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Zeroli C, Gorica A, Elli F, Gallo S, Terranova P, Castelnuovo P, Bignami M. A 28 years surgical experience of 398 sinusal mucoceles: how technologies, techniques and experiences have changed their treatment throughout the years. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08766-y. [PMID: 39042172 DOI: 10.1007/s00405-024-08766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/27/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Sinonasal mucoceles (SM) are benign, expansive neoformations which require surgical marsupialization to prevent severe complications. The present study reports the larger case history ever published: a 28-years expertise in the surgical management of SM. METHODS A retrospective study was conducted on patients surgically treated for SM at the Departments of Otorhinolaryngology of Varese and Pavia, between 1994 and 2022. RESULTS 398 patients were reported. An endoscopic endonasal marsupialization of SM was performed in 92,5% of cases. 7% of patients underwent a combined approach while 0,5% required an exclusive open surgery. The average follow-up after surgery was 10-60 months. SM overall recurrence was observed in 11,4% of cases. CONCLUSION Endonasal endoscopic SM marsupialization is a feasible technique which allows the preservation of the anatomy and physiology avoiding the surgical invasiveness of the external approaches. The well-established surgical expertise in the endonasal endoscopy together with technological improvements widened the indication range of the exclusive endoscopic technique over the traditional open surgery.
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Affiliation(s)
- Chiara Zeroli
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria-Varese, ASST Sette Laghi, Varese, Italy.
| | - Armela Gorica
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria-Varese, ASST Sette Laghi, Varese, Italy
| | - Fabrizia Elli
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria-Varese, ASST Sette Laghi, Varese, Italy
| | - Stefania Gallo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria-Varese, ASST Sette Laghi, Varese, Italy
| | - Paola Terranova
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria-Varese, ASST Sette Laghi, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria-Varese, ASST Sette Laghi, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria-Varese, ASST Sette Laghi, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Shenouda K, Krystal S, Racy E, Veyrat M. Dynamic radiologic changes in repeated barotraumatic frontal sinusitis: A CARE case report. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00074-7. [PMID: 38897905 DOI: 10.1016/j.anorl.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Flight staff are at particular risk of iterative sinus barotrauma. We here report a case of barotraumatic atelectasic frontal sinusitis with dynamic radiologic change in frontal sinus volume. CASE REPORT A 46-year-old air pilot was referred for right frontal pain occurring at each landing. Two sinus CT scans were taken: one after a period of intense flying and the other after a month without flying. In the right frontal sinus, a type-3 Kuhn cell changed in volume from 6×11×12mm to 13×18×19mm. The alteration involved a modification in the medial wall, which was demineralized and changed position within the frontal sinus. Removal during endoscopic frontal sinusotomy allowed complete resolution of pain. DISCUSSION This article reports radiologic change in a frontal sinus wall in a setting of repeated barotraumatic frontal sinusitis with a dynamic atelectasic component. In iterative barotrauma, we advocate imaging at different time points. When the ostial obstruction is identified, functional aeration surgery can be applied.
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Affiliation(s)
- K Shenouda
- Service d'oto-rhino-laryngologie, chirurgie cervico-faciale, hôpital Fondation Adolphe-de-Rothschild, Paris, France.
| | - S Krystal
- Service de neuroradiologie, hôpital Fondation Adolphe-de-Rothschild, Paris, France
| | - E Racy
- Service d'oto-rhino-laryngologie, chirurgie cervico-faciale, hôpital Fondation Adolphe-de-Rothschild, Paris, France
| | - M Veyrat
- Service d'oto-rhino-laryngologie, chirurgie cervico-faciale, hôpital Fondation Adolphe-de-Rothschild, Paris, France
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Gokani S, Kumaresan K, Adari S, Ergisi M, Oludeye O, Jegatheeswaran L, Philpott C. The Clinical Course of Paranasal Sinus Mucocoeles-A Retrospective Case Series. J Clin Med 2024; 13:397. [PMID: 38256532 PMCID: PMC10816877 DOI: 10.3390/jcm13020397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/21/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Paranasal sinus mucocoeles can be secondary to chronic rhinosinusitis and can result in intra-orbital and intra-cranial complications requiring surgical management. The natural history of conservatively managed mucocoeles is not well established. We aimed to quantify the proportion of radiologically identified paranasal sinus mucocoeles resulting in complications over 10 years. We retrospectively reviewed anonymised data on radiologically diagnosed mucocoeles between 2011 and 2021 at two UK hospitals. We collected data on age at presentation, extent of sinus involvement, management and complications. We identified 60 patients with mucocoeles, of which 35 (58%) were incidental findings from radiological investigations. The mean age was 58 years. Fifteen patients (25%) were managed surgically and one presented with recurrence following surgery. Overall, six patients (10%) had an intra-orbital extension of their mucocoele and three (5%) had an intra-cranial extension. There was no difference in the rates of intra-cranial extension between conservative and surgical cases but surgical cases included a higher rate of intra-orbital extensions (27% vs. 4%, p = 0.01). The proportion of patients requiring surgical intervention in this study is low. Incidental and asymptomatic mucocoeles have a relatively benign disease course and selected uncomplicated cases can be considered for conservative management with serial scanning at 12 months.
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Affiliation(s)
- Shyam Gokani
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (K.K.); (M.E.); (C.P.)
| | - Kala Kumaresan
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (K.K.); (M.E.); (C.P.)
| | - Sushritha Adari
- Department of Ear, Nose and Throat Surgery, James Paget University Hospital, Great Yarmouth NR31 6LA, UK; (S.A.); (O.O.); (L.J.)
| | - Mehmet Ergisi
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (K.K.); (M.E.); (C.P.)
| | - Oladapo Oludeye
- Department of Ear, Nose and Throat Surgery, James Paget University Hospital, Great Yarmouth NR31 6LA, UK; (S.A.); (O.O.); (L.J.)
| | - Lavandan Jegatheeswaran
- Department of Ear, Nose and Throat Surgery, James Paget University Hospital, Great Yarmouth NR31 6LA, UK; (S.A.); (O.O.); (L.J.)
| | - Carl Philpott
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (K.K.); (M.E.); (C.P.)
- Department of Ear, Nose and Throat Surgery, James Paget University Hospital, Great Yarmouth NR31 6LA, UK; (S.A.); (O.O.); (L.J.)
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Dennis SK, Steele TO, Gill AS, Hwang JC, Sarhadi KS, Cheema KS, Aulakh SS, Wilson MD, Strong EB. Treatment Outcomes With Conservative Management of Frontal Sinus Outflow Tract Fractures. Otolaryngol Head Neck Surg 2023; 169:1455-1461. [PMID: 37573490 PMCID: PMC10840897 DOI: 10.1002/ohn.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Historically, early surgical management of frontal sinus outflow tract (FSOT) fractures has been standard practice. There has been a paradigm shift toward nonsurgical or delayed management. Unfortunately, clinical indications and treatment outcomes for this approach are poorly understood. This study evaluates radiologic indicators, as well as sinus reaeration and complication rates for FSOT injuries treated nonsurgically. STUDY DESIGN A retrospective cohort study of FSOT injuries between 2005 and 2019. SETTING Academic, tertiary care medical center. METHODS Radiographic fracture patterns of the frontal ostia (FO) and frontal recess (FR) were recorded as either patent, disrupted, or obstructed. Sinus reaeration, surgical rescue, and complication rates were documented. Patients with follow-up imaging >42 days were included. Patients undergoing immediate surgical intervention were excluded. RESULTS One hundred patients were identified and 44 met the criteria (88 sinuses). Among nonobstructed FSOT injuries (ie, patent or disrupted), reaeration occurred in 91% of the FO and 98% of FR injuries. Two sinuses required surgical rescue including 1 Draf IIB (1%), and 1 obliteration (1%). Two sinuses had complications including 1 mucocele (1%) and 1 cerebrospinal fluid leak (1%). FO and FR fracture patterns had no identifiable correlation with long-term reaeration rates or the need for surgical intervention. CONCLUSION Among nonobstructive injuries to the FSOT, average reaeration rates in observed patients were high (91%-98%). Rescue surgery (2%) and complication rates (2%) were low, suggesting that nonsurgical management of nonobstructed FSOT is a viable strategy. No radiographic features were clearly identified to be predictive of sinus reaeration.
