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Moniakis A, Malli A, Smponias V, Kasapas K. Delayed Post-traumatic Frontal Mucocele Occurrence: A Case Report. Cureus 2024; 16:e67108. [PMID: 39310471 PMCID: PMC11416066 DOI: 10.7759/cureus.67108] [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: 08/17/2024] [Indexed: 09/25/2024] Open
Abstract
Mucoceles, benign cystic lesions with pseudo-stratified epithelial lining, typically arise due to chronic sinus ostia obstruction. Mucoceles can cause expansive erosion and, in severe cases, intracranial or intraorbital extension. Here, we present a case of delayed frontal mucocele formation following head trauma, emphasizing the importance of timely diagnosis and surgical intervention. Treatment involves careful mucocele removal and cranialization or obliteration of sinuses. Meticulous reconstruction using various materials ensures optimal cosmetic outcomes.
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Affiliation(s)
- Alexandros Moniakis
- Department of Neurosurgery, Athens General Hospital "Georgios Gennimatas", Athens, GRC
| | - Antonia Malli
- Department of Neurosurgery, Athens General Hospital "Georgios Gennimatas", Athens, GRC
| | - Velissarios Smponias
- Department of Oral and Maxillofacial Surgery, Athens General Hospital "Georgios Gennimatas", Athens, GRC
| | - Konstantinos Kasapas
- Department of Neurosurgery, Athens General Hospital "Georgios Gennimatas", Athens, GRC
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2
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Baeza M, Young BD, LaQuaglia KA, Rollins A, Aboellail TA. Computed tomographic imaging of a maxillary sinus mucocele in an 8-year-old French Bulldog. Vet Radiol Ultrasound 2023; 64:E73-E77. [PMID: 37667996 DOI: 10.1111/vru.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
An 8-year-old male neutered French Bulldog was referred for continued nasal dyspnea following a staphylectomy revision performed one month prior to presentation. The patient had a prior history of skin allergies and underwent brachycephalic airway surgery performed at one year of age. Computed tomography (CT) revealed an osseous-encased, cystic mass arising from the right maxillary sinus. Surgical biopsies were performed and a mucocele with sinusitis and glandular hyperplasia was diagnosed. Based on our systematic review of the literature, maxillary sinus mucocele has not been reported in the dog and should be among the differentials for sinus cystic masses.
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Affiliation(s)
- Mercedes Baeza
- VCA Alameda East Veterinary Hospital, Denver, Colorado, USA
| | | | | | - Amanda Rollins
- VCA Alameda East Veterinary Hospital, Denver, Colorado, USA
| | - Tawfik A Aboellail
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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3
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Alouda N, Alkhiary H, Alsaleh S. Isolated extra-sinus subcutaneous mucocele: A case report. Int J Surg Case Rep 2023; 109:108488. [PMID: 37454551 PMCID: PMC10372322 DOI: 10.1016/j.ijscr.2023.108488] [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: 05/29/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Paranasal sinus mucoceles are epithelialized cystic masses formed through the accumulation of sterile mucus. Mucoceles are expansile lesions, and their symptoms change according to their extension into the surrounding structures: anteriorly to the subcutaneous tissue, laterally to the orbit, or posteriorly to the cranium. Herein, we report the case of a pediatric patient with an isolated subcutaneous mucocele with no sinus connection. PRESENTATION OF CASE Physical examination revealed a non-tender fluctuating round mass approximately 4 cm in diameter in the right supraorbital region. Computed tomography and magnetic resonance imaging findings suggested a mucocele, and the diagnosis was confirmed via histopathological examinations postoperatively. The patient underwent a combined surgical approach that included an endoscopic transseptal approach to the frontal sinus with a right sub-brow incision and drain placement. The right frontal sinus was opened, and the mucocele was marsupialized. At the 3-month follow-up visit, the frontal sinus neo-ostium appeared patent on endoscopic examination, and the frontal sinuses were clear on imaging. DISCUSSION The optimal treatment for frontal mucoceles is marsupialization and adequate sinus drainage. As the patient had an isolated subcutaneous extra-sinus mucocele above the orbit, a combined approach was used to ensure thorough removal of the lesion to reduce the recurrence rate. CONCLUSION This report emphasizes the importance of using a combined approach for the removal of lesions and limiting the potential risk of recurrence in similar cases.
