve kafa tabanı gibi önemli yapıların duvarında erozyon olup olmadığı saptanabilmekte; hem de menenjit, orbital apse, kraniyal apse gibi süpüratif komplikasyonların gelişip gelişmediği öğrenilebilmektedir. [1,7] Paranazal sinüs mukosellerin tedavisinde marsupiyalizasyon yapılabildiği [10,24,25] gibi kisti enf lame mukoza ile birlikte çıkaran yaklaşımlar da mevcuttur. [4,12] Endoskopik marsupiyalizasyon daha çok KBB hekimlerince yapılmaktayken kist eksizyonu daha çok frontal sinüs mukosellerinde açık cerrahi yaklaşımla beyin cerrahları tarafından gerçekleştirilmektedir. [4,10,12,24,25] Ayrıca KBB hekimleri ulaşılması zor veya lateral yerleşimli frontal sinüs mukosellerinde, dev mukosellerde ve revizyon olgularda endoskopik ve açık cerrahi yaklaşımın birarada kullanıldığı kombine yaklaşımı kullanmaktadır. ...
... (3) Pat ie nt s u s u a l l y pr e s e nt non -s p e c i f ic symptomatology, however, extensive mucoceles may exhibit nasal obstruction, facial asymmetry, visual alterations (4,5) and even diplopia, depending on the paranasal sinus comprised. (6) In some cases, it may invade the skull base and orbit (7) and, in rare cases, enlarged mucoceles can lead to bone destruction, (5) such as erosion or thickening, through compression of sinus surrounding bone wall. ...
Mucoceles are locally-expansive, slow-growing benign lesions that are generated from obstructed seromucous glands in the sinonasal mucosa. It has a cystic aspect and leads to sinus opacification. Patients usually present non-specific opacification and, in rare cases, enlarged mucoceles can lead to bone destruction through the compression of sinus surrounding bone walls. This report shows the case of a female patient without any clinical complaints who presented an evident opacification in her left maxillary sinus eroding the sinus wall, which was noticeable by means of panoramic radiograph, aside from maxillary sinus wall thinning and destruction, demonstrated through cone beam computed tomography examinations. The main diagnosis hypothesis was mucocele, as confirmed by the patient’s otolaryngologist. As the presence of any inflammatory disease in the maxillary sinus contraindicates sinus augmentation, the patient was referred to otorhinolaryngy treatment before implant rehabilitation. DESCRIPTORS | Maxillary Sinus; Mucocele; Cone-beam Computed Tomography; Paranasal Sinus Disease.
Pneumosinus dilatans (PD) is a rare disorder of unknown etiology which consists of an abnormal dilatation of one or more paranasal air sinuses without radiological evidence of localized mucous membrane alterations, hyperostosis, or bony erosion. Sinus walls are therefore of normal thickness. The enlargement of the bone may be generalized or focal, and apart from the aesthetic problem it carries, it is important to bear in mind the possible functional consequences it may imply. Although PD is usually a benign asymptomatic condition, some patients may develop progressive neurological signs and symptoms caused by the expanded sinuses. We herein present the case of a 12-year-old boy who had been referred to the Ophthalmology Department, complaining of a progressive and painless exophthalmos of his left eye, developed during 1 year. The cause was unknown and there were no functional problems. Computed tomography and magnetic resonance showed a large pneumatized ethmoidal sinus and confirmed the resulting proptosis. We asked the Ear Nose and Throat (ENT) department for a further examination, and finally, the patient was taken to the operating room, where the left ethmoidal sinus was exposed to an endoscopic endonasal technique; in particular, a maxillary and frontal endoscopic antrostomy ethmoidectomy was performed. Excellent results were obtained and the patient had no complaints. Currently, he remains well after a 16-month postoperative period.