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Affiliation(s)
- Steven Kennedy Dennis
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Joshua C Hwang
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Kamron S Sarhadi
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Karmtej S Cheema
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Sukhkaran S Aulakh
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Machelle D Wilson
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
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Clarke K, Wilde C, Walker A, Nghiem AZ, Little S, Osborne SF. Combined upper lid skin crease and endoscopic approach to frontal sinus mucocoeles. Orbit 2023:1-8. [PMID: 38032741 DOI: 10.1080/01676830.2023.2287638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE This case series describes the ophthalmic manifestations of frontal sinus mucoceles and reports the long-term surgical outcomes of a combined endoscopic and upper-lid skin crease drainage approach carried out jointly with otorhinolaryngology. METHODS We present a retrospective case review of 18 orbits and 15 patients presenting with frontal sinus mucocoeles, all of whom underwent drainage via an adapted anterior orbitotomy approach between January 2015 and July 2023. Data collection included preoperative and postoperative examination findings (visual acuity, extraocular motility, lid retraction, and lagophthalmos), mucocoele recurrence, cosmetic satisfaction, and surgical complications. Patients were followed up for an average of 22 months. RESULTS All patients underwent successful frontal mucocoele drainage via a modified anterior orbitotomy and simultaneous endonasal approach. At presentation, three (20%) had extraocular restriction leading to diplopia, and six (40%) had proptosis in the eye adjacent to the mucocoele. One patient presented acutely with no light perception in the affected eye due to compressive optic neuropathy. All patients who had reduced extraocular motility before surgery regained full motility post-operatively. Treatment was successful in all cases, and there was no documented mucocoele recurrence during follow-up. Satisfactory aesthetic outcomes were achieved in all cases. Reported complications included temporary forehead numbness and ptosis of the affected eyelid, which resolved without intervention. CONCLUSION The modified anterior orbitotomy approach to frontal mucocoeles allows optimal frontal sinus access and mucocoele treatment while preserving cosmesis.
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Affiliation(s)
- Kirsty Clarke
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Caroline Wilde
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Abigail Walker
- Adnexal Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Allan Z Nghiem
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Sarah Little
- Adnexal Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah F Osborne
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Cancio LM, Chin M, Tumuluri K. Isolated Orbital Apex Mucocele: A Case Study and Literature Review. Ophthalmic Plast Reconstr Surg 2023; 39:e192-e194. [PMID: 37405766 DOI: 10.1097/iop.0000000000002443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Isolated orbital mucocele without connection between the mass and paranasal sinuses is extremely rare and poorly understood. Literature review of these cases are very few and present more anteriorly in the orbit. Here, the authors present a 33-year-old female with an isolated left orbital apex mucocele without direct communication with the adjacent paranasal sinuses and other vital orbital structures. Endoscopic sinus surgery with marsupialization was performed, and an orbital mucocele was confirmed on histopathology. Although uncommon, previously reported cases, including our patient have remained disease free of recurrence for at least 1 year post-operatively.
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Affiliation(s)
- Lorenzo Maria Cancio
- Department of Oculoplastic Surgery, Sydney Eye Hospital, New South Wales, Australia
| | - Michael Chin
- The Departments of Otolaryngology and Ophthalmology, Liverpool Hospital, New South Wales, Australia
| | - Krishna Tumuluri
- Department of Oculoplastic Surgery, Sydney Eye Hospital, New South Wales, Australia
- The Departments of Otolaryngology and Ophthalmology, Liverpool Hospital, New South Wales, Australia
- Save Sight Institute, University of Sydney, New South Wales, Australia
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Bonomo G, Bussone G, Gans A, Iess G, Bonomo R, Restelli F, Falco J, Mazzapicchi E, Stanziano M, Amato A, Broggi M, Acerbi F, Ferroli P, Schiariti M. Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension. BRAIN & SPINE 2023; 3:102676. [PMID: 38021026 PMCID: PMC10668106 DOI: 10.1016/j.bas.2023.102676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/07/2023] [Accepted: 09/17/2023] [Indexed: 12/01/2023]
Abstract
Background Meningoencephalocele is defined as an abnormal sac of brain tissue and meninges extending beyond natural skull margins, often leading to cerebrospinal fluid (CSF) leakage. When this condition arises in the spheno-ethmoidal region, the diagnosis becomes more challenging as it can be mistaken for other nasal pathologies, such as mucocele. Research question We show in this case report a non-congenital sphenoethmoidal meningoencephalocele causing rhinoliquoral fistula and spontaneous intracranial hypotension. Results this 65-year-old woman presented with sporadic rhinoliquorrhoea associated with orthostatic headache, nausea and dizziness. Brain MRI revealed a small lesion of an ethmoidal sinus, which was successfully treated with endoscopic endonasal surgery. Histology confirmed the presence of meningoencephalic tissue positive for S100 protein on immunohistochemistry. Conclusions When dealing with lesions of the paranasal sinuses in contact with the anterior skull base, rhinoliquorrhoea presence suggests meningoencephalocele. In dubious cases, a proper workup, including a thorough clinical history and neurological examination, specific imaging, and a direct search of CSF-like markers, is essential to support the differential diagnosis. In such cases, a transnasal endoscopic surgical approach is recommended to obtain a final histological diagnosis and to perform eventual dural plastic surgery.
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Affiliation(s)
- Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
- Department of Neurological Surgery, Policlinico “G. Rodolico-S. Marco” University Hospital, Catania, Italy
| | - Gennaro Bussone
- Department of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Alessandro Gans
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Guglielmo Iess
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Roberta Bonomo
- Department of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- School of Medicine and Surgery, Kore University of Enna, Enna, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Mario Stanziano
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- Neurosciences Department “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Alessia Amato
- Department of Child Neuropsychiatry, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
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Magboul NA, Alzubaidi AA, Abumsmar LA, Alzarei A, Al-Ahmari M, Alshehri MA. Mucocele of the Paranasal Sinuses: Retrospective Analysis of a Series of Eight Cases. Cureus 2023; 15:e41986. [PMID: 37593272 PMCID: PMC10427889 DOI: 10.7759/cureus.41986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Paranasal sinus mucoceles are epithelium-lined cystic masses usually resulting from obstruction of sinus ostia. They most frequently occur in the frontal and ethmoid sinuses. The etiology is not clarified, but the most common identifiable cause of mucoceles following functional endoscopic sinus surgery (FESS), trauma, neoplasms, and allergy. The clinical symptoms of mucocele vary and are not specific, the most common being ophthalmic symptoms and headache, impinging on adjacent orbital structures, and causing ophthalmic sequelae such as double vision, commonly followed by orbital swelling, epiphora, proptosis, and ptosis. All patients in this study had frontal and frontoethmoidal mucocele and initially complained of frontal headache and ophthalmic symptoms. Definitive treatment options for paranasal sinus mucoceles include external approaches and endoscopic marsupialization. Objective: The study aimed to identify the etiology, clinical presentation, most common para nasal sinus affected by mucocele, management, and the rate of recurrence in eight cases with mucocele of the paranasal sinuses. METHODS Eight patients diagnosed with mucocele of the paranasal sinuses were admitted to our institution between 2014 and 2021. There were two females and six males aged between 14 and 67. Initial symptoms, duration, clinical presentation upon admission, location of the mucocele, type of surgical intervention, and outcome have all been studied. Results: The most common symptoms at diagnosis were orbital involvement, retrobulbar, and frontal headache. Most patients were diagnosed with frontal mucocele (40%), and three were frontoethmoidal mucocele at the time of presentation. The rest of the cases were diagnosed with ethmoidal mucocele (25%). The etiology was identified in four patients and was unclear in the rest. All patients underwent endoscopic sinus surgery. The most identifiable postoperative complication was a headache. CONCLUSIONS The endonasal endoscopic approach is a safe and effective treatment for paranasal sinus mucocele and provides adequate drainage with a low recurrent rate.
