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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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Combined Surgical Approach in the Treatment of Oculoorbital Complications of Frontal Sinus Mucocele: A Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2018-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Paranasal sinus mucoceles are benign cystic masses filled with mucous content. Mucoceles are locally destructive, causing pressure on sinus walls with their resorption, allowing them to spread on adjacent structures causing local, orbital or intracranial complications. They are most commonly found in frontal sinuses.
The aim of this report is to present case of oculo-orbital complications of frontal sinus mucocele, with focus on treatment using combined surgical approach.
A 75-year old female patient with frontal sinus mucocele which led to destruction of orbital roof and occurrence of complications in form of orbital cellulitis and palpebral abscess was successfully treated with a combination of external frontoethmoidectomy and endoscopic sinus surgery. After initial incision of the upper eyelid abscess with drainage of purulent content, modified external frontoethmoidectomy was performed using preformed defect of orbital roof. Finally, using endoscopic sinus surgery, natural drainage of anterior group of paranasal sinuses was achieved.
Various endoscopic and open approaches have been described in mucocele treatment. In this case we showed that the combined surgical approach in the treatment of frontal sinus mucoceles with destruction of sinus floor and appearance of oculo-orbital complications, provides an effective treatment and allows natural drainage of anterior group of sinuses.
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AlShakhs A, AlMomen A, Alharbi M, Almolani F, Alawadh A, Alameer M. The endonasal endoscopic management of pediatric lateral frontal mucocele. Int J Surg Case Rep 2021; 78:405-409. [PMID: 33418279 PMCID: PMC7804337 DOI: 10.1016/j.ijscr.2020.12.040] [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] [Received: 11/08/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/05/2022] Open
Abstract
Frontal mucoceles in children are rare. A child with lateral frontal mucocele with no known etiology. This shows the usefulness of image-guided endoscopic sinus surgery.
Objectives The aim of this report is to show the usefulness of endoscopic sinus surgery in management of lateral frontal mucocele in pediatric patient. Case presentation A 14 years old girl presented with right frontal bone depression and headache. CT and MRI showed lateral mucocele occupying the right frontal sinus. The patient was managed successfully by image-guided endoscopic sinus surgery and she was well after two years follow up. Discussion & conclusion Frontal mucoceles in children are rare. We report a rare case of a child with lateral frontal mucocele with no known etiology, treated successfully by image-guided endoscopic sinus surgery with no recurrence after two years follow-up. This case shows the usefulness of image-guided endoscopic sinus surgery in treatment of lateral frontal mucocele in children.
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Affiliation(s)
| | - Ali AlMomen
- Rhinology and Endoscopic Skull Base Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
| | - Maha Alharbi
- ENT Trainee Resident, Saudi ORL Program, Eastern Province, Saudi Arabia
| | - Fadhel Almolani
- Radiology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Dey S, Agarwal M. Frontoethmoidal mucocele causing proptosis and visual loss. Natl J Maxillofac Surg 2020; 11:121-123. [PMID: 33041590 PMCID: PMC7518502 DOI: 10.4103/njms.njms_93_18] [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] [Received: 12/30/2018] [Revised: 09/09/2019] [Accepted: 10/10/2019] [Indexed: 11/04/2022] Open
Abstract
Mucoceles are benign mucus-containing cysts formed due to the obliteration of sinus ostium. They are most commonly found in the frontal sinus. Mucoceles can spread both intraorbitally and intracranially causing complications such as meningitis, brain abscess, and loss of vision. Radiological investigations are required for diagnosis, with both computed tomography (CT) and magnetic resonance imaging (MRI) being useful. Surgical approaches for management have changed from external to endonasal these days. We report a case where a 54-year-old patient presented to us with a 14 days' history of loss of vision and complete closure of eyes over 2 days. Contrast-enhanced CT scan and MRI confirmed the diagnosis of frontoethmoidal mucocele breaching the left frontal sinus floor. Endoscopic orbital decompression with functional endoscopic sinus surgery was done. Eye movements and ptosis recovered completely after the surgery, but the vision did not. Although the etiology of mucocele is multifactorial, obstruction of sinus ostium is the most plausible cause. Increasing pressure on adjacent structures by the expanding mucocele can cause intraorbital and intracranial complications. MRI is superior to CT in differentiating mucocele from soft-tissue neoplasms, although CT gives a more detailed information on bone structure. Endoscopic approaches have become the most preferred way to access frontoethmoidal mucoceles, with external approaches being reserved for mucoceles in certain inaccessible locations. Timely intervention is imperative to prevent undesirable complications.
