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Naik D, Aten K, Lopez D, Patel J. A Real Headache: Intracranial Extension and Epidural Abscess As Complication of Chronic Mucocele. Cureus 2023; 15:e49875. [PMID: 38170035 PMCID: PMC10760984 DOI: 10.7759/cureus.49875] [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: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Mucoceles are benign lesions of salivary glands typically originating from the paranasal sinuses. Intracranial extension and superinfection of these lesions are rare but serious complications of chronic mucoceles. Here, we discuss a patient with a known mucocele, initially lost to follow-up, who presented three years later with headache, purulent rhinorrhea, and intracranial extension of his mucocele with development of an epidural abscess. This case highlights the potential complications of chronic, large mucoceles and emphasizes the importance of thorough evaluation in patients with facial abscesses in the setting of known sinus pathology. Any mucocele with signs of superinfection such as purulent rhinorrhea, abscess near the sinuses, or refractory symptoms should warrant cranial imaging. Mucoceles with evidence of intracranial extension require neurosurgical and/or otolaryngologic evaluation for evacuation and debridement to avoid neurologic injury or devastating infection.
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Affiliation(s)
- Divya Naik
- Internal Medicine, Methodist Health System, Dallas, USA
| | | | - Dylan Lopez
- Internal Medicine, Methodist Health System, Dallas, USA
| | - Jaimin Patel
- Internal Medicine, Methodist Health System, Dallas, USA
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Ali EH. Post Traumatic Frontal Sinus Mucocele with Subcutaneous Extension: A Case Report and Literature Review. Int Med Case Rep J 2023; 16:599-604. [PMID: 37789831 PMCID: PMC10543422 DOI: 10.2147/imcrj.s436224] [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: 08/20/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
Background Langenbach (1820) first described paranasal sinus mucoceles under the name of hydatids. Roulette (1909) introduced the name mucocele. Paranasal sinus mucocele is the accumulation of mucus secretions and exfoliated epithelium in the sinuses, causing enlargement of the sinus walls. It is considered a cystic, dilatation-eroding lesion. However, the mucocele often occurs as a localized mass, causing bone erosion and displacement of surrounding structures. If left untreated, a nearby mucocele in the brain can become infected and lead to death. Frontal sinuses are often involved; sphenoid, ethmoid, and maxillary mucoceles are rare. Mucoceles usually result from sinus ostium obstruction due to infection, fibrosis, inflammation, trauma, surgery, or obstruction by tumors such as osteomas. Of all causes, patients most often present with cranio-facial trauma (82.97%) and the most common mechanism is human aggression (90.85%). Case Presentation This 30-year-old male patient presented with a frontal head swelling of one year duration that started after he sustained a stick injury on the frontal head one year ago, and he has an associated frontal headache for one year. There was a 4x5cm frontal, firm, palpable, non-tender lesion extending from the nasion to the frontal head. On the brain CT scan, there was frontal bone erosion at multiple sites with partial frontal sinus opacity, an externally growing mass, and an old frontal sinus fracture noted. Bifrontal craniotomy and bilateral frontal sinus cranialization were done, and the patient was discharged on the third day and seen a month later with complete improvement from headache and swelling. Conclusion The incidence and pathophysiology of posttraumatic frontal sinus mucoceles are not known yet. The surgical management of mucocele demand a multidisciplinary team involving neurosurgeons, ear nose and throat surgeons, oral and maxillofacial surgeons, ophthalmologists and plastic and reconstructive surgeons. By treating the primary cause, frontal sinus fracture at contact, this case report aims to raise awareness of and prevent frontal sinus mucocele and related complications.
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Affiliation(s)
- Endris Hussen Ali
- Department of Neurosurgery, St. Paul’s Millennium Medical College, Addis Ababa, Ethiopia
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Intracerebral hemorrhage after endoscopic marsupialization of huge frontal sinus mucocele. Auris Nasus Larynx 2021; 49:1042-1045. [PMID: 33875272 DOI: 10.1016/j.anl.2021.03.016] [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: 12/02/2020] [Revised: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 11/21/2022]
Abstract
Frontal Mucocele grows gradually and unnoticed as a benign lesion but, as the frontal mucocele expands to and compresses surrounding organs like brain, orbit, etc., it can cause diverse symptoms and signs. Although the surgical approaches of mucocele include open, endoscopic and combined approach, endoscopic marsupialization has been commonly used because endoscopic marsupialization was reported with high success rates, low complication rates and better operative vision. However, recently we experienced rare complication of endoscopic marsupialization of huge frontal mucocele, large amount of intracerebral hemorrhage, immediately after successful surgery and report this rare case with short review.
