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Concha bullosa mucocele with orbital invasion and secondary frontal sinusitis: a case report.

Lee JH, Hong SL, Roh HJ, Cho KS - BMC Res Notes (2013)

Bottom Line: The mass caused a bony defect on the lamina papyracea and displaced medial rectus muscle and orbit laterally.Moreover, the right frontal and ethmoid sinus was totally opacified.Therefore, we consider this entity in the differential diagnosis of orbital complications and secondary sinusitis caused by intranasal mass.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Busan, South Korea. choks@pusan.ac.kr.

ABSTRACT

Background: Although concha bullosa (CB) is the most common variants of the middle turbinate, mucocele of CB is uncommon. Furthermore, CB mucocele with orbital invasion and secondary frontal sinusitis has not been reported previously.

Case presentation: A 42-year-old Korean male presented with gradually progressive proptosis of right eye and right-sided frontal headache. He had previously undergone endoscopic sinus surgery (ESS) 15 and 9 years ago. The endoscopic examination showed an expansive, large middle turbinate with normal mucosa filled the majority of right nasal cavity and displaced the septum to the left. A computed tomography and magnetic resonance imaging showed a well demarcated cystic huge mass at right nasal cavity extending to ethmoid sinus and orbit. The mass caused a bony defect on the lamina papyracea and displaced medial rectus muscle and orbit laterally. Moreover, the right frontal and ethmoid sinus was totally opacified. This article reports orbital invasion and frontal sinusitis complicating a CB mucocele, which was successfully treated by endoscopic resection of the lateral wall of CB and frontal sinusotomy.

Conclusions: This case illustrates that CB mucocele could develop to such a massive extent that it leads to orbital complication and secondary frontal sinusitis. Therefore, we consider this entity in the differential diagnosis of orbital complications and secondary sinusitis caused by intranasal mass.

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Preoperative magnetic resonance (MR) images of the paranasal sinus. MR images show a huge cystic mass displaying intermediate signal intensity on T1 axial (A), T2 axial (B), and T2 coronal images (C). Post-contrast T1 mage (D) show no enhancement of the cystic mass. Right ethmoidal sinusitis is noted (asterisk).
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Figure 2: Preoperative magnetic resonance (MR) images of the paranasal sinus. MR images show a huge cystic mass displaying intermediate signal intensity on T1 axial (A), T2 axial (B), and T2 coronal images (C). Post-contrast T1 mage (D) show no enhancement of the cystic mass. Right ethmoidal sinusitis is noted (asterisk).

Mentions: A 42-year-old Korean male presented with gradually progressive proptosis of right eye for 2 years. He also complained of right-sided frontal headache for 1 week. He had previously undergone endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyp 15 and 9 years ago. There were no other rhinological or ophthalmological symptoms. He had suffered from adult onset diabetes mellitus for 5 years and was well controlled on oral hypoglycemic agents. The endoscopic examination showed an expansive, large middle turbinate with normal mucosa filled the majority of right nasal cavity and displaced the septum to the left. Ophthalmologic examination revealed exophthalmos and globe was displaced antero-laterally. Ocular motion and visual acuity were normal. A computed tomography (CT) scan of the orbit showed a well demarcated huge mass at right nasal cavity extending to ethmoid sinus and orbit. The mass caused a bony defect on the lamina papyracea and displaced medial rectus muscle and orbit laterally. Moreover, the right frontal and ethmoid sinus was totally opacified (Figure 1). Magnetic resonance (MR) images of the paranasal sinus revealed a cystic mass displaying intermediate signal intensity on T1-weighted images (T1WIs) and T2WIs without enhancement. In addition, right frontal and ethmoid sinusitis was also observed (Figure 2). From these findings, the lesion was suspected to be a CB mucocele with orbital invasion and frontal sinusitis. Resection of the lateral and inferior walls of the right middle turbinate was performed under general anesthesia combined with a right frontal sinusotomy. The middle turbinate consisted of thick, dark brown, and inspissated material surrounded by a partially bony shell with mucosa at both inner and outer side, confirming the diagnosis of a mucocele in CB. No organism was seen on gram, AFB, and fungus stain and culture yielded no growth in the pus from CB. After frontal sinusotomy, pulsating pus like discharge and inflammation-induced edematous sinus mucosa were noted. An oral antibiotic treatment with Amoxicillin and Clavulanate was started for concurrent paranasal sinus infection, and planned to complete for 2 weeks. The patient’s symptoms quickly diminished postoperatively and a follow-up CT scan 9 month after surgery demonstrated complete resolution of CB mucocele and frontal sinusitis.