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Affiliation(s)
- Subhankar Dey
- Department of ENT and Head and Neck, Apollo Gleneagles Hosipitals, Kolkata, West Bengal, India
| | - Mehak Agarwal
- Department of ENT and Head and Neck, Apollo Gleneagles Hosipitals, Kolkata, West Bengal, India
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Brown JD, Woerde DJ, Hoffmann KL, Liu WM, Goldsmid S, Brown NL. Partial resolution of chronic unilateral sinonasal obstructive disease in a cat using a temporary polyvinylchloride stent. JFMS Open Rep 2020; 6:2055116920943689. [PMID: 32843988 PMCID: PMC7418253 DOI: 10.1177/2055116920943689] [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] [Accepted: 06/18/2020] [Indexed: 12/02/2022] Open
Abstract
Case summary A 3-year-old male neutered domestic shorthair cat presented for further investigation of a swollen left eyelid and a hard, non-painful bony swelling over the left frontal sinus. Physical examination revealed no nasal discharge or airflow through the left nostril. A CT of the head revealed a left frontal sinus obstruction with expansile remodelling and osteolucency. Drainage of the frontal sinus obstruction was alleviated via placement of a temporary polyvinylchloride (PVC) stent that was left in place for 6 weeks. Purulent material removed from the frontal sinus returned a positive culture for Pseudomonas aeruginosa susceptible to marbofloxacin that was continued for 4 weeks, and for an additional 2 weeks after stent removal. A left-sided mucoid nasal discharge returned 3 months after removal of the stent. Repeat CT performed 20 months after surgery found the presence of a gas-filled frontal sinus and partial resolution in the amount of fluid within the mid and rostral nasal cavity. A repeat positive culture for P aeruginosa was also obtained. The exact cause of the chronic unilateral sinonasal obstruction remains unclear, but an underlying chronic rhinitis with secondary obstructive frontal sinusitis or sinus mucocoele with secondary nasal extension was suspected. Relevance and novel information Chronic rhinosinusitis in cats can be a challenging condition to treat and cure. This case illustrates the partial resolution of chronic unilateral sinonasal obstructive disease in a cat using a temporary PVC stent.
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Affiliation(s)
| | | | - Karon L Hoffmann
- Animal Referral Hospital, Homebush, NSW, Australia.,Imaging Vets, Putney, NSW, Australia
| | - Wen-Meng Liu
- Animal Referral Hospital, Homebush, NSW, Australia
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Abstract
The aim of the study was to correlate several studies dating from 1997 to 2015 to identify the most effective treatments for mucocele in the frontal sinus (with/without other paranasal sinuses), considering successful outcomes and recurrence. We aimed to conduct a literature review for articles published between 1997 and 2015. For this, we accessed articles in the SciELO database, as well as LILACS, PubMed, and Google Scholar databases. Were identified 32 work-related injuries in the paranasal sinuses; 2 of these were not related to mucoceles or mucopyocele, 4 had no relation to the frontal sinus, 9 were related to the frontal sinus and other paranasal sinuses, 4 were related to mucocele associated with other sinuses, and 13 involved only the frontal sinus. Endoscopic techniques decrease intra- and postoperative morbidity, reducing the operative time, allow a larger view of the lesion and surrounding anatomical structures, and decrease chances of recurrence. Thus, the successful outcomes have been beneficial to both the surgeon and the patient.
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Carniol ET, Vázquez A, Patel TD, Liu JK, Eloy JA. Utility of intraoperative flexible endoscopy in frontal sinus surgery. ALLERGY & RHINOLOGY 2017; 8:81-84. [PMID: 28583231 PMCID: PMC5468760 DOI: 10.2500/ar.2017.8.0205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Surgical management of the frontal sinus can be challenging. Extensive frontal sinus pneumatization may form a far lateral or supraorbital recess that can be difficult to reach by conventional endoscopic surgical techniques, requiring extended approaches such as the Draf III (or endoscopic modified Lothrop) procedure. Rigid endoscopes may not allow visualization of these lateral limits to ensure full evacuation of the disease process. Methods: Here we describe the utility of intraoperative flexible endoscopy in two patients with far lateral frontal sinus disease. Results: In both cases, flexible endoscopy allowed confirmation of complete evacuation of pathologic material, thereby obviating more extensive surgical dissection. Conclusion: In cases where visualization of the far lateral frontal sinus is inadequate with rigid endoscopes, flexible endoscopy can be used to determine the need for more extensive dissection.
