Endonasal endoscopic marsupialization of paranasal sinus mucoceles

Postoperative ethmoid sinus mucoceles: Late complication of endoscopic ethmoidectomy and MWA management in outpatient

OBJECTIVE

The aim of this study was to investigate the feasibility of intranasal endoscopic microwave ablation (MWA) on the management of postoperative ethmoid sinus mucoceles.

METHODS AND MATERIALS

The patients with postoperative ethmoid sinus mucoceles were ablated through intranasal endoscopic MWA. Postoperative pain intensity was measured via visual analogue scale (VAS), post-operative complications were recorded.

RESULTS

Of the 26 patients with unilateral postoperative ethmoid sinus mucoceles, the mucoceles were diagnosed 3 to 11 years with average time of time of 6.9 ± 2.7 years after endoscopic ethmoidectomy. The ipsilateral middle turbinate was present and intact in 24 patients and partially resected during the original surgery in the remaining 2. There were adhesions in the middle meatus in one case. All 26 patients were successfully treated with the intranasal endoscopic ablation technique in outpatient. The ablation time was 6 to 11 min, with an average duration of 6.84 ± 1.27 min. The mean VAS pain score was 2.41 ± 1.22. There were no perioperative complications reported in this series. No evidence of recurrence was observed in any patients during follow-up periods.

CONCLUSIONS

The present study demonstrates the safety and efficacy of intranasal endoscopic MWA in the office. The procedure is well tolerated by patients with low complication rates. Thus, it is alternative to conventional endonasal endoscopic marsupialization for treatment of postsurgical ethmoid sinus mucoceles.

Intracranial abscess formation following sphenoid sinus occlusion with nasoseptal flap skull base reconstruction: A cautionary tale

The formation of an intracranial abscess secondary to sphenoid sinus occlusion after nasoseptal flap skull base reconstruction has not been previously described. We report such a case that occurred at our institution in a 23-year-old man who underwent flap reconstruction for a cerebrospinal fluid leak. We determined that occlusion of the sphenoid sinus outflow might have played a role in this complication. The patient was treated via a combined surgical and medical approach that entailed a bur-hole craniotomy and endoscopic debridement followed by administration of an intravenous antibiotic. The patient recovered without long-term deficit. When closing a defect of the posterior ethmoid and sphenoid skull base, especially with a pedicled graft, care must be taken to reduce the potential for retention of secretions and blood because this may lead to an intracranial complication.

Outcomes in Surgical Treatment of Mucocele in Frontal Sinus

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.

Role of Macrophage Migration Inhibitory Factor in Paranasal Sinus Mucocele

Background

Little is known about the immunologic aspects and the pathogenesis of the paranasal sinus mucocele.

Methods

The fluids of paranasal sinus mucoceles were obtained from 12 subjects. The concentration of macrophage migration inhibitory factor (MIF), interleukin 1β, tumor necrosis factor a, and regulated on activation normal T cell expressed and secreted (RANTES) were determined by enzyme-linked immunosorbent assay, and the levels of endotoxin were detected with kinetic Turbidimetric Assay.

Results

MIF and endotoxin were detected in the fluid of all samples, whereas interleukin-1β and RANTES were detected in 1 and 3 subjects out of 12 samples. Tumor necrosis factor a was not detected in any of the samples. A significant positive correlation between the levels of MIF and the period with symptoms such as pain, swelling of face, and visual disturbance was observed.

Conclusion

These findings suggest that MIF and endotoxin may play an important role in the pathogenesis of paranasal sinus mucocele. MIF may be an important factor causing the development and exacerbation of the disease.