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Affiliation(s)
| | - Atheer A Alzubaidi
- Otolaryngology - Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait, SAU
| | - Lamya A Abumsmar
- Otolaryngology - Head and Neck Surgery, Aseer Central Hospital, Abha, SAU
| | - Ali Alzarei
- Otolaryngology - Head and Neck Surgery, Aseer Central Hospital, Abha, SAU
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Li R, Ren M, Wang W, Li R, Zhang L, Liu L. Orbitofrontal cholesterol granuloma masquerading as frontal sinus mucoceles: report of two cases. BMC Ophthalmol 2023; 23:98. [PMID: 36915085 PMCID: PMC10010065 DOI: 10.1186/s12886-023-02842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Two cases of orbitofrontal cholesterol granuloma masquerading as frontal sinus mucoceles were reported to understand image findings, clinical and histopathologic features of orbitofrontal cholesterol granuloma to improve its diagnosis and treatment. CASE PRESENTATION Two East Asian patients aged 41 and 27 without personal or familial medical or trauma history presented with the common complaint of proptosis and inferomedial displacement of the eyeballs. The computed tomography (CT) of both cases showed an irregularly shaped, well-defined lesion in the left frontal bone associated with bony erosion. The lesions resulted in the bone absorption of frontal bone and orbital roof, which extended into the superior orbital space. Anterior orbitotomy through subbrow incision by drainage and curettage resulted in a curative outcome. The histopathological examination revealed inflammatory granulation tissues, fibrous capsule wall, cholesterol clefts with altered blood pigments, and calcifications, consistent with the diagnosis of cholesterol granuloma. No recurrence was observed for one year after surgery in one case and three years in the other. CONCLUSIONS When the following features are observed: orbital CT exhibits cystic lesion with irregular bone destruction in the superolateral orbit, magnetic resonance imaging (MRI) depicts lesions are hyperintense signals on T1 weighted images (T1WI), and T2 weighted images (T2WI), and the contrast-enhanced imaging reveals that the most of tumor is showed a non-significant enhancement, orbitofrontal cholesterol granuloma should be considered.
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Affiliation(s)
- Ruimiao Li
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai, 054001, Hebei, China
| | - Mingyu Ren
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai, 054001, Hebei, China.
| | - Wenjing Wang
- People's Hospital of Pingxiang County, Xingtai, 054001, Hebei, China
| | - Ruixin Li
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai, 054001, Hebei, China
| | - Lili Zhang
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai, 054001, Hebei, China
| | - Limin Liu
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai, 054001, Hebei, China
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Danic A, Fath L, Kennel P. Sudden-onset exophthalmos of sinus origin. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:93-94. [PMID: 35688678 DOI: 10.1016/j.anorl.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Danic
- Service d'ORL et de chirurgie cervico-faciale, hôpitaux civils de Colmar, 68024 Colmar cedex, France; Service d'ORL et de chirurgie cervico-faciale, hôpitaux universitaires de Strasbourg, 67091 Strasbourg cedex, France.
| | - L Fath
- Service d'ORL et de chirurgie cervico-faciale, hôpitaux universitaires de Strasbourg, 67091 Strasbourg cedex, France
| | - P Kennel
- Service d'ORL et de chirurgie cervico-faciale, hôpitaux civils de Colmar, 68024 Colmar cedex, France
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11
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Nasal Sinus Mucoceles Manifesting Ocular Symptoms. J Craniofac Surg 2023; 34:e141-e145. [PMID: 35946831 DOI: 10.1097/scs.0000000000008888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/05/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION To describe the ocular symptoms in a series of patients with nasal sinus mucoceles of different locations. METHODS The authors analyzed the diagnosis and treatment of patients with sinus mucoceles and ocular symptoms who presented to the hospital from February 2010 to April 2020. A total of 61 patients were included in the study. The locations of the mucoceles were the frontal sinus (8 patients), ethmoid sinus (25 patients), and sphenoid sinus (28 patients). The authors selected 1 typical mucocele case from each of the sinuses, including the frontal, ethmoid, and sphenoid sinuses, and analyzed the history, diagnosis, and treatment of mucoceles in each location. RESULTS The main clinical manifestations were ophthalmic symptoms, such as exophthalmos or displacement, eye pain, blindness or decreased vision, blepharoptosis, and diplopia; no obvious nasal symptoms were noted. Most patients with these symptoms went to an ophthalmologist first. All lesions in this study were found through imaging examinations. Most symptoms improved after surgical interventions. Only 2 of the 61 patients had no improvement in vision because of the long period of vision loss. CONCLUSIONS Although sinus mucoceles are located in the sinuses, ocular symptoms are more prevalent than nasal symptoms. The earlier the imaging examinations are performed; the sooner lesions are detected, and the patients can be treated.
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12
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Loh SA, Wan Hitam WH, Ramli RR, Sayuti KA, Sonny Teo KS. Orbital Apex Syndrome Secondary to Huge Primary Ethmoidal Sinus Mucocele: A Case Report. Cureus 2023; 15:e34853. [PMID: 36923171 PMCID: PMC10009821 DOI: 10.7759/cureus.34853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/13/2023] Open
Abstract
Ethmoidal sinus mucoceles are benign expansile lesions that may progressively invade the orbit causing optic nerve compression and its nearby structures. We report a rare case of primary ethmoidal sinus mucocele instigating orbital apex syndrome. A 40-year-old man presented with right eye (RE) progressive blurring of vision with diplopia for 2 weeks. It was preceded by right-sided facial pain for 3 months. Clinical examination revealed RE proptosis with multiple cranial nerves palsy involving right cranial nerves II, III, IV, V, and VI, suggestive of right orbital apex syndrome. Magnetic resonance imaging (MRI) demonstrated right eye proptosis and right ethmoidal mucocele with intracranial and right intraorbital extension compressing the right medial rectus and optic nerve. The patient underwent an uncomplicated endoscopic sinus surgery resulting in a return to normal appearance and function post-operation. Thus, ethmoidal mucoceles are benign and curable with early recognition and intervention.