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Affiliation(s)
- Nada Alouda
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hattan Alkhiary
- Department of Ophthalmology, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Rhinology and Endoscopic Skull Base Surgery Unit, Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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4
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Rastin MS, Rasouly N. Giant ethmoid mucocele presenting as a nasal region mass with intracranial extension, a case report. Radiol Case Rep 2023; 18:156-158. [DOI: 10.1016/j.radcr.2022.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
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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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6
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Bouhafs K, Lachkar A, Bouamama T, Benfadil D, Ghailan MR. Bilateral orbito-cerebral-extending frontal mucocele following nasosinus polyposis: A case report. Ann Med Surg (Lond) 2021; 66:102432. [PMID: 34141415 PMCID: PMC8188244 DOI: 10.1016/j.amsu.2021.102432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction and importance: Mucoceles are expansive pseudocystic formations, developed from the sinuses of the face, affecting mainly adults. Evolving at low noise, they are most often revealed by neurological or ophthalmological complications. We report a rare case of a bilateral frontal mucocele with orbito-cerebral extension following nasal sinus polyposis. Case presentation This was a 35-year-old patient with a history of Widal syndrome, who presented frontal headaches and left proptosis evolving for 4 months, in whom clinical examination revealed a left superomedial eyelid swelling, left proptosis and stage 2 nasosinus polyposis. Computed tomography and craniofacial magnetic resonance imaging were in favor of a bilateral frontal mucocele with left orbital and bilateral cerebral extensions. The patient was bilaterally operated by a combined approach including external Jacques eyebrow and endonasal Draf IIa procedure in addition to a radical total ethmoidectomy. The outcomes were favorable with regression of headaches and resolution of exophthalmos. Clinical discussion The frontal mucocele, although benign, has an aggressive potential in the absence of treatment either towards the endocranium or the orbit behind the orbital septum causing intra-orbital extension, or in front of it; causing the dominant upper palpebral form as in the case of our patient. The treatment is still based on surgical excision of the cyst with drainage of the causal sinus, which was carried out for our patient. Conclusion Despite its benign behavior, frontal mucocele may become serious by compression of neighboring organs which require an early and appropriate surgical management. Mucoceles are rare benign sinus tumors of the frontoethmoid complex. They rarely extend to the endocranial anatomical structures. Imaging is of capital importance for its multidisciplinary management. Surgery is the standard treatment of mucocele based on external and endonasal routes.
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Affiliation(s)
- Khalid Bouhafs
- Otorhinolaryngology and Head and Neck Surgery Department, Mohammed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Azeddine Lachkar
- Otorhinolaryngology and Head and Neck Surgery Department, Mohammed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Tayeb Bouamama
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco.,Department of Radiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Drissia Benfadil
- Otorhinolaryngology and Head and Neck Surgery Department, Mohammed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Mohammed Rachid Ghailan
- Otorhinolaryngology and Head and Neck Surgery Department, Mohammed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
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Giant Frontal Paranasal Mucocele: Case Report and Review of the Literature. J Belg Soc Radiol 2020; 104:48. [PMID: 32964189 PMCID: PMC7485410 DOI: 10.5334/jbsr.2117] [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: 11/20/2022] Open
Abstract
Teaching point: Giant mucocele is a rare expansile lesion that may mimic other locally aggressive lesions of the cranial vault. Giant frontal mucoceles with massive osteolytic destruction mimicking an aggressive lesion are rare compared to smaller mucoceles. This article reports a giant mucocele of the frontal sinus and reviews the literature. Important imaging clues pointing toward the diagnosis of a mucocele on computed tomography (CT) and magnetic resonance imaging (MRI) are a well-defined expansile mass, an intimate relationship with the frontal sinus, subtle peripheral rim enhancement, and slow progression on serial imaging. The density on CT and signal on MRI may vary along with the lesion content. The potential role of diffusion-weighted imaging should be elaborated in future reports.
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8
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Koh LT, Pollaers K, Dhepnorrarat CR. Frontal sinus mucocele in association with polyostotic fibrous dysplasia: A case report. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105818823787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fibrous dysplasia is an uncommon developmental anomaly of bone wherein normal bone marrow is substituted and subsequently expanded by fibro-osseous tissue. Its association with mucocele formation in the paranasal sinuses is extremely rare. We present a case report of a patient with polyostotic fibrous dysplasia with frontal sinus mucocele formation, who underwent endoscopic drainage and marsupialisation via a transnasal approach.
