Introduction: Mucoceles originating from supraorbital ethmoid cells are difficult to treat. Due to its lateral location the endonasal approach with endoscopes is sometimes not sufficient to achieve adequate exposure and the use of extended transnasal techniques and even external approaches is required.Objectives: To determine the success rate of surgical treatment performed endonasally with endoscopes or combined, endonasal and trough a transpalpebral approach to treat mucoceles originating in supraorbital cells.Methods: Patients with mucoceles originating in supraorbital cells were treated using endonasal extended approaches to the frontal sinus and external transpalpebral approach with fat obliteration of the supraorbital cell cavity. Endoscopes were used in all.Results: Four patients had mucoceles located in supraorbital cells. All had erosion of the anterior and inferior wall of the supraorbital cell and entered the orbit, one also had erosion of the posterior wall and the mucocele capsule contacted the meningeal.The disease was resolved in all four patients, but in two of them it was necessary to perform a new combined endonasal and transpalpebral approach, with fat obliteration of the supraorbital cell due to recurrence of the mucocele. Conclusions:The success rate with primary and revision surgery in patients treated by mucoceles located in supraorbital cells was 100%.Mucosal resection, bone drilling, and supraorbital cell obliteration with fat are part of a treatment algorithm, representing the point of greatest surgical aggressiveness.
Objectives: Schwannomas of the nasal cavity and paranasal sinuses are uncommon. Treatment is surgical and endoscopic excision is a main indication. Our aim was to determine the incidence of rhinosinusal Schwannomas and the effectiveness of endonasal surgery with endoscopes to treat these tumors. Methods:The electronic medical records of all patients diagnosed with head and neck schwannomas were reviewed, excluding acoustic nerve neurilemomas and neurofibromas. Those who presented tumors located in the nose or paranasal sinuses were selected. They were treated with surgery in the Rhinosinusology section of ENT Department of the Hospital Italiano de Buenos Aires between March 1998 and December 2019.Results: Eighteen patients were selected who had histological (15/18) and clinical and imaging (3/18) diagnoses of neural type neoplasia, located in the head and neck.Two neck neurofibromas were excluded.Five patients with schwannomas located in the nasal cavity and paranasal sinuses were treated with surgery and had histopathological confirmation.The surgical technique varied according to the time of its indication.In four patients, an endonasal approach with endoscopes alone or combined with a frontal craniotomy was performed and in another a sublabial approach was made.The resection was complete in 4 patients and subtotal in another (intracranial extension with bilateral compromise of visual acuity). Conclusions:The incidence of sinonasal schwannomas within the nerve tumors diagnosed in the head and neck was 31.25% (5/16).Endoscopic excision was very safe and effective to treat the patients with sinonasal schwannomas.
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