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Affiliation(s)
- Sue Anne Loh
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, MYS
| | - Wan-Hazabbah Wan Hitam
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, MYS
| | - Ramiza Ramza Ramli
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, MYS
| | - Khairil Amir Sayuti
- Department of Radiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, MYS
| | - Khairy Shamel Sonny Teo
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, MYS
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13
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Shanbag RD, Pandurangi A, Dinesh R. Mucoceles of Paranasal Sinuses: A Single Centre Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:1147-1152. [PMID: 36452573 PMCID: PMC9702458 DOI: 10.1007/s12070-020-02206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022] Open
Abstract
Describe experience of managing paranasal sinus mucoceles, with either endoscopic endonasal approach (EESS) or combined external with EESS approach. Retrospective study done at SDMCMS&H, between 2007 and 2019, on patients undergoing surgical excision of mucocele. Results described as mean, median, mode, percentages. Twenty-one patients were included, with male to female ratio (0.75:1), mean age (42.95 years). Commonest presentation were facial pain (42.85%),visual symptoms (28.57%), headache (23.80%). Signs included, proptosis (52.38%), facial deformity (23.80%). Imaging: showed frontal mucoceles (42.85%), fronto-ethmoid (38.09%), ethmoid (14.28%), sphenoid (4.76%). Orbital extension in 42.85%, sinusitis (33.33%), skull base erosion (23.80%). EESS or combined external and EESS approach (61.90%, 38.09% respectively) were performed. Complete excision of mucocele wall done. Recurrence in two cases(average-2.5 years),revision surgery performed without further recurrences. Either EESS or combined external and EESS approach used based on site and extension of mucoceles. Complete peeling of mucocele wall without obliteration of the sinus cavity was the mode of surgical management in all cases.
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Affiliation(s)
- Raghunath D. Shanbag
- Department of Otorhinolaryngology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka India
| | - Aniketh Pandurangi
- Department of Otorhinolaryngology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka India
| | - Rashmi Dinesh
- Department of Otorhinolaryngology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka India
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14
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Clarke KM, Wilde C, Walker A, Little S, Osborne SF. Frontal sinus mucocele with orbital extension drained via a combined upper lid skin crease and endoscopic approach. Clin Case Rep 2022; 10:e6206. [PMID: 35999979 PMCID: PMC9388840 DOI: 10.1002/ccr3.6206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/28/2022] [Accepted: 07/21/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | - Abi Walker
- Department of Otorhinolaryngology St George's Hospital London UK
| | - Sarah Little
- Department of Otorhinolaryngology St George's Hospital London UK
| | - Sarah F. Osborne
- Department of Otorhinolaryngology St George's Hospital London UK
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15
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Peng Z, Wang Y, Fang Y, Wang Y, Chen X, Fan R, Zhang H, Xie Z, Jiang W. Precision Endonasal Endoscopic Surgery of the Frontal Recess Cells and Frontal Sinus Guided by the Natural Sinus Drainage Pathway. Front Surg 2022; 9:862178. [PMID: 35548182 PMCID: PMC9081679 DOI: 10.3389/fsurg.2022.862178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background The endoscopic endonasal approach to removing lesions in the nasal cavity and sinuses has become the modern first choice. However, if endoscopic surgery is performed without proper knowledge of sinus anatomy, there is a risk of residual lesions, recurrence, and even serious complications. Therefore, this article illustrates the importance of precise sinus opening guided by the natural sinus drainage pathway, using the anatomy of the frontal sinus (FS) and the frontal recess (FR) cells as an example. Method A total of 82 sides cadaveric heads were dissected and analyzed, and the natural drainage pathways of the FR cells and FS were observed at 0°and 70°nasal endoscopic views, and the findings were summarized. The data of 79 patients who accepted endonasal endoscopic surgery (EES) guided by natural sinus drainage pathways to remove mucoceles in our department from January 2015 to January 2021 were retrospectively analyzed. Results Two natural drainage pathways of the FR cells were discovered, identified, and named the medial pathway of the FR (MPFR) and the lateral pathway of the FR (LPFR). The 79 patients who accepted EES to remove mucoceles through the natural drainage pathways of FR cells and the FS showed significant improvement in clinical symptoms, and none of them had recurrence after surgery without serious complications. Conclusion The EES of the FR cells and FS through the natural drainage pathways to remove the mucoceles facilitates exposure of the cells without residual lesions and without serious complications.
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Affiliation(s)
- Zhouying Peng
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Yumin Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Yan Fang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Yaxuan Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Ruohao Fan
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Hua Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
| | - Zhihai Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
- Zhihai Xie
| | - Weihong Jiang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Weihong Jiang
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16
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Geng C, Tong Q, Wang Y, Huang S, Wang M, Xing Z, Sun K. Onodi cell mucocele with cholesterol granuloma is more likely to cause serious optic neuropathy, compared with simple Onodi cell mucocele. EAR, NOSE & THROAT JOURNAL 2022:1455613221080069. [PMID: 35213237 DOI: 10.1177/01455613221080069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective is to describe the clinical features, treatments, and outcomes of a case series of patients with Onodi cell mucocele, with or without cholesterol granuloma (CG). MATERIAL AND METHODS We retrospectively reviewed the medical records of eight patients diagnosed with Onodi cell mucocele at a single tertiary care university hospital in Beijing, China, between January 2017 and September 2020. Data regarding nasal symptoms, ocular symptoms, sinus computed tomography findings, treatments, histopathological results, and clinical outcomes were extracted. RESULTS We identified eight patients (six men and two women) of an average age of 48.1 (range, 26-70) years. Four patients presented nasal symptoms. Three patients presented ocular symptoms. Among them, one patient experienced concurrent nasal and ocular symptoms. Two patients were diagnosed based on a physical examination in the absence of nasal or ocular symptoms. All patients underwent endoscopic sinus surgery. The pathological specimens showed mucocele in four cases and mucocele with CG in the other four cases. Among the four cases with CG, three cases presented with decreased vision. After endoscopic sinus surgery, one patient recovered completely, and two patients showed significant improvement. CONCLUSION If Onodi cell opacity is observed, especially with optic neuropathy, mucocele and CG are important differential diagnoses. The combination of mucocele and CG is more likely to promote bone destruction and cause serious optic neuropathy than simple mucocele. Endoscopic sinus surgery is appropriate. Diagnoses, treatments, and follow-up should be performed by a multidisciplinary team.
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Affiliation(s)
- Congli Geng
- Department of Otorhinolaryngology, Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, China
| | - Qizhe Tong
- Department of Ophthalmology, 71185Peking University People's Hospital, Beijing, China
| | - Yi Wang
- Department of Ophthalmology, 71185Peking University People's Hospital, Beijing, China
| | - Shien Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, China
| | - Min Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, China
| | - Zhimin Xing
- Department of Otorhinolaryngology, Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, China
| | - Kunkun Sun
- Department of Pathology, 71185Peking University People's Hospital, Beijing, China
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17
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Alaraifi AK, Alrusayyis DF, Alzuwayed A, Alobaid F, AlRajeh M, Alhedaithy R. Endoscopic transorbital management of frontal sinus mucocele: a case report and review of the literature. J Surg Case Rep 2021; 2021:rjab491. [PMID: 34733477 PMCID: PMC8560720 DOI: 10.1093/jscr/rjab491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/01/2021] [Indexed: 11/14/2022] Open
Abstract
The frontal sinus is the most common site for paranasal mucoceles, resulting in potentially threatening intraorbital or intracranial complications. Surgical drainage of mucoceles is the mainstay of treatment, which can be achieved usually through open or endoscopic transnasal approaches. Transorbital endoscopic surgery is a relatively novel approach to selective skull base lesions with limited data in the literature. It could be utilized as a safe and effective alternative approach in managing frontal sinus lesions when the endoscopic transnasal access alone is insufficient or inadequate. Here, we present a case of an isolated lateral left frontal mucocele that was managed successfully using an endoscopic transorbital approach alone with complete resolution of symptoms during a 10-month follow-up period.
