Manejo endoscópico de mucoceles de senos paranasales: experiencia en 46 pacientes

The Relationship Between Destruction Sites and Clinical Findings in Diffuse Paranasal Sinus Mucoceles

Objective

This study aimed to investigate that complicated mucoceles of paranasal sinuses and their clinical presentation, complications of relations with size, destructions areas, extension limits in affected patients.

Materials and methods

A retrospective review was performed on patients who were diagnosed and treated as paranasal sinus mucoceles at ENT department from 2002 to 2013 years. Patients' demographic data, mucoceles location, symptoms, surgical approach and complications were evaluated.

Results

The study group included 9 male and 10 female patients with a mean age of 45,0 years (range, 12-76 years). This case series include fronto-ethmoidal complex (52,6%), followed by frontal (26,3%), maxillary (15,7%) and sphenoid sinus mucoceles (5,2%). Endoscopic sinus surgery (ESS) was performed on 11 patients (57.8%); endoscopic procedures included marsupialization through an infundibulotomy, associated with an anterior ethmoidectomy and maxillary sinus antrostomy. Four patients (21%) underwent an external surgical procedure. 8 patients (42%) were treated by a combination of both endoscopic and external approaches such as trephination of the anterior wall of the frontal sinus, osteoplastic flap approach, Caldwell-Luc operation, anterior craniotomy and Lynch procedure. Complications occurred only in 2 cases (10.5%).

Conclusion

The majority of patients with extensive paranasal sinus mucoceles exhibited ophthalmologic and intracranial symptoms. A satisfactory outcome can be achieved after surgical treatment of both endoscopic and external approaches.

Frontoethmoidal mucocele presenting with ocular manifestations

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.

Mucocele: Clinical Characteristics and Outcomes in 46 Operated Patients

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.

[Experience in the surgical treatment of paranasal sinus mucoceles in a university hospital]

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.

[Paranasal sinus mucoceles: About 32 cases]

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.

[Clinical and surgical evaluation of patients with mucocele in the Conde de Valenciana Ophthalmology Institute]

PURPOSE

Mucoceles are cystic lesions, resulting from an obstruction in the paranasal sinuses and an accumulation of mucus, causing enlargement of the affected paranasal sinus. The signs and symptoms depend on the affected sinus. Treatment consists of surgical resection. The purpose of this study was to describe the clinical presentation of patients with mucocele, and also to describe the surgical results with our mucocele resection in patients treated in our institution over the last 10 years.

METHODS

All patients with a diagnosis of mucocele over the last 10 years and treated in our institution were included. An analysis was performed on the symptoms, surgical technique, and results.

RESULTS

Frontoethmoidal sinus mucoceles were the most common. Both eyes were affected but with no significant statistical differences. The median age at presentation was 52 years old, with no difference between both genders. The time to seek medical attention was shorter in frontal mucoceles. Proptosis was the most common symptom. Complications during surgery were reported in just one patient. Recurrence was reported in 12% of patients.

DISCUSSION

Our results correlate with those in the literature. We reported satisfying results with our technique, avoiding sinus obliterations, with a recurrence of 12% versus 6% reported in previous studies. We believe that our technique is safe and accessible for ophthalmologists in mucoceles treatment.

Mucocele formation under pedicled nasoseptal flap

The pedicled nasoseptal flap has become an indispensible tool for the reconstruction of skull base defects. This flap is easily harvested, provides a large surface area of vascularized tissue, and has few reported complications. We describe the case of a 60-year-old man who underwent endoscopic, endonasal transsphenoidal surgery with septal flap reconstruction who developed a sphenoid sinus mucocele postoperatively. We also have reviewed the literature for similar findings and discuss this complication in the setting of pituitary surgery and endoscopic skull base repair. Although likely a rare occurrence, mucocele formation after septal flap reconstruction should be recognized and monitored with postoperative nasal endoscopy and radiologic imaging. Reoperation or mucocele drainage may be necessary if symptomatic or in cases of rapid enlargement.