Mucoceles of the Paranasal Sinuses with Intracranial Extension-Postoperative Course

Mucoceles of the paranasal sinuses cause progressive distension of the bony walls and induce compressive symptoms. Although rare, cases of massive intracranial extension have occurred. We believe that an endoscopic transnasal approach is the best choice for such huge mucoceles because it is the least invasive and can provide an adequate surgical field of view for wide marsupialization. However, the results of long-term follow-up after endoscopic transnasal surgery have not been reported. This study was designed to evaluate prospectively the postoperative course of patients with intracranially extended mucocele. In the last 5 years, we have operated on four patients with intracranially extended mucocele. Although postoperative scanning is not recommended routinely after surgery for inflammatory disease, we followed up two patients who consented by using magnetic resonance imaging (MRI) along with endoscopy. Dural descent to the original skull base plane necessitated long periods of follow-up, lasting 18 and 5 months, respectively. On the mucocele wall mucosa, which had been smooth during surgery, polyps and granulations developed after surgical drainage and lasted for a considerable time. Although endoscopic transnasal opening of mucocele is a method of choice, we recommend follow-up of such patients for long periods, at least until the frontal skull base dura returns to its original position.

Transnasal endoscopic surgery of post-operative maxillary cysts

OBJECTIVE

The present study investigates the indications for transnasal endoscopic surgery in treating post-operative maxillary cysts.

METHODS

In this retrospective study, the records of 118 patients with post-operative maxillary cysts (88 unilateral and 30 bilateral) consisting of 148 procedures were reviewed.

RESULTS

A transnasal endoscopic approach was performed in 144 lesions (97.3 per cent). A combined endonasal endoscopic and canine fossa (external) approach was performed in 4 of 148 lesions, because the cysts were located distant from the nasal cavity and had a thick bony wall. A ventilation stent was placed in four patients (four cysts) to avoid post-operative meatal antrostomy stenosis. Recurrence was observed in five patients (4.2 per cent), all of whom subsequently underwent transnasal endoscopic revision surgery.

CONCLUSION

Transnasal endoscopic surgery is an effective treatment for post-operative maxillary cyst with the exception of cysts located distant from the nasal cavity.

Outcomes of frontal mucoceles treated with conventional endoscopic sinus surgery

CONCLUSION

Conventional endoscopic sinus surgery (CESS) is useful for frontal mucoceles. A patient with short anterior-posterior distance and bone thickening may need an axillary flap, Draf type IIb, or Draf type III procedure.

OBJECTIVE

To present outcomes of frontal mucoceles treated with CESS and predict risk factors for poor outcomes to help define surgical indications.

METHODS

A consecutive clinical series was reviewed retrospectively. The authors performed CESS without agger nasi resection (Draf type IIa) for 13 frontal sinus mucoceles in 12 patients between October 2011 and July 2013. Patient age, sex, blood eosinophil count, history of operation and co-existence of acute infection were compared. For the condition of the frontal sinus, anterior-posterior distance and width of frontal recess, bone thickening of the frontal recess, bone absorption due to continuous pressure by mucocele and anatomy of the frontal recess was noted.

RESULTS

All operations were done without a navigation system. The post-operative course was uneventful in all 12 patients, and all symptoms gradually receded. Among 13 mucoceles, one frontal sinus (7.7%) closed during follow-up.

Contemporary management of frontal sinus mucoceles: a meta-analysis

OBJECTIVES/HYPOTHESIS

To analyze trends in the surgical management of frontal and fronto-ethmoid mucoceles through meta-analysis.

STUDY DESIGN

Meta-analysis and case series.

METHODS

A systematic literature review on surgical management of frontal and fronto-ethmoid mucoceles was conducted. Studies were divided into historical (1975-2001) and contemporary (2002-2012) groups. A meta-analysis of these studies was performed. The historical and contemporary cohorts were compared (surgical approach, recurrence, and complications). To study evolution in surgical management, a senior surgeon's experience over 28 years was analyzed separately.