Concha bullosa mucocele with orbital invasion and secondary frontal sinusitis: a case report.

Lee JH, Hong SL, Roh HJ, Cho KS - BMC Res Notes (2013)

Preoperative magnetic resonance (MR) images of the paranasal sinus. MR images show a huge cystic mass displaying intermediate signal intensity on T1 axial (A), T2 axial (B), and T2 coronal images (C). Post-contrast T1 mage (D) show no enhancement of the cystic mass. Right ethmoidal sinusitis is noted (asterisk).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222113&req=5

Figure 2: Preoperative magnetic resonance (MR) images of the paranasal sinus. MR images show a huge cystic mass displaying intermediate signal intensity on T1 axial (A), T2 axial (B), and T2 coronal images (C). Post-contrast T1 mage (D) show no enhancement of the cystic mass. Right ethmoidal sinusitis is noted (asterisk).
Mentions: A 42-year-old Korean male presented with gradually progressive proptosis of right eye for 2 years. He also complained of right-sided frontal headache for 1 week. He had previously undergone endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyp 15 and 9 years ago. There were no other rhinological or ophthalmological symptoms. He had suffered from adult onset diabetes mellitus for 5 years and was well controlled on oral hypoglycemic agents. The endoscopic examination showed an expansive, large middle turbinate with normal mucosa filled the majority of right nasal cavity and displaced the septum to the left. Ophthalmologic examination revealed exophthalmos and globe was displaced antero-laterally. Ocular motion and visual acuity were normal. A computed tomography (CT) scan of the orbit showed a well demarcated huge mass at right nasal cavity extending to ethmoid sinus and orbit. The mass caused a bony defect on the lamina papyracea and displaced medial rectus muscle and orbit laterally. Moreover, the right frontal and ethmoid sinus was totally opacified (Figure 1). Magnetic resonance (MR) images of the paranasal sinus revealed a cystic mass displaying intermediate signal intensity on T1-weighted images (T1WIs) and T2WIs without enhancement. In addition, right frontal and ethmoid sinusitis was also observed (Figure 2). From these findings, the lesion was suspected to be a CB mucocele with orbital invasion and frontal sinusitis. Resection of the lateral and inferior walls of the right middle turbinate was performed under general anesthesia combined with a right frontal sinusotomy. The middle turbinate consisted of thick, dark brown, and inspissated material surrounded by a partially bony shell with mucosa at both inner and outer side, confirming the diagnosis of a mucocele in CB. No organism was seen on gram, AFB, and fungus stain and culture yielded no growth in the pus from CB. After frontal sinusotomy, pulsating pus like discharge and inflammation-induced edematous sinus mucosa were noted. An oral antibiotic treatment with Amoxicillin and Clavulanate was started for concurrent paranasal sinus infection, and planned to complete for 2 weeks. The patient’s symptoms quickly diminished postoperatively and a follow-up CT scan 9 month after surgery demonstrated complete resolution of CB mucocele and frontal sinusitis.

Bottom Line: The mass caused a bony defect on the lamina papyracea and displaced medial rectus muscle and orbit laterally.Moreover, the right frontal and ethmoid sinus was totally opacified.Therefore, we consider this entity in the differential diagnosis of orbital complications and secondary sinusitis caused by intranasal mass.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Busan, South Korea. choks@pusan.ac.kr.

ABSTRACT

Background: Although concha bullosa (CB) is the most common variants of the middle turbinate, mucocele of CB is uncommon. Furthermore, CB mucocele with orbital invasion and secondary frontal sinusitis has not been reported previously.

Case presentation: A 42-year-old Korean male presented with gradually progressive proptosis of right eye and right-sided frontal headache. He had previously undergone endoscopic sinus surgery (ESS) 15 and 9 years ago. The endoscopic examination showed an expansive, large middle turbinate with normal mucosa filled the majority of right nasal cavity and displaced the septum to the left. A computed tomography and magnetic resonance imaging showed a well demarcated cystic huge mass at right nasal cavity extending to ethmoid sinus and orbit. The mass caused a bony defect on the lamina papyracea and displaced medial rectus muscle and orbit laterally. Moreover, the right frontal and ethmoid sinus was totally opacified. This article reports orbital invasion and frontal sinusitis complicating a CB mucocele, which was successfully treated by endoscopic resection of the lateral wall of CB and frontal sinusotomy.

Conclusions: This case illustrates that CB mucocele could develop to such a massive extent that it leads to orbital complication and secondary frontal sinusitis. Therefore, we consider this entity in the differential diagnosis of orbital complications and secondary sinusitis caused by intranasal mass.

Show MeSH
Related in: MedlinePlus