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Affiliation(s)
- Leslie Timothy Koh
- Department of Otorhinolaryngology – Head and Neck Surgery, Changi General Hospital, Singapore
| | - Katherine Pollaers
- Department of ENT, Sir Charles Gairdner Hospital, Perth, Western Australia
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Kochetkov PA, Svistushkin VM, Mokoyan ZT, Karpova OY, Ordyan AB. [Extended trans-ethmoidal decompression of the orbit for the treatment of frontal sinus mucopyocele]. Vestn Otorinolaringol 2019; 83:55-57. [PMID: 30721187 DOI: 10.17116/otorino20188306155] [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: 11/17/2022]
Abstract
Mucocele of the paranasal sinuses is a rare disease not infrequently associated with massive bone destruction, orbital and intracranial complications. The authors report a patient presenting with the giant post-traumatic frontal mucopyocele associated with the erosion of the posterior and inferior sinus walls that was clinically manifested as hypo- and exophthalmos and has caused the inferolateral eye deviation and orbital decompression. The patient displayed the ophtalmological symptoms 8 years after the frontal sinus fracture. The mucopyocele was treated effectively with the combination of the endoscopic trans-ethmoidal and open trans-frontal approaches. The noticeable intraoperative finding in this patient was the absence of complaints as well as the combination of dura mater defects in the form of its erosion and the leakage of the cerebrospinal fluid together with the presence of purulent discharge in the sinus in the absence of intracranial complications.
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Affiliation(s)
- P A Kochetkov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991
| | - V M Svistushkin
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991
| | - Zh T Mokoyan
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991
| | - O Yu Karpova
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991
| | - A B Ordyan
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991
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10
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Computed Tomography Findings in a Case of Giant Frontal Sinus Mucopyocele in a Dog. ACTA VET-BEOGRAD 2018. [DOI: 10.2478/acve-2018-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
A 16-month-old male crossbreed dog, which suffered a previous traumatic incident, was presented for evaluation of a chronic fluctuant right supraorbitary mass. On computed tomography, a well-defined, expansile, hypodense mass, showing a thin peripheral enhancement was occupying the right frontal sinus and extending into the cranial cavity. Imaging findings, bacteriological culture, and histopathology of the surgically excised mass were consistent with a frontal sinus mucopyocele. Frontal sinus mucopyocele should be included as a differential diagnosis for a well-marginated expansile frontal sinus mass, especially when present in young animals or/and associated with a previous craniofacial trauma.
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11
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Vandenberghe H, Thibaud JL, Moissonnier P, Blot S. Magnetic resonance imaging of a giant frontal hemorrhagic mucocele with intracranial extension in a cat. Vet Radiol Ultrasound 2018; 61:E45-E49. [PMID: 29931704 DOI: 10.1111/vru.12654] [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: 08/25/2017] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 12/01/2022] Open
Abstract
A 6-year-old domestic short-haired cat was presented with an acute onset of right cortical encephalopathy. Magnetic resonance imaging (MRI) performed 4 days after the onset of clinical signs revealed a lesion originating from the right frontal sinus with intracranial extension and compression of the right frontal lobe. The lesion was T1-weighted hypointense and T2-weighted and fluid-attenuated inversion recovery hyperintense. Signal voids within the lesion were observed on T2* images, consistent with hemorrhage. Peripheral ring enhancement was visible on postcontrast sequences. These features were consistent with a giant hemorrhagic mucocele. To the authors' knowledge, this is the first report of MRI characteristics of this lesion in a cat.