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Affiliation(s)
- Abdulaziz K Alaraifi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Danah F Alrusayyis
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Alzuwayed
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad Alobaid
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed AlRajeh
- Division of Ophthalmology, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Riyadh Alhedaithy
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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18
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Saratziotis A, Zanotti C, Baldovin M, Prosenikliev V, Emanuelli E. Burkholderia Cepacia Causes Frontal Mucopyocele with Anterior Cranial Fossa Extension: A Novel Case Report. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2021; 33:327-332. [PMID: 34692580 PMCID: PMC8507942 DOI: 10.22038/ijorl.2021.51654.2753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 07/24/2021] [Indexed: 11/16/2022]
Abstract
Introduction: Burkholderia cepacia complex (Bcc) is a group of gram-negative bacilli that have rarely been isolated in the ear, nose and throat region in immunocompetent patients. Bcc show resistance to most available antibacterial drugs. Case Report: We present the case of an immunocompetent 31-year-old male reporting a pulsating headache with right supraorbital swelling associated with exophthalmos. A brain CT scan showed an expansive giant cystic lesion occupying the right frontal sinus, extending to the anterior cranial fossa. Management and outcome: drainage with the resecting of the floor of the frontal sinus from the orbital plate of the ethmoid bone to the nasal septum (Draf IIb) was performed with wide marsupialization of the mucopyocele. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was used to identify the isolate. MRI 1 and 12 months after surgery showed complete lesion removal. The patient was followed for 12 months with complete recovery of symptoms. Conclusion: Paranasal sinuses disease with cranial expansion and orbital complications constitutes an emergency. For the first time in the literature, Bcc was isolated in the frontal sinus, extending into the anterior cranial fossa, in an immunocompetent patient. An endoscopic surgical approach with microbiological identification and management by appropriate antibacterial drug treatment seems to be the key to success.
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Affiliation(s)
| | - Claudia Zanotti
- Department of Neurosciences, Otolaryngology Section, University of Padua, Italy
| | - Maria Baldovin
- Department of Neurosciences, Otolaryngology Section, University of Padua, Italy
| | - Vlatko Prosenikliev
- Department of Otolaryngology, General Hospital San Dona di Piave, Venice, Italy
| | - Enzo Emanuelli
- Department of Neurosciences, Otolaryngology Section, University of Padua, Italy
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19
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Liu M, Jin K, Sun J, Lou Z. Postoperative ethmoid sinus mucoceles: Late complication of endoscopic ethmoidectomy and MWA management in outpatient. Am J Otolaryngol 2021; 42:103120. [PMID: 34167833 DOI: 10.1016/j.amjoto.2021.103120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/14/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the feasibility of intranasal endoscopic microwave ablation (MWA) on the management of postoperative ethmoid sinus mucoceles. METHODS AND MATERIALS The patients with postoperative ethmoid sinus mucoceles were ablated through intranasal endoscopic MWA. Postoperative pain intensity was measured via visual analogue scale (VAS), post-operative complications were recorded. RESULTS Of the 26 patients with unilateral postoperative ethmoid sinus mucoceles, the mucoceles were diagnosed 3 to 11 years with average time of time of 6.9 ± 2.7 years after endoscopic ethmoidectomy. The ipsilateral middle turbinate was present and intact in 24 patients and partially resected during the original surgery in the remaining 2. There were adhesions in the middle meatus in one case. All 26 patients were successfully treated with the intranasal endoscopic ablation technique in outpatient. The ablation time was 6 to 11 min, with an average duration of 6.84 ± 1.27 min. The mean VAS pain score was 2.41 ± 1.22. There were no perioperative complications reported in this series. No evidence of recurrence was observed in any patients during follow-up periods. CONCLUSIONS The present study demonstrates the safety and efficacy of intranasal endoscopic MWA in the office. The procedure is well tolerated by patients with low complication rates. Thus, it is alternative to conventional endonasal endoscopic marsupialization for treatment of postsurgical ethmoid sinus mucoceles.
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20
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Agrawal S, Modaboyina S, Rathod A, Das D. Double globes in single-orbit sign. THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:246. [PMID: 35112540 DOI: 10.25259/nmji_600_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Sahil Agrawal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sujeeth Modaboyina
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Aishwarya Rathod
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepsekhar Das
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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21
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Theofilou NE, Becker M, Lombardi T, Scolozzi P. Posttraumatic Respiratory Epithelial Orbital Cyst With Intracranial Extension: A Unique Association. Ophthalmic Plast Reconstr Surg 2021; 37:e25-e28. [PMID: 32427731 DOI: 10.1097/iop.0000000000001714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Respiratory epithelial orbital cysts (REOC) are rare benign lesions that may be either congenital or acquired. Congenital REOC develop from embryological epithelial rests and are known as choristomas, whereas acquired forms develop from the sequestration of respiratory epithelium from adjacent paranasal sinuses following trauma and/or fracture repair procedures. The final diagnosis can be difficult because congenital and acquired REOC and mucoceles share the same features histologically. The involvement of the paranasal sinuses, which is the landmark of mucoceles, does not occur with REOC. Moreover, the intracranial extension, which is known for mucoceles, has never been reported for REOC. Respiratory epithelial orbital cysts warrant prompt radical surgical resection given that these lesions may lead to a progressive intracranial progression and/or recurrent infection with a potential for meningitis or cerebral abscess. The authors report a unique case of a patient with an intraorbital posttraumatic respiratory epithelial orbital cyst associated with intracranial involvement.
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Affiliation(s)
| | - Minerva Becker
- Division of Radiology, Department of Imaging and Medical Informatics
| | | | - Paolo Scolozzi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
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22
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James D, Garry S, Corbett M, Keogh I. 'A Down and Out Eye': Case Report of a Primary Ethmoid Mucocele. Cureus 2021; 13:e14432. [PMID: 33996298 PMCID: PMC8114966 DOI: 10.7759/cureus.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Paranasal sinus mucoceles are benign, locally expansile masses of the paranasal sinuses that are lined by epithelial cells. They result from obstruction of sinus ostia. The close proximity of paranasal sinus mucoceles to the orbit and skull base predisposing the patient to significant morbidity. We describe the case of a previously healthy 23-year-old gentleman presenting with a five-day history of unilateral (left) eye pain and swelling with an obvious deformity. There was also no history of trauma or prior surgery. He underwent a CT sinus, which showed near complete opacification of the left anterior ethmoid sinus with bony destruction and obvious displacement of the orbit both laterally and anteriorly. This was assessed as to be in keeping with an ethmoid mucocele. Endoscopic marsupialization has become the preferred surgical approach over obliterative procedures for the treatment of paranasal sinus mucoceles. Primary ethmoid mucocele is an uncommon entity, especially in the absence of prior ear, nose and throat (ENT) complaints, and therefore should remain an important differential when a patient presents with a unilateral swelling causing proptosis.
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Affiliation(s)
- Danielle James
- Otolaryngology - Head and Neck Surgery, University Hospital Galway, Galway, IRL
| | - Stephen Garry
- Otolaryngology - Head and Neck Surgery, University Hospital Galway, Galway, IRL
| | - Mel Corbett
- Otolaryngology, University Hospital Galway, Galway, IRL
| | - Ivan Keogh
- Otolaryngology - Head and Neck Surgery, University Hospital Galway, Galway, IRL
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23
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 384] [Impact Index Per Article: 128.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Pinarci M, Haas C, Flaig MJ, Oppel EM. [Frontal sinus mucocele]. Hautarzt 2020; 71:14-15. [PMID: 32974704 DOI: 10.1007/s00105-020-04630-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Melda Pinarci
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland.
