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Mentions: A 61-year-old female presented to our OPD with chief complaints of right superomedial eye swelling for last 2 years. The swelling was associated with excessive watery discharge and pain in right eye as well as pain in right frontal region. There was no history of diplopia or decreased vision from right eye. There was no history of nasal discharge or nasal obstruction. There was previous history of endoscopic marsupilization of mucocele by a private practitioner 2 months back but it recurred again. On physical examination, there was fluctuant swelling present in superomedial region above the right eye. There was mechanical ptosis due to swelling and the eyeball was pushed inferiorly and laterally. Vision was normal in right eye with full extraocular movements in all directions except in supero-medial direction. Pupillary reaction to light and accomodation were normal. Fundus examination was normal. On anterior rhinoscopy, nose was normal. On contrast-enhanced CT, there was large expansile cystic lesion was found to be present involving right frontal sinus containing hypodense contents with expansion of both anterior and posterior table of frontal sinus [Figure 1]. The swelling had so much eroded the anterior and posterior table of frontal sinus that frontal lobe of brain was in direct contact with the eyeball and it was compressing the eyeball and blocking the sinus ostia [Figure 1]. On MRI, the swelling was isointense on T1 and hyperintense on T2. The swelling was in close contact with both orbit and frontal lobes and was almost adherent to both these structures.
Frontal sinus mucocele with orbital complications: Management by varied surgical approaches
Bottom Line: Floor of frontal sinus is shared with the superior orbital wall which explains the early displacement of orbit in enlarging frontal mucoceles.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.
Affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India.
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.