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Affiliation(s)
- Hélène Vandenberghe
- U955-IMRB, Inserm, Ecole Nationale Vétérinaire d'Alfort, Unité de neurologie, UPEC, Maisons-Alfort, F-94700, France
| | | | - Pierre Moissonnier
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Unité de Chirurgie, UPEC, Maisons-Alfort, F-94700, France
| | - Stéphane Blot
- U955-IMRB, Inserm, Ecole Nationale Vétérinaire d'Alfort, Unité de neurologie, UPEC, Maisons-Alfort, F-94700, France
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12
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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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13
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Stokken J, Wali E, Woodard T, Recinos PF, Sindwani R. Considerations in the management of giant frontal mucoceles with significant intracranial extension: A systematic review. Am J Rhinol Allergy 2017; 30:301-5. [PMID: 27456600 DOI: 10.2500/ajra.2016.30.4323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Giant frontal mucoceles, characterized by significant intracranial and/or intraorbital extension, can present with significant neurologic symptoms. Although typical mucoceles are managed endoscopically, giant mucoceles are often treated with an open or combined approach due to various concerns, including frontal lobe displacement, size, and rapid decompression of the intracranial component. The impact of significant intracranial extension on outcomes is not well described. OBJECTIVE This review studied key neurologic considerations in the management of giant frontal sinus mucoceles and analyzed outcomes of different management strategies. METHODS Systematic literature review by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS Thirty-two articles, which represented 85 cases, met inclusion criteria. Neurologic symptoms on presentation ranged from headache (24.7%) and vision loss (12.9%) to extremity weakness (1.2%), frontal lobe syndrome (2.4%), and seizures (4.7%). Twenty-eight patients were treated endoscopically (34.1%), and 54 (65.9%) were treated with an external approach. Twenty-five of the open procedures included a craniotomy. Indications for the open approach included subdural empyema, enucleation, or large anterior table defects. Perioperative antibiotics were not consistently used. No perioperative seizures were reported with any approach. There were six cerebrospinal fluid leaks, all in the patients who underwent open procedures. The overall recurrence rate was 3.5%, with no recurrences reported in patients treated with an open approach. Follow-up ranged from 1 week to 8 years. CONCLUSIONS Giant frontal mucoceles often present with various neurologic symptoms. Both open and endoscopic techniques offer excellent results. Endoscopic management is effective and preferred, except in special circumstances. An interdisciplinary team approach should be used to optimize surgical planning.
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Affiliation(s)
- Janalee Stokken
- Section of Rhinology, Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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14
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Hssaine K, Belhoucha B, Rochdi Y, Nouri H, Aderdour L, Raji A. [Paranasal sinus mucoceles: About 32 cases]. ACTA ACUST UNITED AC 2016; 117:11-4. [PMID: 26740203 DOI: 10.1016/j.revsto.2015.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/17/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Mucocele is a pseudo-cystic tumor of the paranasal sinuses. Despite its benign histological nature, it is aggressive towards neighboring structures (orbit and brain). Our aim was to study the epidemiological, clinical, therapeutic, and evolution aspects of this pathology. PATIENT AND METHODS We conducted a retrospective study over a period of 9 years on 32 patients operated on and followed for mucocele in our department. RESULTS Mean age was 43.28 years with a sex ratio to 1. Mucoceles were located in the fronto-ethmoid sinus (27 cases), the maxillary sinus (3 cases) and the sphenoid sinus (2 cases). The most common symptoms were periorbital swelling and exophthalmia. CT scan confirmed the diagnosis in the majority of cases. MRI was performed in 3 patients. Surgery consisted in a large marsupialization by endonasal approach in 30 cases, and by a combined approach in two cases. A recurrence was observed in two patients after a mean period of 18 months. DISCUSSION Mucocele is a benign and expansive pseudo-cystic tumor, affecting mostly adults and developing in the paranasal sinuses. Clinical symptoms are not specific. It may reveal itself by ophthalmic or intracranial complications. Diagnosis is based on imaging (CT and MRI). Endonasal surgery has become the gold standard for the treatment of mucoceles and is endowed with low morbidity.
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Affiliation(s)
- K Hssaine
- Service d'ORL et de chirurgie cervico-faciale, CHU Mohammed VI, Marrakech, Maroc.
| | - B Belhoucha
- Service d'ORL et de chirurgie cervico-faciale, CHU Mohammed VI, Marrakech, Maroc.
| | - Y Rochdi
- Service d'ORL et de chirurgie cervico-faciale, CHU Mohammed VI, Marrakech, Maroc.
| | - H Nouri
- Service d'ORL et de chirurgie cervico-faciale, CHU Mohammed VI, Marrakech, Maroc.
| | - L Aderdour
- Service d'ORL et de chirurgie cervico-faciale, CHU Mohammed VI, Marrakech, Maroc.
| | - A Raji
- Service d'ORL et de chirurgie cervico-faciale, CHU Mohammed VI, Marrakech, Maroc.