| | - Carolin Haas
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland
| | - Eva Maria Oppel
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland
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Abstract
AIMS To evaluate clinical features of patients who first present with orbital symptoms and signs due to undiagnosed sinonasal pathology. PATIENTS AND METHODS Retrospective chart review for patients seen at Moorfields Eye Hospital between 1969 and 2020. Patient demographics and clinical features were reviewed. RESULTS Four hundred and forty-eight patients (250 males; 56%) presented to ophthalmologists with undiagnosed sinonasal pathologies, the patients attending at an average age of 47 years and having first symptoms at an average age of 46 years. The commonest presenting symptoms were proptosis (153 patients; 34%), orbital ache or pain (133; 31%), periorbital swelling (130; 29%), and diplopia (98; 22%). Eighty-seven patients (20%) had a corrected acuity of 6/18 or worse, and 66 (16%) had an ipsilateral relative afferent pupillary defect. There was 2.3 mm relative exophthalmos (median 2 mm; range 0-17 mm) in patients with unilateral disease, an orbital mass was palpable in 218 patients (49%), ocular movements were reduced in 252/448 (56%), and nonaxial displacement of the globe was recorded in 296/424 (74%). The commonest pathologies were sinus mucoceles (38%), sinus carcinoma (11%), and granulomatous polyangiitis (10%). Multivariate regression analysis of mass lesions identified periorbital pain (odds ratio, 6.0; 95% confidence interval, 1.7-21.5; P = 0.005) and reduced motility (odds ratio, 3.2; 95% confidence interval, 1.1-9.0; P = 0.03) as features most predictive for undiagnosed sinonasal malignancy. CONCLUSION This study describes a large group of patients in whom unknown midfacial masses presented initially to the ophthalmologist: Mucoceles and sinonasal malignancy were the commonest lesions, and nonaxial globe displacement-particularly inferolateral, lateral, or upward-is commonly associated with sinonasal pathology. Pain and reduced ocular movements significantly favor a malignant, rather than benign, tumor.
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Crocetta FM, Farneti P, Sollini G, Castellucci A, Ghidini A, Spinosi MC, Fernandez IJ, Zoli M, Mazzatenta D, Pasquini E. Endoscopic management of frontal sinus diseases after frontal craniotomy: a case series and review of the literature. Eur Arch Otorhinolaryngol 2020; 278:1035-1045. [PMID: 32880737 DOI: 10.1007/s00405-020-06335-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate frontal sinus complications developed after previous external craniotomies requiring frontal sinus reconstruction and their treatment with an endoscopic approach. METHODS We retrospectively evaluated 22 patients who referred to Sant'Orsola-Malpighi University Hospital and Bellaria Hospital (Bologna, Italy) between 2005 and 2017. All patients presented with frontal sinus disease after frontal craniotomy with sinus reconstruction performed to treat various pathological conditions. We reported our experience in the endoscopic management of such complications and we reviewed the current literature concerning the endoscopic treatment of these conditions. RESULTS In total, 14 frontal mucoceles, 4 cases of chronic frontal sinusitis, 2 mucopyoceles and 2 fungus ball of the frontal sinus were identified. Endoscopic surgical treatment included 7 DRAF IIa, 1 DRAF IIb, 11 DRAF III and 3 DRAF IIc (modified DRAF III) approaches. The success rate of the surgical procedure was 86% (19/22 patients). Recurrence of the initial pathology occurred in three patients (14%) requiring a conversion of previous frontal sinusotomy into a DRAF III sinusotomy. CONCLUSION Frontal sinusopathy can be a long-term complication following craniotomies and may lead to potentially severe pathological conditions, such as mucoceles and frontal sinus inflammation. Its management is still debated and requires recovery of the patency of nasal-frontal route. Our study confirms that the endoscopic endonasal approach may offer a valid solution with low morbidity avoiding re-opening of the craniotomic access. For selected cases, endoscopic approach could also be performed simultaneously to craniotomy as a combined surgery to reduce the risk of short- and long-term complications. Long-term follow-up is mandatory in patients with a history of opened and reconstructed frontal sinus and should include imaging and endoscopic outpatient evaluation.
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Affiliation(s)
- F M Crocetta
- ENT Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. .,ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - P Farneti
- ENT Department, Santa Maria Della Scaletta Hospital, Imola, BO, Italy
| | - G Sollini
- ENT Department, Bellaria Hospital, Bologna, Italy
| | - A Castellucci
- ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - A Ghidini
- ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - M C Spinosi
- ENT Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - I J Fernandez
- ENT Department, University Hospital of Modena, Modena, Italy
| | - M Zoli
- Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery - IRCCS, Bologna, Italy
| | - D Mazzatenta
- Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery - IRCCS, Bologna, Italy
| | - E Pasquini
- ENT Department, Bellaria Hospital, Bologna, Italy
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27
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Roncone DP. Frontoethmoidal mucocele presenting with ocular manifestations. Clin Exp Optom 2019; 103:610-617. [PMID: 31773805 DOI: 10.1111/cxo.13006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/19/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Mucocele of the paranasal sinuses is a slowly expanding benign lesion developing when there is impeded physiological drainage of the mucous produced by the epithelial lining of the paranasal sinuses, at the sinus ostium, which is an opening that connects the sinus to the nasal cavity. Aetiologies of ostial occlusion include infection, allergy, trauma, previous surgery, benign neoplasm (osteoma or fibrous dysplasia), and malignant or metastatic tumours. Mucoceles commonly develop in the frontal sinus (70-80 per cent), followed by the ethmoid (25 per cent), frontoethmoidal (10-14 per cent), and maxillary (three per cent or less) sinuses. The most common manifestations in these cases are ocular oedema, proptosis (22-83 per cent), and diplopia (28 per cent). Due to these ocular signs and symptoms, the optometrist may be first in line managing paranasal sinus disease patients, reducing the risk of permanent damage. A case report and review of frontoethmoidal mucocele will be discussed in this report, to include the role of the optometrist in its management and treatment.
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Affiliation(s)
- David P Roncone
- Optometry Clinic, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
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28
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Williams V, Iyer R, Reshma A, Jayashree M, Mohindra S, Verma S. Frontal pyomucocoele as forehead swelling in a five-year-old girl. Trop Doct 2019; 49:316-318. [PMID: 31311462 DOI: 10.1177/0049475519864249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mucocoeles are slow-growing, locally aggressive, mucus-containing cysts, lined by epithelium, which, when infected, are called pyomucocoeles. We present the case of a five-year-old girl who presented with a frontal pyomucocoele requiring decompression and adequate antibiotics.
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Affiliation(s)
- Vijai Williams
- Senior Resident, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Rajalakshmi Iyer
- Senior Resident, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Aramanadka Reshma
- Senior Resident, Department of Pediatrics, PGIMER, Chandigarh, India
| | | | | | - Sanjay Verma
- Professor, Department of Pediatrics, PGIMER, Chandigarh, India
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Affiliation(s)
- Satvinder Singh Bakshi
- Department of Ear, Nose, and Throat; Mahatma Gandhi Medical College and Research Institute; Pillayarkuppam, Pondicherry, India.,Department of Ear, Nose, and Throat; Sri Balaji Vidyapeeth; Pondicherry, India
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30
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Jaafoura H, Tbini M, Riahi I, Harhira MR, Ben Salah M. Mucocèles nasosinusiennes post-radiques à propos de trois cas. Cancer Radiother 2019; 23:228-231. [PMID: 31126746 DOI: 10.1016/j.canrad.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 10/26/2022]
Abstract
Nasosinusal mucoceles, although benign, are aggressive and sometimes destructive lesions. They may occur as a result of trauma, infection, sinus surgery and head and neck radiation. We describe three patients presenting mucocele, with the history of nasopharyngeal and temporal fossa cancers treated by radiotherapy.