RESULTS

Thirty-one studies were included for meta-analysis. The historical cohort included 425 mucoceles from 11 studies. The contemporary cohort included 542 mucoceles from 20 studies. More endoscopic techniques were used in the contemporary versus historical cohort (53.9% vs. 24.7%; P = <0.001). In the authors' series, a higher percentage was treated endoscopically (82.8% of 122 mucoceles). Recurrence (P = 0.20) and major complication (P = 0.23) rates were similar between cohorts. Minor complication rates were superior for endoscopic techniques in both cohorts (P = 0.02 historical; P = <0.001 contemporary). In the historical cohort, higher recurrence was noted in the external group (P = 0.03).

CONCLUSIONS

Results from endoscopic and open approaches are comparable. Although endoscopic techniques are being increasingly adopted, comparison with our series shows that more cases could potentially be treated endoscopically. Frequent use of open approaches may reflect efficacy, or perhaps lack of expertise and equipment required for endoscopic management. Most contemporary authors favor endoscopic management, limiting open approaches for specific indications (unfavorable anatomy, lateral disease, and scarring).

LEVEL OF EVIDENCE

N/A.

Ethmoid mucocele: a new feature of primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) is a rare congenital autosomal recessive disease that produces impairment of mucosal ciliary movement. Children with this disorder usually manifest recurrent and chronic infections of the upper and lower airways. We describe the history of a 12-month-old boy in whom the correct diagnosis of PCD was achieved after the occurrence of ethmoid mucocele associated with omolateral proptosis. A careful description of this new feature of PCD and its dangerous complications are also presented.

[Clinical features of patients with paranasal sinus cysts]

This study retrospectively analyzed the clinical features of patients with paranasal sinus cysts. Between April 1995 and March 2008 at Hyogo College of Medicine, we performed sinus surgery on 218 patients with paranasal sinus cysts. There were 125 men and 93 women with the mean age of 57.5 years (17-85 years old). Diagnosis was based on the preoperative endonasal and radiological findings as well as surgical findings. The patients were followed for 6 months or more after surgery. Of 218 patients, postoperative cysts were observed in 173 patients (79.4%), and idiopathic cysts were found in 45 patients (20.6%). In postoperative cysts, the maxillary sinus was the most common lesion (124/173 patients, 71.7%). Most patients (53.8%) presented with cheek swelling and pain. The mean interval between the first and most recent surgery was 31.2 years (4-55 years). Among idiopathic cysts, anterior ethmoid sinus (19/45 patients, 42.2%) and frontal sinus (15/45 patients, 33.3%) were common lesion sites. More than a half of them (53.3%) presented with ophthalmologic symptoms. For treatment, endoscopic sinus surgery (ESS) was performed on 206 patients. The navigation system for ESS was utilized in 6 patients (2.8%). External approaches were required in 23 patients (10.6%). The Caldwell-Luc procedure for maxillary sinus cysts and Killian's procedure for frontal sinus cysts were performed on 18 and 5 patients, respectively. Dacryocystorhinostomy (DCR) with the endonasal approach was additionally performed on 4 patients with epiphora due to postoperative maxillary sinus cysts. Recurrence of cysts was observed in 5 patients (2.3%) at the mean interval of 25 months after surgery, comprising three patients with maxillary sinus cysts, one patient with a frontal sinus cyst, and one patient with a sphenoid sinus cyst. In conclusion, most paranasal sinus cysts (approximately 80%) occurred postoperatively. Symptoms were predominantly ophthalmologic. Selecting an endoscopic and/or an external approach is critical, considering minimally invasive surgery and risk of recurrence.

Endoscopic middle meatal antrostomy in treatment of maxillary sinus mucoceles

BACKGROUND/AIM

Mucocele of a paranasal sinus is a benign non-neoplastic condition characterized by cystic expansion and distension of the sinus cavity by retained mucoid secretions. Etiology is unknown. The purpose of this study was to estimate the efficiency of the endoscopic middle meatal antrostomy (MMA) as a treatment modality in patients with maxillary sinus mucoceles.

METHODS

This retrospective study involved 11 patients with maxillary sinus mucoceles/pyoceles treated endoscopically in the Clinic for Otorhinolaryngology of Military Medical Academy, Belgrade over a 3-year period (2005-2007). The presented symptoms and signs, radiological and pathohistological findings and surgical treatment were reviewed.

