Frontal sinus mucocele with orbital extension drained via a combined upper lid skin crease and endoscopic approach

Abstract

This case report discusses the ophthalmic complications of frontal sinus mucoceles and describes the favorable long‐term surgical outcomes of a combined endoscopic and upper‐lid skin crease drainage approach carried out jointly with otorhinolaryngology. A 47‐year‐old single mother presented to eye casualty with markedly swollen eyelids and visual acuity of 6/6 in the left eye, no perception of light in the right. Ophthalmic examination revealed right‐sided hypoglobus and proptosis with exposure keratopathy inferiorly. There was complete ophthalmoplegia in the right eye and a hemorrhagic optic disc visible on fundoscopy. CT orbit with contrast confirmed a diagnosis of giant frontal mucocele with orbital extension. The patient underwent mucocele drainage via a modified anterior orbitotomy approach and FESS (Functional Endoscopic Sinus Surgery) drainage performed jointly with otorhinolaryngology. Two weeks post‐operatively her proptosis was resolving and by three months she had regained full extraocular motility. As expected, vision was not restored in the right eye. At one year, the patient's upper lid skin crease scar was completely buried in the eyelid's natural contour, and repeat CT scanning confirmed no re‐stenosis or mucocele recurrence. This case demonstrates, that a multidisciplinary approach to far‐lateral frontal sinus mucoceles with orbital extension and ophthalmic complications which combines an upper lid skin crease incision with FESS drainage, allows adequate access to the frontal sinus while preserving cosmesis.

Ophthalmology and oculoplastics for the rhinologist

“…The use of multiport surgery, especially in conjunction with endoscopy has allowed for better surgical exposures. The oculoplastic surgeon may utilize a trans-palpebral approach to expose the frontal sinus from a more rostral aspect, which when combined with an endoscopic endonasal approach together with a rhinologist can effectively clear pathology such as frontal sinus mucoceles and neoplasms [22–24]. Such co-surgeries yield improved outcomes and reduced patient morbidity and mortality, as well as improved cosmesis [15 ▪▪ ,18].…”