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Affiliation(s)
- H Jaafoura
- Service ORL et chirurgie cervicofaciale, hôpital Charles-Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie.
| | - M Tbini
- Service ORL et chirurgie cervicofaciale, hôpital Charles-Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie
| | - I Riahi
- Service ORL et chirurgie cervicofaciale, hôpital Charles-Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie
| | - M R Harhira
- Service ORL et chirurgie cervicofaciale, hôpital Charles-Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie
| | - M Ben Salah
- Service ORL et chirurgie cervicofaciale, hôpital Charles-Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie
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31
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Mizushima Y, Mumo T, Yasui T, Ito K. Paranasal sinus mucocele with visual disturbances whose causative legion was hardly identified on computed tomography imaging: A case report. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2019. [DOI: 10.1080/23772484.2019.1589376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Yu Mizushima
- Department of Otolaryngology and Head and Neck Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Mumo
- Department of Otolaryngology and Head and Neck Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takuya Yasui
- Department of Otolaryngology and Head and Neck Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Ito
- Department of Otolaryngology and Head and Neck Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Devaraja K, Verma H, Kumar R. Implication of frontal sinus mucocele's location and intrasinus septation. BMJ Case Rep 2019; 12:12/3/e226830. [PMID: 30898953 DOI: 10.1136/bcr-2018-226830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mucocele of paranasal sinuses commonly affects frontal or frontoethmoidal air cells. With the evolution of endoscopic sinus surgery, the endoscopic marsupialisation has become the standard of care for these lesions. However, the external approach still has a role in selected cases of frontal sinus mucocele. The location of the mucocele and its communication with the natural outflow tract of the frontal sinus are some of the critical factors to be considered while choosing the surgical approach. We have discussed the management of three cases of frontal mucoceles having different locations and one of them having intervening septa. We emphasise that the successful management of far laterally located mucoceles and those with laterally situated septation require an external approach in conjunction with endoscopic marsupialisation.
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Affiliation(s)
- K Devaraja
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
| | - Hitesh Verma
- Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rajeev Kumar
- Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Benkhatar H, Khettab I, Sultanik P, Laccourreye O, Bonfils P. Mucocele development after endoscopic sinus surgery for nasal polyposis: A long-term analysis. EAR, NOSE & THROAT JOURNAL 2019; 97:284-294. [PMID: 30273428 DOI: 10.1177/014556131809700918] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to determine the prevalence of long-term mucocele development after functional endoscopic sinus surgery (FESS) for nasal polyposis, to search for a statistical relationship with preoperative variables and to analyze the management of this complication. A retrospective analysis of 153 patients who underwent FESS for nasal polyposis, with a minimum of 7 years of follow-up, was performed. Mucocele diagnosis was based on regular clinical and radiologic evaluation. Univariate and multivariate statistical analysis was performed. The postoperative mucocele rate was 13.1% (20 patients). The mean delay between surgery and mucocele diagnosis was 6.25 years. A high preoperative Lund-Mackay score (>19) was a risk factor for postoperative mucocele (p = 0.04). Asthma and aspirin intolerance did not increase the risk of this complication. Endoscopic marsupialization of mucoceles was successful in 19 patients, with only one recurrent frontal mucocele. One patient required external approaches for two frontal mucoceles. In conclusion, mucocele risk after FESS for nasal polyposis is significant, especially in case of a high preoperative Lund-Mackay score (>19). Long-term clinical follow-up is recommended, imaging being prescribed based on symptoms or abnormal findings on clinical examination. Endoscopic marsupialization is very effective, but frontal mucoceles are more likely to recur.
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Affiliation(s)
- Hakim Benkhatar
- ORL, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
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Plantier DB, Neto DB, Pinna FDR, Voegels RL. Mucocele: Clinical Characteristics and Outcomes in 46 Operated Patients. Int Arch Otorhinolaryngol 2018; 23:88-91. [PMID: 30647790 PMCID: PMC6331304 DOI: 10.1055/s-0038-1668126] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/26/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction
Paranasal sinus mucocele is a benign, expansive lesion associated with paranasal sinus obstruction. It affects mostly adults, and is most common in the frontal and ethmoidal sinuses.
Objective
To evaluate outcomes in patients undergoing surgical treatment for paranasal sinus mucocele.
Methods
Retrospective review of medical records of patients treated for paranasal sinus mucocele at the ENT department of a tertiary care hospital between 2005 and 2016.
Results
Forty-six patients underwent surgical treatment of paranasal sinus mucocele. The mean age was 50.1 years, and 56.5% were male. The most prevalent symptom was pain, and the frontal sinus was most commonly affected. The vast majority of patients (89.1%) underwent endoscopic sinus marsupialization; 10.9% required combined open and endoscopic access. Seven recurrences occurred.
Conclusion
Sinus mucocele is an expansive disease that primarily affects the frontal sinus of adult patients. In most cases, endoscopic surgery is an effective treatment modality.
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Affiliation(s)
- Diogo Barreto Plantier
- Department of Otolaryngology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Deusdedit Brandão Neto
- Department of Otolaryngology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Fabio de Rezende Pinna
- Department of Otolaryngology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Richard Louis Voegels
- Department of Otolaryngology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
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Abstract
PURPOSE OF REVIEW To review the recent literature of pediatric endoscopic sinus surgery (ESS). RECENT FINDINGS Sinus balloon catheter dilation is an important addition to the surgical treatment tools for pediatric chronic rhinosinusitis (PCRS). ESS is a safe and effective therapeutic modality for uncomplicated PCRS. For PCRS complicated by comorbidities including cystic fibrosis and primary ciliary dyskinesia, ESS and adjuvant medical therapy confers significant sinus, pulmonary, and quality of life benefits to pediatric patients. SUMMARY ESS is a safe and effective treatment modality in the management of pediatric acute and chronic sinus disorders.
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Rodriguez DP, Orscheln ES, Koch BL. Masses of the Nose, Nasal Cavity, and Nasopharynx in Children. Radiographics 2017; 37:1704-1730. [DOI: 10.1148/rg.2017170064] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Diana P. Rodriguez
- From the Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205 (D.P.R.); and Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, Ohio (E.S.O., B.L.K.)
| | - Emily S. Orscheln
- From the Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205 (D.P.R.); and Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, Ohio (E.S.O., B.L.K.)
| | - Bernadette L. Koch
- From the Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205 (D.P.R.); and Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, Ohio (E.S.O., B.L.K.)
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Verillaud B, Le Clerc N, Blancal JP, Guichard JP, Kania R, Classe M, Herman P. Mucocele formation after surgical treatment of inverted papilloma of the frontal sinus drainage pathway. Am J Rhinol Allergy 2017; 30:181-4. [PMID: 27657893 DOI: 10.2500/ajra.2016.30.4351] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Inverted papillomas (IP) inserted in the frontal sinus and/or recess may be treated by using an endoscopic endonasal or an external approach. There are still few data available on this uncommon localization of IPs. OBJECTIVE To report our experience in the management of IP of the frontal drainage pathway, to describe a previously unreported specific complication of this surgery, and to discuss the optimal surgical strategy. METHODS A retrospective study of the patients at a tertiary care center between 2004 and 2014 who were operated on for an IP with an insertion in the frontal recess and/or the frontal sinus. Clinical charts were reviewed for demographics, clinical presentation, imaging findings, surgical treatment, and outcome. RESULTS Twenty-seven patients were included. Patients were operated on by using a purely endoscopic approach (Draf procedure; n = 14 [51.9%]) when the IP was inserted in the frontal recess and/or the frontal sinus infundibulum (with a nasoseptal-septoturbinal flap placed on the exposed bone in four patients), or by using a combined endoscopic and open approach (osteoplastic flap procedure; n = 13 [48.1%]) when the IP invaded the frontal sinus beyond the infundibulum. There were two recurrences (7.4%), with a mean follow-up of 40 months (range, 9-123 months). During follow-up, single or multiple iatrogenic frontal mucoceles were observed in 10 patients (37%), with a mean delay of 60 months (range, 27-89 months). These mucoceles occurred both after using endoscopic (n = 3) or combined (n = 7) approaches, and required a surgical treatment in eight patients. No postoperative mucocele was observed in the four patients who had had a septal flap. CONCLUSION In our experience, an approach based on the localization of the IP insertion provided acceptable results in terms of the local control rate (92.6%). However, the significant rate of postoperative mucoceles indicated that specific strategies (such as local flaps) still need to be developed to avoid this iatrogenic complication.