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Abstract
BACKGROUND Mucoceles occur as a result of accumulation and retention of mucous secretions in a paranasal sinus and are uncommon in the pediatric age group. Persistent or intermittent closure of its ostium through a variety of causes, including previous surgery, is implicated in etiology. The authors report 2 cases of frontoethmoidal mucocele that followed box osteotomies for the treatment of orbital dystopia, with medical literature review and discussion of possible causal factors and events. METHODS Case histories and radiological imaging are presented on 2 patients presenting with frontoethmoidal mucoceles following craniofacial surgery. Both had transcranial craniofacial techniques where all orbital walls and globe are moved en bloc as a "box." RESULTS Patient 1, a 12-year-old male patient with Crouzon syndrome, developed mucoceles within 18 months of monobloc distraction surgery and box osteotomies. This was successfully marsupialized with a combined external and endoscopic surgical approach. The second patient, a 15-year-old boy with previously corrected right-sided facial cleft, developed mucocele 9 years following box osteotomies; this was successfully managed by endoscopic drainage. Of 3 other patients having similar box osteotomies in our unit, no other mucoceles were noted as complications. CONCLUSIONS Mucoceles are a rare complication of craniofacial surgery, and literature review confirms a paucity of reports. Only 1 case has previously been alluded to of mucocele complicating box osteotomy for orbital dystopia. Our 2 cases illustrate and highlight a successful management approach in a multidisciplinary craniofacial unit.
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16
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Carmichael RA, Kang DR. Frontal Sinus Mucopyocele Presenting as a Subcutaneous Forehead Mass. J Oral Maxillofac Surg 2015; 73:2155-61. [DOI: 10.1016/j.joms.2015.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 11/30/2022]
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17
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Complicated giant mucoceles of the frontal sinus: approach to endoscopic marsupialization technique. J Craniofac Surg 2015; 25:e461-3. [PMID: 25148622 DOI: 10.1097/scs.0000000000001034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A number of external and radical procedures have been the only surgical approaches for the treatment of frontal sinus mucoceles. However, these procedures have major complications including high surgical morbidity, esthetic concerns of postoperative scar formation, and difficulty in radiologic diagnosis of recurrence after obliteration. In this clinical report, we demonstrated an endoscopic marsupialization technique that could easily be applied to a very large mucocele that has extended to the intracranial region, without any serious complications.
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18
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Endoscopic marsupialization of frontoethmoid mucocele with underlying craniofacial fibrous dysplasia. J Craniofac Surg 2015; 26:e73-4. [PMID: 25569425 DOI: 10.1097/scs.0000000000001322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Fibrous dysplasia (FD) is a benign progressive fibro-osseous lesion that is rarely associated with mucocele formation. This complication most probably results from the involvement and subsequent occlusion of the recesses of the sinuses by the dysplastic process. The frontoethmoid mucocele associated with FD represents a rare pathology, but it is important to consider this in the differential diagnosis of patients with proptosis, visual disturbance, and bony fronto-orbital swellings. Here, we describe the first case of frontoethmoid mucocele with underlying craniofacial FD, which was successfully treated by wide marsupialization via the transnasal endoscopic approach.
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19
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Işık AÜ, Arslan S, Arslan E, Baykal S. A giant frontoethmoid mucocele with intracranial extension. Scott Med J 2014; 60:e1-3. [PMID: 25428941 DOI: 10.1177/0036933014561949] [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] [Indexed: 11/17/2022]
Abstract
Mucoceles are mucus-containing cysts lined by epithelium. Although benign, they may show expansive growth and remain undiagnosed until symptoms due to compression of surrounding structures arise. We report a rare case of frontoethmoid mucocele with intracranial extension in an 80-year-old woman with complaints of headache, right diplopia and proptosis. A right frontoorbital craniotomy was performed, and a mucocele in the frontal sinus extending into the frontal lobe and orbit was totally removed. The patient was successfully treated without any complication. The two-year follow-up results were satisfactory. Magnetic resonance imaging excluded any recurrence of the mucocele. Combined intranasal and transcranial approach is necessary to treat giant frontoetmoid mucoceles with intracranial extension.
