Paranasal sinus mucoceles with visual disturbance

Imaging of the Sinonasal Cavities

This article describes the various abnormalities that affect the sinonasal cavities and discusses inflammations, tumors, and tumor-like conditions. Specific imaging evaluations that focus on the sinonasal cavities are described in more detail.

Sudden Unilateral Visual Loss Due to an Onodi Cell Mucocele

In a patient whose sudden vision loss is suspected on the side of a previously operated sphenoid or ethmoid sinus, an ischemic insult to the optic nerve may occur due to a compressing mucocele, especially when there is bony dehiscence of the orbital apex. We report a case of a 41-year-old healthy male patient who had a history of previous sinus surgery, and visited the emergency department for an abrupt left ocular pain following visual loss of the affected eye. The patient's left eye's best corrected visual acuity (BCVA) was hand motions with a reduced light reflex. A sphenoethmoidal sinus cell (Onodi cell) mucocele with bone dehiscence in the left orbital apex was seen on computed tomography. Upon suspicion of compressive ischemic optic neuropathy, urgent endoscopy-assisted endonasal marsupialization of the Onodi cell mucocele with high-dose pulse intravenous dexamethasone was performed. The pathology showed an inflamed nasal mucosa, confirming a mucocele. On the second postoperative day, his BCVA slightly improved in counting fingers at 30 cm. However, even though the nasalized Onodi cell remained intact, his eyesight did not show further improvement. The optic nerve may be directly insulted when a mucocele in the Onodi cell takes place, especially when there is bony dehiscence in the orbital apex. Despite accelerated surgical marsupialization and high-dose steroids, the chance of visual recovery remains very low, as demonstrated in our case.

A Fronto-ethmoidal Sinus Mucocele presenting with optic disc edema

The frontal and anterior ethmoidal sinus mucoceles may enlarge progressively and invade into the orbit by destructing the bony walls of the sinuses leading to diplopia or proptosis, but it rarely result in optic nerve impairment. We report on a case of fronto-ethmoidal sinus mucoceles presenting with unilateral optic disc edema without visual disturbances. Ocular manifestations, radiographic techniques, and histopathological evaluation were used to make the diagnosis. Early diagnosis through a combination of ophthalmological examinations and radiographic techniques is imperative in patients with fronto-ethmoidal sinus mucoceles presenting with optic disc edema. It is important for the ophthalmologist to be aware of the ocular manifestations associated with sinus mucoceles to avoid misdiagnosis.

An interesting case report of delayed presentation of visual loss from an Ethmoid Mucocoele. Should we offer emergency decompression?

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Consider rhinological causes for unilateral vision disturbances or loss.

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Consider emergency flexible nasendoscopy and imaging to identify sinonasal disease.

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Consider emergency endoscopic intervention in compressive Optic neuropathy.

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Communicate frankly with patients about the chances of success and complications.

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Pre-operative bedside assessment of vision is recommended at the minimum.

Paranasal sinus mucocoeles commonly involve the frontoethmoidal sinuses and can rarely present with vision changes due to expansion and invasion through the orbit. A 50-year-old female presented out of hours with an acute, 16-h history of complete left sided visual loss, on a background of 3 days of visual changes. A left ethmoid mucocoele extending into the left orbital apex causing compression of the optic nerve was diagnosed on imaging. Emergency endoscopic sinus surgery with decompression and marsupialization of the ethmoid mucocoele was performed, which resulted in improvement of vision. This case is unusual due to improvement in vision despite the length of visual loss prior to surgical intervention. This case demonstrates the importance of considering rhinological causes for vision loss, and how critical early identification and surgical intervention can be to prevent serious complications such as permanent vision loss.

An ethmoid mucocele causing diplopia: A case report

RATIONALE

Mucocele is a disease lined primarily by epithelium, and occurs mainly when the sinus ostium is obstructed.

PATIENT CONCERNS

We report a case of a 37-year-old man who presented with painless proptosis of the right eye and diplopia.

DIAGNOSES

The preoperative finding was mucocele of the ethmoid sinus.

INTERVENTIONS

We performed endoscopic sinus surgery, which included uncapping of the anterior and superior wall of the mucocele.

OUTCOMES

The mucocele was treated safely and effectively without touching the medial orbital wall.

LESSONS

Clinicians should note that minimally invasive surgery to remove ethmoid mucoceles is relatively straightforward and can prevent the various complications associated with these lesions.

Comprehensive review on endonasal endoscopic sinus surgery

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.

A case report of malignant melanoma of the sphenoid sinus

Malignant melanoma of the sphenoid sinus is a very rare disease, and only 6 cases have previously been reported. The present case involved a 74-year-old woman who was examined for visual disturbance of the left eye. Computed tomography revealed a soft tissue shadow, but only mucosal hypertrophy was found on opening the sphenoid sinus under general anesthesia. One month postoperatively, visual disturbance of the right eye and paresis of cranial nerve III appeared. Malignant melanoma was diagnosed from biopsy. Multiple bone metastases were identified, but the patient declined active treatment. As a result, palliative care was provided and she died 3 months later. When there is no improvement in postoperative visual acuity as in this case, in consideration of the possibility of neoplastic lesions, rigorous followup including monitoring for neurological symptoms is warranted.

Evaluation of sinus computed tomography scans: a collaborative approach between radiology and otolaryngology

PURPOSE OF REVIEW

Sinus computed tomography (CT) interpretation is subject to individual variation. We propose a template-driven approach as a method to ensure CT interpretation that is complete and efficient.

RECENT FINDINGS

Recent years have seen the description of newly noted anatomic abnormalities in the paranasal sinuses that should be noted during sinus CT interpretation.

SUMMARY

There exists significant variation in the methodology by which sinus CT scans are interpreted and the findings are reported. We believe that it will benefit radiologists and otolaryngologists alike to use a simple, template-driven approach to describe the findings encountered on a sinus CT. In this study, we present one such approach.

Sinus mucocele: natural history and long-term recurrence rate

OBJECTIVE

To define the natural history, clinical signs, treatment and the modalities of medium- and long-term follow-up of patients operated for sinus mucocele.

PATIENTS AND METHOD

Retrospective study of all patients operated for sinus mucocele between January 1993 and December 2009 (n=68). Demographic data, symptoms, medical imaging findings, surgical treatment and results were recorded.

RESULTS

The mean age of patients in this series was 53 years (range: 27-82 years, sex ratio: 3/2). The most common site was fronto-ethmoidal. Fifty-one patients (75%) had a history of sinus surgery, essentially for nasal polyposis. Only 15% of mucoceles occurred spontaneously. Presenting symptoms, in decreasing order of frequency, were facial pain or headache (38%), ocular or orbital complications (28%), while 20% of patients were asymptomatic. Surgery was performed by endonasal endoscopic sinus surgery (n=57, 84%) or via a combined, transfacial and endonasal approach, associated with navigation after January 2003. The mean follow-up was 7 years (range: 4 months-16 years). During this follow-up period, 23.5% of patients developed recurrence or a second mucocele after a mean interval of 4 years.

CONCLUSION

This study demonstrates the high recurrence rate of mucocele, particularly in multi-operated patients with chronic sinusitis. Long-term, regular, clinical and radiological follow-up is necessary to detect asymptomatic lesions prior to the onset of complications.