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Affiliation(s)
- Benjamin Verillaud
- Department of Otorhinolaryngology-Head and Neck Surgery, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris VII University, Paris, France
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First results of frontal sinus obliteration with a synthetic, resorbable and osteoconductive bone graft of ß-tricalcium phosphate. The Journal of Laryngology & Otology 2017; 131:534-540. [PMID: 28366182 DOI: 10.1017/s0022215117000706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite advances in endoscopic sinus surgery, frontal sinus obliteration is still indicated in some cases. Current options for obliteration include autologous and synthetic materials. The use of ß-tricalcium phosphate as a resorbable bone graft substitute is a good alternative for frontal sinus obliteration. This study aimed to report our experience with this material. METHODS A retrospective chart review of patients who underwent frontal sinus obliteration at our clinic between 2008 and 2013 was performed. Demographic data, indications, previous surgery, and immediate and late complications were examined. Information on persisting symptoms and patient outcomes was collected using a telephone questionnaire in February 2016. RESULTS None of the patients underwent further surgery for frontal sinus disease. All of them reported a good cosmetic result and symptom improvement. CONCLUSION ß-tricalcium phosphate is a good, safe and cost-effective material for frontal sinus obliteration.
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Mehta AA, Wagner LH, Blace N. Spontaneous upper eyelid ecchymosis: A rare presenting sign for frontal sinus mucocele. Orbit 2017; 36:183-187. [PMID: 28282265 DOI: 10.1080/01676830.2017.1280058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Paranasal sinus mucoceles are benign lesions that commonly present with orbital signs due to their anatomic proximity. We are reporting a case of bilateral frontal sinus mucocele presenting with spontaneous eyelid ecchymosis. To our knowledge this is the first case report of eyelid ecchymosis as the initial sign of this condition. In addition, our patient lacked commonly described symptoms such as diplopia or pain. This report highlights the importance of including frontal sinus mucocele in the differential diagnosis of spontaneous periorbital ecchymosis.
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Affiliation(s)
- Amy A Mehta
- a Bronx Lebanon Hospital Center, Bronx , New York , USA
| | | | - Nancy Blace
- a Bronx Lebanon Hospital Center, Bronx , New York , USA.,b Albert Einstein College of Medicine , New York , New York , USA
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40
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Thamboo A, Patel ZM. Office Procedures in Refractory Chronic Rhinosinusitis. Otolaryngol Clin North Am 2017; 50:113-128. [DOI: 10.1016/j.otc.2016.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Abstract
PURPOSE Mucoceles are mucus-containing cysts that form in paranasal sinuses; although mucoceles themselves are benign, this case report highlights the extensive damage they can cause as their expansion may lead to bony erosion and extension of the mucocele into the orbit and cranium; it also presents a rarely reported instance of frontal sinus mucocele leading to frontal lobe syndrome. A thorough discussion and review of mucoceles is included. CASE REPORT A 68-year-old white man presented with intermittent diplopia and a pressure sensation in the right eye. He had a history of chronic sinusitis and had had endoscopic sinus surgery 5 years prior. A maxillofacial computed tomography scan revealed a large right frontal sinus mucocele, which had caused erosion along the medial wall of the right orbit and the outer and inner tables of the right frontal sinus. The mucocele had protruded both into the right orbit and intracranially, causing mass effect on the frontal lobe, which led to frontal lobe syndrome. The patient was successfully treated with endoscopic right ethmoidectomy, radial frontal sinusotomy, marsupialization of the mucocele, and transcutaneous irrigation. CONCLUSIONS Paranasal sinus mucoceles may expand and lead to bony erosion and can become very invasive in surrounding structures such as the orbit and cranium. This case not only exhibits a very rare presentation of frontal sinus mucocele with intracranial extension and frontal lobe mass effect causing a frontal lobe syndrome but also demonstrates many of the ocular and visual complications commonly associated with paranasal sinus mucoceles. Early identification and surgical intervention is vital for preventing and reducing morbidity associated with invasive mucoceles, and the patient must be followed regularly to monitor for recurrence.
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Mora-Horna ER, López VG, Anaya-Alaminos R, Ceriotto A, Salcedo G. Optic neuropathy secondary to a sphenoid-ethmoidal mucocele: Case report. ACTA ACUST UNITED AC 2015; 90:582-4. [PMID: 26243436 DOI: 10.1016/j.oftal.2015.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/05/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
CASE REPORT The case is presented of a 51-year old male patient with a history of blunt trauma in the frontal region and a one-year history of vision loss, proptosis and paresis of the lateral rectus muscle of the right eye. A right ethmoid and bilateral sphenoid mucocele was diagnosed. Drainage was performed using an external and endoscopic approach with improvement in symptoms without recurrence at 10 months. DISCUSSION Sphenoid mucoceles represent 1% of all mucoceles and may present with different clinical manifestations. Surgical excision is the treatment of choice, and early intervention is indicated to prevent complications.
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Affiliation(s)
- E R Mora-Horna
- Servicio de Párpados, Órbita y Vía Lagrimal, Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sánchez Bulnes, México, DF, México.
| | - V G López
- Servicio de Párpados, Órbita y Vía Lagrimal, Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sánchez Bulnes, México, DF, México
| | - R Anaya-Alaminos
- Departamento de Órbita, Oculoplástica y Vías Lagrimales, Institut Català de Retina, Barcelona, España
| | - A Ceriotto
- Servicio de Párpados, Órbita y Vía Lagrimal, Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sánchez Bulnes, México, DF, México
| | - G Salcedo
- Servicio de Párpados, Órbita y Vía Lagrimal, Asociación para Evitar la Ceguera en México, Hospital Dr. Luis Sánchez Bulnes, México, DF, México
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Simões JC, Nogueira-Neto FB, Gregório LL, Caparroz FDA, Kosugi EM. Visual loss: a rare complication of maxillary sinus mucocele. Braz J Otorhinolaryngol 2015; 81:451-3. [PMID: 26141207 PMCID: PMC9442742 DOI: 10.1016/j.bjorl.2015.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 02/25/2015] [Accepted: 03/16/2015] [Indexed: 12/03/2022] Open
Affiliation(s)
- Juliana Caminha Simões
- Rhinology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | | | - Luciano Lobato Gregório
- Rhinology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | - Fábio de Azevedo Caparroz
- Rhinology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | - Eduardo Macoto Kosugi
- Rhinology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil.
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Barrow EM, DelGaudio JM. In-office drainage of sinus Mucoceles: An alternative to operating-room drainage. Laryngoscope 2014; 125:1043-7. [DOI: 10.1002/lary.25042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/25/2014] [Accepted: 09/09/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Emily M. Barrow
- Department of Otolaryngology-Head and Neck Surgery; Emory University School of Medicine; Atlanta Georgia U.S.A
| | - John M. DelGaudio
- Department of Otolaryngology-Head and Neck Surgery; Emory University School of Medicine; Atlanta Georgia U.S.A
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Jacobs J. Editorial: allergy and immunology. Int Forum Allergy Rhinol 2014; 3:689-90. [PMID: 24078290 DOI: 10.1002/alr.21225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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