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Affiliation(s)
- Abdülcemal Ümit Işık
- M.D., Department of Otorhinolaryngology, School of Medicine, Karadeniz Technical University, Turkey
| | - Selçuk Arslan
- M.D., Department of Otorhinolaryngology, School of Medicine, Karadeniz Technical University, Turkey
| | - Erhan Arslan
- M.D., Department of Neurosurgery, School of Medicine, Giresun University, Turkey
| | - Süleyman Baykal
- M.D., Department of Neurosurgery, School of Medicine, Karadeniz Technical University, Turkey
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Lee JT, Brunworth J, Garg R, Shibuya T, Keschner DB, Vanefsky M, Lin T, Choi S, Stea R, Thompson LDR. Intracranial mucocele formation in the context of longstanding chronic rhinosinusitis: A clinicopathologic series and literature review. ALLERGY & RHINOLOGY 2014; 4:e166-75. [PMID: 24498523 PMCID: PMC3911807 DOI: 10.2500/ar.2013.4.0064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Chronic rhinosinusitis (CRS) can lead to serious long-term adverse sequelae, particularly if left untreated. The aim of this study was to describe a series of intracranial mucoceles (ICMs) that arose in the context of longstanding CRS combined with a review of the pertinent literature. A retrospective chart review was performed on all patients who developed ICMs in association with CRS between 2003 and 2012. The clinical presentation, radiographic features, surgical approach, intraoperative findings, and patient outcome were examined in the context of a literature review. Sixty-five cases of mucoceles were identified in patients with a history of CRS, of which seven (10.8%) were intracranial. Five patients were men and two were women with a mean age of 42.1 years. Headache, facial pressure, retro-orbital pain, and visual disturbances were the most common presenting symptoms. Five of the seven had previously undergone sinonasal surgery. Imaging studies showed ICMs involving the anterior cranial fossa, two of which were bilateral. Latency between onset of CRS and ICM detection ranged from 3 to 19 years (mean, 9.4 years). All patients underwent endoscopic transnasal drainage with three also requiring a concurrent, open neurosurgical procedure to access the intracranial component. There were no postoperative complications, and no recurrences were observed after a mean follow-up of 2.7 years. ICMs presenting as delayed complications of CRS are uncommon and constitute a surgical challenge. Open, external skull base approaches used in conjunction with transnasal endoscopic drainage procedures may be necessary to achieve successful management of this rare condition.
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Affiliation(s)
- Jivianne T Lee
- Orange County Sinus Institute, Southern California Permanente Medical Group, Irvine, California, ; Department of Head and Neck Surgery, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
| | - Joseph Brunworth
- Orange County Sinus Institute, Southern California Permanente Medical Group, Irvine, California
| | - Rohit Garg
- Orange County Sinus Institute, Southern California Permanente Medical Group, Irvine, California
| | - Terry Shibuya
- Orange County Sinus Institute, Southern California Permanente Medical Group, Irvine, California
| | - David B Keschner
- Orange County Sinus Institute, Southern California Permanente Medical Group, Irvine, California
| | - Marc Vanefsky
- Department of Neurosurgery, Anaheim Medical Center, Southern California Permanente Medical Group, Anaheim, California
| | - Tina Lin
- Department of Neurosurgery, Anaheim Medical Center, Southern California Permanente Medical Group, Anaheim, California
| | - Soohoo Choi
- Department of Neurosurgery, Anaheim Medical Center, Southern California Permanente Medical Group, Anaheim, California
| | - Richard Stea
- Department of Neurosurgery, Anaheim Medical Center, Southern California Permanente Medical Group, Anaheim, California
| | - Lester D R Thompson
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, California
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Complications ophtalmiques des mucocèles rhino-sinusiennes. J Fr Ophtalmol 2014; 37:93-8. [DOI: 10.1016/j.jfo.2013.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 06/19/2013] [Indexed: 11/18/2022]
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Aggarwal SK, Bhavana K, Keshri A, Kumar R, Srivastava A. Frontal sinus mucocele with orbital complications: Management by varied surgical approaches. Asian J Neurosurg 2013; 7:135-40. [PMID: 23293669 PMCID: PMC3532760 DOI: 10.4103/1793-5482.103718] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A mucocele of a para-nasal sinus is an accumulation of mucoid secretion and desqua-mated epithelium within the sinus with distension of its walls and is regarded as a cyst like expansile and destructive lesion. If the cyst invades the adjacent orbit and continues to expand within the orbital cavity, the mass may mimic the behavior of many benign growths primary in the orbit. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid, and maxillary mucoceles are rare. Floor of frontal sinus is shared with the superior orbital wall which explains the early displacement of orbit in enlarging frontal mucoceles. Frontal sinus mucoceles are prone to recurrences if not managed adequately. Here, we are evaluating different approaches used to manage various stages of frontal mucoceles which presented to us with orbital complications. Three cases of frontal sinus mucocele are discussed which presented to our OPD with different clinical symptoms and all cases were managed by different surgical approaches according to their severity. We also concluded that it is prudent to collaborate with the neurosurgeons for adequate management of such complex mucoceles by a craniotomy approach.
