Endoscopic sinus surgery for mucoceles: A viable alternative

Abstract

Functional endoscopic surgery affords the potential for dramatically reducing operative morbidity of surgery for paranasal sinus mucoceles by offering a minimally invasive approach under local anesthesia. Following surgery, direct endoscopic visualization of the area enables accurate follow-up. Unlike sinus obliteration, the ability to accurately image the sinus by CT is also preserved. This paper presents our preliminary experience with 18 mucoceles in which endoscopic sinus surgery was attempted. Five patients had preoperative proptosis and diplopia, three had Pott's puffy tumor and five had erosion of the posterior table of the frontal sinus. Fifteen patients were satisfactorily treated endoscopically, two lesions could not be satisfactorily approached and required external surgery, and one patient had persistent disease. No disease recurrence has been noted to date with endoscopic follow-up of up to 42 months.

Endoscopic sinus surgery for paranasal sinus mucocoele with orbital involvement

“…The length of hospital stay was short, and compares favourably with external sinus surgery which has an average stay of 7 days. 3 Traditionally, treatment for paranasal sinus mucocoele involved complete removal of the sinus mucosal lining and obliteration of the sinus. In the frontal sinuses, some rhinologists have preferred osteoplastic flap with fat obliteration, as it is more cosmetically acceptable.…”

“…The follow-up of an obliterated sinus can also be unreliable as imaging may not be able to distinguish an obliterated sinus from a recurrent mucocoele. 3,9 In addition, it has been shown that mucosa of a mucocoele does not lose normal respiratory epithelium. 14 Histological examination of frontal mucocoele lining 6 months after marsupialization revealed areas of normal ciliated pseudostratified epithelium, 15 and follow-up endoscopic examination has also found well-mucosalized cavities following ESS for sinus mucocoele JJ Khong et al 880 marsupialization.…”

“…1 Over the past decade, intranasal drainage and marsupialization of mucocoeles using ESS has emerged as definitive management, with minimal morbidity and a low recurrence rate. [3][4][5][6][7][8][9][10][11][12] With the advent of more advanced instrumentation, refined surgical techniques, and intraoperative imaging, even the more technically challenging frontal mucocoeles can be approached endoscopically.…”

Giant frontoethmoid mucoceles — what is the surgical choice

“…They are, the excision of mucocele with Lynch Howarth frontoethmoidectomy, a craniofacial approach and thirdly creating drainage pathway with nasal endoscopes. Kennedy (1989) has reported successful excision of frontal, ethmoidal and sphenoidal mucoceles with no recurrences. Endoscopic removal of mucoceles have been described of late for large frontal mucoceles with intracranial extention (Hat-El G 1995), Benninger et al in a report of 15 cases of frontoethmoid mucoceles treated with endoscopic decompression encountered recurrence in mucoceles with intracranial extension requiring another session of endoscopic treatment.…”

Factors Affecting the Outcome of Frontal Sinus Surgery: A Prospective Study

“…Functional endoscopic sinus surgery (FESS) has been accepted as the procedure of choice for the surgical management of chronic sinus pathologies [1][2][3][4][5]. The endoscope has afforded direct visualization of critical landmarks and greater ease of access to remove disease from areas most commonly responsible for obstruction of the frontal recess.…”