Paranasal sinus mucocele

• Detailed evaluation of the risk of infraorbital nerve injury in postoperative maxillary cyst surgery
• Comparison of outcomes for Draf IIB vs Draf III in endoscopic frontal sinus surgery: a comprehensive systematic review and meta-analysis
• The endonasal endoscopic management of pediatric infected maxillary mucocele: a case report and literature review
• Do Variations in Frontal Recess Anatomy Predispose to Mucocele Formation?
• Paranasal sinus mucoceles and its distortion of craniofacial-orbital anatomy: a narrative synthesis
• Uncommon Nasal Mass Presentation: A Radiological Case Series
• Serum and Tissue Periostin Expression in Unilateral Benign Lesions of the Nose and the Paranasal Sinuses
• Complications following open treatment of frontal sinus fracture: A nationwide analysis of 1492 patients

Langenbach (1820) first described paranasal sinus mucoceles under the name of hydatids. Roulette (1909) introduced the name mucocele. Paranasal sinus mucocele is the accumulation of mucus secretions and exfoliated epithelium in the sinuses, causing enlargement of the sinus walls. It is considered a cystic, dilatation-eroding lesion. However, the mucocele often occurs as a localized mass, causing bone erosion and displacement of surrounding structures. If left untreated, a nearby mucocele in the brain can become infected and lead to death. Frontal sinuses are often involved; sphenoid, ethmoid, and maxillary mucoceles are rare. Mucoceles usually result from sinus ostium obstruction due to infection, fibrosis, inflammation, trauma, surgery, or obstruction by tumors such as osteomas. Of all causes, patients most often present with craniofacial trauma (82.97%) and the most common mechanism is human aggression (90.85%).

Paranasal sinus mucoceles are classified based on their location and extent. The classification may include:

Simple Mucocele:

Confined to a single sinus without involving adjacent sinuses.

Complex Mucocele:

Involves multiple sinuses or extends beyond the boundaries of a single sinus.

Frontal Sinus Mucocele:

Specifically involves the frontal sinus.

Ethmoid Sinus Mucocele:

Specifically involves the ethmoid sinus.

Sphenoid Sinus Mucocele:

Specifically involves the sphenoid sinus.

Maxillary Sinus Mucocele:

Specifically involves the maxillary sinus.

Anterior Ethmoid Mucocele:

Primarily involves the anterior part of the ethmoid sinus.

Posterior Ethmoid Mucocele:

Primarily involves the posterior part of the ethmoid sinus.

Sinonasal Mucocele:

Extends beyond the sinus boundaries and involves adjacent nasal structures.

Inverted Papilloma-Associated Mucocele:

Develops in association with an inverted papilloma, a benign tumor of the nasal cavity and sinuses. The classification may vary slightly among medical sources, and additional details about the size, extension, and impact on surrounding structures may be considered for a more comprehensive categorization. It's important to note that the management and treatment approach for mucoceles depend on their specific characteristics and the symptoms they cause.

Frontoethmoidal mucocele.

Gokani et al. identified 60 patients with mucoceles, of which 35 (58%) were incidental findings from radiological investigations. The mean age was 58 years. Fifteen patients (25%) were managed surgically and one presented with recurrence following surgery. Overall, six patients (10%) had an intra-orbital extension of their mucocele and three (5%) had an intracranial extension. There was no difference in the rates of intracranial extension between conservative and surgical cases but surgical cases included a higher rate of intra-orbital extensions (27% vs. 4%, p = 0.01). The proportion of patients requiring surgical intervention in this study is low. Incidental and asymptomatic mucoceles have a relatively benign disease course and selected uncomplicated cases can be considered for conservative management with serial scanning at 12 months ¹⁾.

Case presentation: This 30-year-old male patient presented with a frontal head swelling of one year duration that started after he sustained a stick injury on the frontal head one year ago, and he has had an associated frontal headache for one year. There was a 4x5cm frontal, firm, palpable, non-tender lesion extending from the nasion to the frontal head. On the brain CT scan, there was frontal bone erosion at multiple sites with partial frontal sinus opacity, an externally growing mass, and an old frontal sinus fracture noted. Bifrontal craniotomy and bilateral frontal sinus cranialization were done, and the patient was discharged on the third day and seen a month later with complete improvement from headache and swelling.

Conclusion: The incidence and pathophysiology of posttraumatic frontal sinus mucoceles are not known yet. The surgical management of mucocele demands a multidisciplinary team involving neurosurgeons, ear nose, and throat surgeons, oral and maxillofacial surgeons, ophthalmologists, and plastic and reconstructive surgeons. By treating the primary cause, frontal sinus fracture at contact, this case report aims to raise awareness of and prevent frontal sinus mucocele and related complications ²⁾.