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Affiliation(s)
- Sushil Kumar Aggarwal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
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Ch'ng SW, Pillai MB, Morton C. Frontal sinus mucoceles presenting in the upper eyelid: an easily missed diagnosis. BMJ Case Rep 2012; 2012:bcr-03-2012-5974. [PMID: 22675146 DOI: 10.1136/bcr-03-2012-5974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Frontal sinus mucoceles are epithelium-lined mucus-containing sacs that are capable of bony expansion causing a spectrum of ophthalmological symptoms. If left untreated, they can erode the thin sinus wall causing life-threatening complications such as meningitis. We would like to alert the clinicians to this diagnosis that can be easily misdiagnosed. The first patient appeared to have an allergic blepharo-conjunctivitis that was not responding to topical and systemic medications. The second patient presented with recurrent preseptal cellulitis unresponsive to oral antibiotics. CT imaging of both patients revealed frontal sinus mucoceles. Both patients recovered well with sinus surgery. Management of these patients needed a close liaison with our ENT and radiology colleagues to warrant a good outcome.
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Affiliation(s)
- Soon Wai Ch'ng
- Department of Ophthalmology, Abertawe Bro Morgannwg University Health Board, Swansea, UK.
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Park CM, Stoffella E, Gile J, Roberts J, Herford AS. Osteoplasty flap technique for repair of latent (30-year) post-traumatic frontal sinus mucocele: case report and review of the literature. J Oral Maxillofac Surg 2012; 70:2092-6. [PMID: 22542331 DOI: 10.1016/j.joms.2011.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/13/2011] [Indexed: 11/19/2022]
Abstract
Mucoceles are benign, slow-growing lesions defined as mucus-filled pseudocystic formations. Paranasal mucoceles predominantly affect the frontal sinus (60% to 65%), followed in frequency by the ethmoidal (20% to 30%), maxillary (10%), and sphenoid (2% to 3%) sinuses. Mucoceles usually arise because of sinus ostium obstruction, preceded by infection, fibrosis, inflammation, trauma, surgery or tumors such as osteomas. Mucoceles arising from the frontal sinus present with a variety of clinical signs, including decreased visual acuity, visual field abnormalities, proptosis, ptosis, periorbital swelling, displacement of the globe, restricted ocular movements, and choroidal folds. We describe a case of orbital involvement from a mucocele of the frontal sinus 30 years after the initial trauma, with a review of the published data concerning the etiology, diagnosis, and treatment planning.
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Affiliation(s)
- Chan M Park
- Department of Oral and Maxillofacial Surgery, University of Pacific, San Francisco/Highland General Hospital, Oakland, CA, USA
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Abstract
The authors report the case of a 75-year-old man presenting with an exceptionally large giant posttraumatic mucocele of the frontal sinus years after a gunshot blast to the head. The lesion had grown so extensively that the right eye had shrunk and calcified, resulting in total monocular blindness, a complication that has been reported only once. To the best of our knowledge, it is the first time that a giant mucocele of such a large size is reported. We describe how the patient underwent surgical removal of this massive lesion, cranial base reconstruction, and a cosmetic oculoplastic procedure. The etiology, clinical presentation, and possible complications are reviewed, as well as the importance of a regular clinical follow-up and early surgical cure. Although the diagnosis and management of mucoceles are nowadays considered quite standard, the exceptional size of the lesion illustrated here emphasizes the destructive potential of such seemingly indolent lesions. Despite the benign histology of mucoceles, one should never underestimate their morbid potential or be lulled in delaying surgical cure. Large mucoceles should be removed as quickly as possible to prevent such unacceptable complications as permanent visual loss.