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Affiliation(s)
- Eric T. Carniol
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Tapan D. Patel
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - James K. Liu
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, and
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- The Sinus Institute of Rhode Island, East Providence, Rhode Island
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, and
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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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Karligkiotis A, Pistochini A, Turri-Zanoni M, Terranova P, Volpi L, Battaglia P, Bignami M, Castelnuovo P. Endoscopic endonasal orbital transposition to expand the frontal sinus approaches. Am J Rhinol Allergy 2016; 29:449-56. [PMID: 26637586 DOI: 10.2500/ajra.2015.29.4230] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The management of frontal sinus disease still remains a challenging issue for rhinologists. Although endoscopic frontal sinus surgery has significantly advanced over the past years, there are some conditions in which the external approaches are still necessary. Recently, the increasing experience in endoscopic sinus surgery together with important technologic advancements have allowed expansion of the indications for selected lesions localized more and more lateral into the frontal sinus. OBJECTIVE The aim of this study was to describe the endoscopic endonasal approach to the far lateral portion of the frontal sinus and to evaluate the outcomes of this technique. METHODS A retrospective evaluation was carried out with patients at a single institution, who, from 2004 to 2012, underwent an exclusive endoscopic transnasal approach to the far lateral portion of the frontal sinus at a single institution. The surgical technique included the Draf IIb procedure, a modified Lothrop procedure (Draf III), and endoscopic lateralization of the orbit, differently associated according to the needs of each case. RESULTS Twenty-four patients were eligible for the present study. The lesions included were mucoceles in 9 cases, fibro-osseous lesions in 10 cases, and inverted papillomas in 5 cases. The overall follow-up ranged from 12 to 120 months (mean, 40.6 months). At the time of the last follow-up, no recurrence of disease was observed in the patients treated; in one case of osteoma, a small and stable in size (1 mm) persistent lesion was observed in an asymptomatic patient. One scheduled and one accidental cerebrospinal fluid leak with immediate skull base reconstruction occurred. No intraoperative or postoperative early or late orbital complication was observed in any case. CONCLUSION The endoscopic endonasal orbital transposition seems to facilitate the endoscopic management of selected far-lateral frontal sinus lesions. However, it is a demanding procedure that requires experience and skill to avoid intraoperative skull base and orbital complications.
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Affiliation(s)
- Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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[Experience in the surgical treatment of paranasal sinus mucoceles in a university hospital]. CIR CIR 2016; 85:4-11. [PMID: 27212640 DOI: 10.1016/j.circir.2016.03.004] [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: 09/02/2015] [Revised: 01/26/2016] [Accepted: 02/26/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mucoceles are benign cystic lesions of the paranasal sinuses. Endoscopic marsupialisation is considered the first choice of treatment, due to its low morbidity and recurrence rates. OBJECTIVE To establish the number of patients with recurrence, who were diagnosed clinically or by computed tomography, and who were submitted to surgery in the Ear, Nose and Throat Unit in a tertiary university hospital. MATERIAL AND METHODS A clinical, cross-sectional, descriptive, observational and retrospective study was conducted on patients with a mucocele diagnosis operated on in the period from January 2006 to December 2013. A descriptive statistical analysis was performed to obtain the frequencies, ratios and proportions. Measures of central tendency and dispersion were obtained. The recurrence rates of each surgical technique were compared using the Chi-squared test. RESULTS Of the 59 patients included in the study, 39 were female and 20 were men. The most common location was in the maxillary sinus (22 patients) followed by frontoethmoidal (20 patients). There was a recurrence of 9% in those submitted to a surgical procedure. The endoscopic approach was used in 51 patients, 8 cases were combined (open plus endoscopic), and there was no open approach. There was a recurrence in 7 of 51 of patients with endoscopic surgery, and one out of 8 patients had a recurrence with a combined technique. CONCLUSIONS No statistically significant relationship was found between the type of surgery and recurrence, or between the presence or absence of a predisposing factor and recurrence.
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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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