Frontal Mucocele Extended Orbita and Endoscopic Marsupialization Technique

Abstract

Mucocele is benign, slow-growing, mucous-filled cystic lesions that arise in the paranasal sinuses. It causes progressive distension of the bony walls and induces compressive symptoms. Surgical treatment of paranasal sinus mucoceles includes endoscopic approach or external approach. The authors report a patient of frontal mucocele who presented with a history of progressive unilateral protrusion. Computed tomography scan revealed a large mucocele of the frontal sinus with orbital extension on the same side. He was successfully treated with endoscopic marsupialization without any serious complications.

Acellular Dermal Matrix, Osseoplastic Flap, and Transnasal Endoscopic Approach for Frontal Mucocele

“…This approach provides direct visualization of the frontal sinus and allows complete removal of the sinonasal mucosa and obliteration of the nasofrontal duct. 9,10 The osteoplastic flap is one of the most important external approaches for frontal sinus surgery because it is versatile to address various pathological entities of the frontal sinus such as lateral displacement and narrow anteroposterior diameter of the sinus, fractures of the posterior table or anterior wall with collapse-type deformity or herniation of its content, and neo-osteogenesis of the nasofrontal recess. 11 Obliteration of the frontal sinus with exposure using an osteoplastic flap is a definitive procedure, which in this study had no recurrences.…”

“…Erdogan et al suggest the benefit of this technique in transnasal marsupialization by constructing a wide ostium that allows easy drainage without the removal of the sinus mucosa even when there is orbital involvement. 10 They also add that there are no changes in the sinus mucosa based on the study by Lund and Milroy, which is why they drain the content and do not see the need to remove the mucosa. 11 On the other hand, the disadvantages of this technique are possibly associated with indirect and difficult visualization of many intrasinusal areas due to a complex anatomy, which does not allow complete mucosal resection or inadequate obliteration.…”

Paranasal sinus mucoceles: Our diagnosis and treatment approach

“…[3] Mukoselin içindeki mukusun enfekte olması sonucu (mukopiyosel) etraf dokularda süpüratif komplikasyonlara da neden olabilmektedir. Klasik sinüzit semptomları olan baş ağrısı ve yüz ağrısı semptomlarının yanı sıra mukoselde proptozis, gözde yer değişikliği, görmede azalma, diplopi gibi orbital komplikasyonlar [4,6,8,10,11] ve beyin apsesi, epidural apse, subdural apse, menenjit gibi kraniyal komplikasyonlar görülebilmektedir. [5,12] Ayrıca çok büyük boyutlara ulaştığında yüzde şekil bozukluğu yaratarak kozmetik sorunlara yol açabilmektedir.…”

“…İyatrojenik durumlar inverted papillom, nazal polip ve kronik sinüzit nedeniyle yapılan endoskopik sinüs cerrahileri sonrası meydana gelmektedir. [2][3][4][5][6][7][10][11][12] Verillaud ve ark. [15] inverted papillom nedeniyle ameliyat ettikleri 27 hastanın 10'unda (%37) iyatrojenik olarak frontal mukosel geliştiğini saptamışlardır.…”

“…[1,3] Günümüzde paranazal sinüs mukosellerinin çoğunluğu endoskopik olarak tedavi edilebilmekle birlikte ulaşımı zor ve nüks olgularda kombine yaklaşım önerilmektedir. [2][3][4]8,11] Plantier ve ark. [1] 46 hastanın 41'inde yalnızca endoskpik yaklaşım beşinde (%10.9) ise kombine yaklaşım uygulamışlardır.…”