RESULTS

There were four females and seven males, age 22 to 65 years (mean 33 years). Two patients were with allergic rhinitis. All the patients complained of nasal obstruction, ten had facial pain, seven had nasal discharge, five had cheek pressure, and four had epiphora, and four had headaches. On endoscopic nasal examination, the medial wall of the maxillary sinus was bulging in ten patients. Purulent drainage was seen in eight patients, septal deviation in ten, and polyps were found in two of the patients. The MMA and marsupialization of the mucocele were performed in all the patients. On histopathological examination, the mucocele wall showed a lining composed of respiratory epithelium. Postoperative follow-up ranged between 8 and 44 months (in six patients, it ranged from 24 to 44 months). No patients required revision surgery.

CONCLUSION

The MMA with mucocele marsupialization abolishes middle meatal obstruction and establishes better drainage and ventilation of the maxillary sinus and restitution of its mucosa.

Expression of IL-12 and T helper cell 1 cytokines in the fluid of paranasal sinus mucoceles

OBJECTIVE

The objective of this study was to assess the expression of regulatory cytokines and T helper cell (Th)1/Th2 cytokines in paranasal sinus mucoceles.

MATERIALS AND METHODS

Fluid samples of 12 paranasal sinus mucoceles were assessed by enzyme-linked immunosorbent assay for concentrations of regulatory cytokines (interleukin [IL]-10 and IL-12), Th1 cytokines (IL-2 and interferon gamma), and Th2 cytokines (IL-4 and IL-5).

RESULTS

IL-12 was detected in all samples, whereas IL-10 was detected in only one case. The concentration of IL-12 tended to correlate with that of interferon gamma and was significantly and positively correlated with that of IL-2.

CONCLUSIONS

Th1 cytokines and the Th1 regulatory cytokine IL-12, but not IL-10, potentially play a key role in the pathogenesis of paranasal sinus mucoceles. Together with our recent report showing that lipopolysaccharide is highly detected in mucocele fluid, the data from this study suggest that the Th1 response induced by lipopolysaccharide may affect the immunological inflammation in the epithelium of paranasal sinus mucoceles.

Pediatric paranasal sinus mucoceles: etiologic factors, management and outcome

OBJECTIVES

To study the local and general etiological factors of paranasal sinus mucoceles in the pediatric population and to evaluate and discuss the clinical management and the results of endonasal marsupialization.

DESIGN

Retrospective study.

PATIENTS AND METHODS

A series of 10 cases of paranasal sinus mucocele in children were managed. For imaging, CT-scan and, sometimes MRI were performed. An ophthalmologic evaluation was performed preoperatively in all cases, and post-operatively in case of preoperative trouble. All patients were treated with endoscopic surgical procedure. Authors also looked for etiological factors.

RESULTS

Cystic fibrosis was found in 6 cases out of 10. Others etiological factors were trauma and inflammatory process; one case was strictly idiopathic. Three patients out of 10 had ophthalmologic trouble related with the mucocele. With a mean follow-up of 17 months, neither recurrence nor complication were noted. All patients with ophthalmologic complain were free of trouble after surgery.

CONCLUSION

Paranasal sinus mucoceles in children are still rare. In our experience, 9 out of 10 patients had predisposing factors, especially cystic fibrosis. Imaging with CT-scan and MRI allow the physician to rule out other tumors such as meningoceles or rhabdomyosarcoma. Endoscopic endonasal surgery is nowadays the gold standard for the treatment of paranasal sinus mucoceles.

Ophthalmic manifestations of paranasal sinus mucoceles

BACKGROUND

Paranasal sinus mucoceles are mucus-containing cysts caused by obstruction of the sinus orifice. Although such mucoceles originate in the paranasal sinuses, they are usually only associated with ophthalmic and not rhinologic symptoms. The purpose of this study was to demonstrate the presence of ophthalmic manifestations in patients with paranasal sinus mucoceles, and to discuss the possible mechanisms and prognosis for such manifestations.