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Benkhatar H, Khettab I, Sultanik P, Laccourreye O, Bonfils P. Mucocele development after endoscopic sinus surgery for nasal polyposis: A long-term analysis. EAR, NOSE & THROAT JOURNAL 2019; 97:284-294. [PMID: 30273428 DOI: 10.1177/014556131809700918] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to determine the prevalence of long-term mucocele development after functional endoscopic sinus surgery (FESS) for nasal polyposis, to search for a statistical relationship with preoperative variables and to analyze the management of this complication. A retrospective analysis of 153 patients who underwent FESS for nasal polyposis, with a minimum of 7 years of follow-up, was performed. Mucocele diagnosis was based on regular clinical and radiologic evaluation. Univariate and multivariate statistical analysis was performed. The postoperative mucocele rate was 13.1% (20 patients). The mean delay between surgery and mucocele diagnosis was 6.25 years. A high preoperative Lund-Mackay score (>19) was a risk factor for postoperative mucocele (p = 0.04). Asthma and aspirin intolerance did not increase the risk of this complication. Endoscopic marsupialization of mucoceles was successful in 19 patients, with only one recurrent frontal mucocele. One patient required external approaches for two frontal mucoceles. In conclusion, mucocele risk after FESS for nasal polyposis is significant, especially in case of a high preoperative Lund-Mackay score (>19). Long-term clinical follow-up is recommended, imaging being prescribed based on symptoms or abnormal findings on clinical examination. Endoscopic marsupialization is very effective, but frontal mucoceles are more likely to recur.
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Affiliation(s)
- Hakim Benkhatar
- ORL, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
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Alshoabi S, Gameraddin M. Giant frontal mucocele presenting with displacement of the eye globe. Radiol Case Rep 2018; 13:627-630. [PMID: 30167023 PMCID: PMC6114114 DOI: 10.1016/j.radcr.2018.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/26/2018] [Indexed: 11/05/2022] Open
Abstract
In this case, a 70-year-old female patient presented with large forehead swelling that occurred 2 years prior, with slow progressive enlargement that mimicked the behavior of a neoplasm. There was severe inferior displacement of the right orbital globe to the level of the nares. Brain computed tomography showed a large expansive lesion in the right frontal sinus with bony wall thinning without destruction or erosion. Brain magnetic resonance imaging showed high signal intensity of the contents in T1- and T2-weighted images with only peripheral enhancement after contrast administration. These features were consistent with a typical right frontal mucocele.
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Affiliation(s)
- Sultan Alshoabi
- Department of Diagnostic Radiologic Technology, Taibah University, Street King Mohammed Bin Abdulaziz, P.O. 30001, Almadinah Almunawarah, Saudi Arabia
| | - Moawia Gameraddin
- Department of Diagnostic Radiologic Technology, Taibah University, Street King Mohammed Bin Abdulaziz, P.O. 30001, Almadinah Almunawarah, Saudi Arabia
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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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Licci M, Zweifel C, Hench J, Guzman R, Soleman J. Frontoethmoidal Osteoma with Secondary Intradural Mucocele Extension Causing Frontal Lobe Syndrome and Pneumocephalus: Case Report and Review of Literature. World Neurosurg 2018; 115:301-308. [PMID: 29679781 DOI: 10.1016/j.wneu.2018.04.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Paranasal sinus osteoma is a common, asymptomatic, histologically benign, slow-growing tumor. However, it can give rise to secondary pathologies such as a mucocele in about 50% of the cases. Rarely, intracranial and orbital extension is present, leading to rhinoliquorrhea, pneumocephalus, or neurologic and visual impairment, which might be potentially life-threatening. CASE DESCRIPTION A 49-year-old man presented with an acute frontal lobe syndrome and rhinoliquorrhea. Cranial magnetic resonance tomography showed a suspected frontoethmoidal osteoma with a mucocele expanding intradurally into the left frontal lobe. It was accompanied by pneumocephalus and showed communication with the left lateral ventricle. Through a bifrontal craniotomy, in toto resection of the frontoethmoidal bony tumor and the intradural mucocele was performed, while thereafter the frontal sinus was cranialized using a pedunculated periosteal flap. Postoperative recovery was uneventful with complete resolution of the tension pneumocephalus and rhinoliquorrhea and led to an improvement of the frontal lobe syndrome. CONCLUSIONS We present a rare case of pneumocephalus caused by a frontoethmoidal osteoma associated with an intradural mucocele. A review of the literature, focusing on the surgical strategies in such cases, is provided.
