Recurrent of a Giant Fronto-Ethmoidal Mucocele with Orbital Extension: A Case Report

Abstract

Mucoceles of the paranasal sinuses are benign expansive pseudo-cystic lesions, affecting mainly adults. These rare lesions are usually evolving at low noise and are most often revealed by neurological or ophthalmological complications. We report a case of a recurrent fronto-ethmoidal mucocele with orbital extension. This was a 69-year-old patient with a previous history of endoscopic marsupilization of mucocele by a private practitioner 10 years back, who presented frontal headaches associated with a left-sided forehead swelling and chronic left proptosis evolving for 3 years, in whom clinical examination revealed fluctuant swelling present in the forehead region above the left eye and unilateral left sided proptosis. Cranio-facial computed tomography (CT) and magnetic resonance imaging (MRI) were in favor of a left fronto-ethmoidal mucocele with homolateral intra-orbital extension. The patient was operated by an endoscopic surgical approach. The outcomes were favorable with regression of headaches and resolution of proptosis. The fronto-ethmoidal mucocele, although benign, has an aggressive potential in the absence of treatment either towards the endocranium or the orbit. Imaging plays a crucial role in the diagnosis, preoperative planning and monitoring of mucoceles and CT and MRI should be used as complementary investigations of sino-nasal pathology. Treatment of mucoceles is surgical and recurrences are uncommon. Although the fronto-ethmoidal is a benign lesion, it is may be responsible for complications involving the functional or even vital prognosis. An early diagnosis and treatment allow to improve mucoceles outcomes.