Complete loss of vision caused by a giant mucocele of the frontal sinus

Frontal Sinus Fractures

Management of frontal sinus fractures is controversial with no universally accepted treatment protocol. Goals of management are to correct aesthetic deformity, preserve sinus function when it is deemed salvageable, prevent sequela related to the injury, and minimize complications associated with intervention. Studies suggest that frontal sinus injuries, including disruption of the nasofrontal outflow tract (NFOT), can be managed nonoperatively in many cases. Advances in the utilization of endoscopic techniques have led to an evolution in management that reduces the need for open procedures, which have increased morbidity compared with endoscopic approaches. We employ a minimally disruptive protocol that treats the majority of fractures nonoperatively with serial clinical and radiographic examinations to assess for sinus aeration. Surgical intervention is reserved for the most severely displaced and comminuted posterior table fractures and unsalvageable NFOTs utilizing endoscopic approaches whenever possible.

Giant mucocele secondary to cocaine abuse

Mucoceles are benign lesions originating in the paranasal sinuses. Presented here is a novel case of a giant frontoethmoidal mucocele extending into the orbit and causing proptosis. The etiology was chronic transnasal cocaine abuse leading to extensive scarring and distortion of the nasal anatomy.

Considerations in the management of giant frontal mucoceles with significant intracranial extension: A systematic review

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.

Strabismus secondary to frontal sinus mucocele associated with nasal polyposis

Paranasal mucoceles are regarded as slow-growing and benign lesions. They are usually recognized by otorhinolaryngologists, but a clinically relevant mucocele with orbital complications may present to an ophthalmologist. We report a 15-year-old's case with unilateral reduced ocular motility due to bilateral frontal mucocele associated with grade II nasal polyposis.