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Affiliation(s)
- Maria Licci
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Christian Zweifel
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Jürgen Hench
- Department of Neuropathology, University Hospital of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
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Neves MWF, Pontelli LOC, de Abreu Mattos LG, Guimarães MM, Belsuzarri TAB, Gonçales TF, Zeviani WM, de Aguiar PHP, Araújo JFM. Giant mucopyocele associated with intracranial hypertension: Case report and literature review. Surg Neurol Int 2017; 8:242. [PMID: 29119040 PMCID: PMC5655756 DOI: 10.4103/sni.sni_18_17] [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: 01/19/2017] [Accepted: 06/29/2017] [Indexed: 11/04/2022] Open
Abstract
Background Mucoceles are epithelial lined sacs that contain mucous. Eventually, they can be infected and so called mucopyoceles, which are usually slow growing lesions with common bone destruction located in the facial sinus. Mucoceles show multivariate etiology and occur between the fourth and seventh decade of life. Case Description Patient, 55-year-old, female, was referred unconscious with Cushing's triad to our department; she had fever since four days. The findings of skull computer tomography highlighted a large bifrontal lesion with an invasion of the rear wall of the frontal sinus, compression of the frontal lobes, and midline deviation. She was taken for an emergency surgery, which showed invasion of the dura and mucous infection. Postoperatively, there was a fast recovery of neurologic level and extubation on the second postoperative day. She took antibiotics for 14 days and was discharged from the hospital without neurologic deficits. Conclusions Mucopyoceles are usually slow growing lesions that rarely increases rapidly. Our patient presented signs of intracranial hypertension; therefore, it was necessary to have quick surgical intervention.
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Štoković N, Trkulja V, Čuković-Bagić I, Lauc T, Grgurević L. Anatomical variations of the frontal sinus and its relationship with the orbital cavity. Clin Anat 2017; 31:576-582. [PMID: 29044800 DOI: 10.1002/ca.22999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/06/2017] [Accepted: 10/13/2017] [Indexed: 11/10/2022]
Abstract
The anatomy of the frontal sinus is highly variable and its variations affect the occurrence/course of pathological processes. We investigated its size and relationship to the orbit, searching for patterns that would allow it to be classified anatomically. Cone beam computed tomography was applied to 91 skulls (age range 21-86 years) to determine sinus height, width, length, and length of contact with the orbit in the coronal and sagittal planes. In addition, orbital roof pneumatization in the coronal plane was categorized as: none; only medial part pneumatized; the medial and a portion of the central part pneumatized; roof predominantly pneumatized. Sinus dimensions varied widely (mm): height 6.2-50.0; width 3.7-54.0; length 2.4-45.0; frontal orbital contact 4.0-41.6; sagittal orbital contact 0.0-41.2. Pneumatization of the orbital roof (coronal plane) mostly affected the medial and a portion of the central part (50%), or the roof was predominantly pneumatized (32%). Three "types" of sinus (cluster analysis) were distinguished by the extent of pneumatization of the orbital roof in the coronal plane: "small", pneumatization absent or only of the medial part; "medium-sized", pneumatization of the medial and a portion of the central part; "large", roof predominantly pneumatized. All dimensions were significantly different among the types (P < 0.001). Sinus type was fairly predictive of the extent of contact with the orbit in the sagittal plane (not routinely assessed clinically). The data confirm the variability of frontal sinus anatomy and suggest a simple and straightforward classification with potential clinical relevance. Clin. Anat. 31:576-582, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Nikola Štoković
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
| | - Vladimir Trkulja
- Department of Pharmacology, School of Medicine, University of Zagreb, Croatia, Zagreb, 10000, Croatia
| | - Ivana Čuković-Bagić
- Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Croatia, Zagreb, 10000, Croatia.,Department of Dental Medicine, University Hospital Center Zagreb, Croatia, Zagreb, 10000, Croatia
| | - Tomislav Lauc
- Department of Anthropology, Faculty of Social Sciences and Humanities, University of Zagreb, Zagreb, 10000, Croatia.,Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, University of Osijek, Osijek, 31000, Croatia
| | - Lovorka Grgurević
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
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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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