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Abstract
A mucocele is a mucus-containing sac lined with epithelium that arises within a sinus when its drainage is compromised. The frontal sinus is the most common location, with frontal mucocele development occurring when the nasofrontal duct becomes obstructed because of polyps, bone tumors, prior surgery, sinusitis, trauma, or anatomic variation. We report an unusual case of a sterile pediatric frontal mucocele presenting as a slowly enlarging forehead mass due to a bifid frontal sinus septum. A 9-year-old girl presented to the craniofacial clinic for evaluation of a right frontal mass that had been slowly growing over the past year. She was otherwise healthy and had no history of previous trauma or sinus infections. Computed tomography (CT) scan results revealed a localized frontal fluid collection with protrusion and thinning of the anterior frontal bone between 2 midline bony septii. Surgical cranialization of the frontal sinus was performed. The anatomy of her lesion seen both on CT scan and intraoperatively likely explains this unusual case presentation. Instead of the usual inciting event of an intact frontal sinus drainage system becoming blocked, this patient seemed to have a primary developmental lack of any drainage system that led to her mucocele. During formation of her frontal sinus, she developed a bifid septum within the midline that excluded a portion of her frontal sinus from the lateral nasofrontal ducts. With mucus-producing epithelium trapped within these bony confines, pressure began to mount with expansion and thinning of the bone both anteriorly and posteriorly. The lack of any infectious symptoms and sterile culture results may support that this space developed primarily and was never in continuity with the external drainage system. Only 4 other patients have been reported with asymptomatic forehead swelling as the only presenting symptom, with the age ranging from 33 to 79 years. This patient represents the first clinical report of a congenital developmental mucocele.
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Derham C, Bucur S, Russell J, Liddington M, Chumas P. Frontal sinus mucocele in association with fibrous dysplasia: review and report of two cases. Childs Nerv Syst 2011; 27:327-31. [PMID: 20730437 DOI: 10.1007/s00381-010-1266-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 08/03/2010] [Indexed: 11/24/2022]
Abstract
We present two paediatric cases of fibrous dysplasia (FD) who presented to the craniofacial neurosurgical clinic with ophthalmological symptoms associated with sinus mucoceles. The first patient presented with a history of orbital cellulitis and an increasing bony swelling around the orbit associated with proptosis. Radiological imaging revealed monostotic FD associated with an obstructive mucocele in the frontal sinus with extension into the orbit. The second patient presented with recurrent conjunctivitis, painful proptosis, rhinitis and a bony peri-orbital swelling. Both patients had histological diagnoses of frontal mucoceles invading the orbit in association with FD. They both underwent frontal craniotomies and excision of the mucocele/fibrous dysplastic complex. In summary, mucocele development is an unusual complication of FD, likely to occur secondary to occlusion of the sinus drainage system. Orbital involvement may lead to visual disturbance caused by pressure effects. A multi-disciplinary approach including maxillofacial surgeons, plastic surgeons and neurosurgeons is advocated.
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Affiliation(s)
- Chris Derham
- Department of Neurosurgery, Leeds General Infirmary, Leeds, West Yorkshire, UK.
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Fernandes R, Pirgousis P. Longstanding giant frontal sinus mucocele resulting in extra-axial proptosis orbital displacement and loss of vision. J Oral Maxillofac Surg 2010; 68:3051-3. [PMID: 20598793 DOI: 10.1016/j.joms.2009.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 12/30/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Rui Fernandes
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, USA.
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Sarsilmaz A, Varer M, Apaydin M, Erdogan N, Uluc E. An Unusual Presentation of a Giant Frontal Mucocoele Manifesting with Frontal Lobe Syndrome. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n10p924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Aysegul Sarsilmaz
- Ataturk Training and Research Hospital, Radiology Department, Izmir, Turkey
| | - Makbule Varer
- Ataturk Training and Research Hospital, Radiology Department, Izmir, Turkey
| | - Melda Apaydin
- Ataturk Training and Research Hospital, Radiology Department, Izmir, Turkey
| | - Nezahat Erdogan
- Ataturk Training and Research Hospital, Radiology Department, Izmir, Turkey
| | - Engin Uluc
- Ataturk Training and Research Hospital, Radiology Department, Izmir, Turkey
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