METHODS

Medical records for 41 patients with paranasal sinus mucoceles, who presented with ophthalmic complaints at our department over a 10-year period (1989-1999), were reviewed retrospectively. For analysis of the relationships between ophthalmic complaints and the affected paranasal sinuses, we considered the paranasal sinuses as anterior and posterior.

RESULTS

Proptosis (n = 19), periorbital pain (7), and impairment of ocular mobility (5), were common manifestations associated with mucoceles in the anterior paranasal sinuses (25 patients), while blurred vision (n = 9) and impairment of ocular mobility (3) were frequently associated with mucoceles in the posterior paranasal sinuses (11 patients). Ophthalmic complaints resolved in 38 of 41 patients (92.7%) after operation.

CONCLUSION

The clinical ophthalmic manifestations of paranasal sinus mucoceles correlated with the paranasal sinuses involved (i.e. anterior or posterior). Because of cranial nerve involvement, mucoceles in the posterior paranasal sinuses had a worse prognosis than those in the anterior paranasal sinuses.

Outer table craniotomy for frontal sinus mucocele

Variants of the external osteoplastic flap procedure or endoscopy have been used to approach the frontal sinus mucocele. The authors introduce a modified external approach for radical resection of the mucocele. Using the bicoronal skin incision, the skin flap exposed the right upper orbital rim. The outer table craniotomy was then performed to expose the frontal sinus cavity while carefully preserving the inner table, with radical removal of the mucocele mucosa. The sinus cavity was irrigated with hyper-oxide solution to ensure adequate destruction of possible residual mucosa. The fascia of the frontalis muscle was split, with one part placed into the mucocele cavity to plug the nasofrontal duct. The advantages of the procedures for mucocele removal include clear visualization of the frontal sinus for radical resection of the mucosa, preservation of the inner table avoiding dura manipulation, prevention of central nervous system infection, possibly lower rates of recurrence, prevention of mucosal ingrowth by plugging of the nasofrontal ducts with fascia, and favorable cosmetic outcome. The disadvantages are more intensive surgery comparable to the endoscopic approaches and execution difficulties when the frontal mucocele is small. Additional clinical studies are needed to evaluate the efficiency and safety of this procedure.

Endoscopic treatment of the isolated sphenoid sinus lesions

Presenting symptoms of the isolated sphenoid sinus lesion are often vague and non-specific. Diagnostic nasal endoscopy procedures and imaging techniques are of great value for an early and precise diagnosis. Moreover, endoscopic sinus surgery is a safe and effective technique that allows a direct route to the sphenoid sinus. Because of its close vicinity to important and vulnerable structures of the skull base, delay in diagnosis and treatment can be potentially lethal. Endoscopically controlled procedures for the sphenoid sinus provide the surgeon with an obvious alternative to the traditional approaches. From November 1994 to May 2001 the authors operated on 41 patients with isolated sphenoid lesions. The pathology spectrum was rather wide and included 11 cases of isolated fungal sinusitis, 10 mucoceles, 7 bacterial sinusitis, 7 cerebrospinal fluid leaks, 3 inverted papillomas, 1 chondrosarcoma, 1 ossifying fibroma and 1 foreign body. The sphenoid sinus was the only sinus involved, and lesions arising from adjacent tissues were excluded. In this paper, the authors present clinical symptoms, endoscopic findings and imaging data as well as endoscopic surgical techniques for the treatment of sphenoid sinus disease.

Endoscopic sinus surgery for paranasal sinus mucocoele with orbital involvement

PURPOSE

To evaluate the results of endoscopic sinus surgery (ESS) for paranasal sinus mucocoele with orbital involvement and assess the frequency with which a direct orbital approach is required in these cases.

METHODS

Retrospective, consecutive series of sinus mucocoeles with orbital involvement treated by ESS by a single surgeon over a 4-year period (1998-2002).

RESULTS

A total of 24 mucocoeles of 15 patients, including 10 frontal, eight frontoethomoidal, two ethmoidal, and four maxillary. All cases demonstrated radiological orbital extension. Globe displacement was seen in 73%. At a median follow-up of 15.5 months, the mean cumulative clinical score improved from 4.2 +/- 1.5 (range 1-7) to 0.4+/-0.7 (range 0-2). Ophthalmic symptoms and signs resolved in all patients but one who had complex sinus anatomy following neurosurgery. Minor, self-limiting complications including epistaxis and intranasal adhesions occurred in three cases. Additional endoscopic sinus surgery was required in four patients for revision of narrowed frontal sinus ostium (two), mucocoele recurrence (two), and sinus toileting (one). No cases required external sinus surgery and the average hospital in-patient stay was 2.5 +/- 1.6 days. At final follow-up, sinus ostia were patent in all excluding one case that required a stent due to disrupted anatomy.

CONCLUSION

ESS is effective in improving ophthalmic symptoms and signs due to paranasal sinus mucocoele. ESS may be a viable treatment for paranasal sinus mucocoele with orbital extension, and a direct orbital approach is rarely necessary.

Surgical treatment of subperiosteal abscess of the orbit: Sendai's ten-year experience

OBJECTIVE

One of the common complications of acute infection of the paranasal sinus is cellulitis of the orbit. This is secondary to the spread of infection through the very thin bony wall between the ethmoid sinuses and the orbit, the roof of the orbit in frontal sinusitis, and the floor of the orbit in maxillary sinusitis. When the infection does not penetrate the periorbita, it dissects under the periosteum and forms subperiosteal abscess.

METHODS

We experienced 10 patients with subperiosteal abscess for 10 years from 1992 to 2002 that required surgical drainage. The age of the patients ranged from 4 to 76 years including five males and five females.

RESULTS

Successful and safe drainage of the abscess with endoscopic sinus surgery was obtained in four patients while six patients required external surgery. The selection of the surgical approach depended upon the localization of abscess in the orbit. Five of the seven patients with visual disturbance resulted in a complete recovery of vision after surgery. However, there was no improvement of visual acuity in the other two patients who had already shown severe damage of vision prior to treatment.

CONCLUSION

Ocular symptoms such as exophthalmos, double vision, and ptosis subsided completely in all patients. It is suggested that prompt diagnosis and surgical drainage before severe loss of visual acuity rescue or recover the vision.

Ethmoid Mucocele as a Late Complication of Endoscopic Ethmoidectomy

OBJECTIVE: Our goal was to describe ethmoid mucocele as a late complication of endoscopic ethmoidectomy.

STUDY DESIGN: This was a retrospective review of 14 patients who were diagnosed with ethmoid mucoceles after endoscopic ethmoidectomy. Reviewed data included patient demographics, indication for the original surgery, presenting symptoms, computed tomography results, surgical treatment, operative findings, and recurrence of disease.

RESULTS: The mucoceles were diagnosed 1 to 13 years after endoscopic ethmoidectomy. The most common presenting symptom was facial pressure or pain. Twelve patients had middle meatal adhesions. A round mass was seen by endoscopy in the ethmoid cavity in 5 patients. Nine mucoceles were located in the anterior ethmoid and 3 were located in the posterior ethmoid, and 2 involved both. The mucoceles were marsupialized via revision endoscopic ethmoidectomy in 12 patients, whereas 2 had both external and endoscopic approaches taken.

CONCLUSION: Ethmoid mucocele can form as a late complication of endoscopic ethmoidectomy. It is commonly associated with middle meatal adhesions.

Endoscopic trans-nasal-vestibular approach to the maxillary sinus--application for mucoceles of the maxillary sinus

Endoscopic endonasal surgery has been applied to the treatment of paranasal mucoceles. The approach is, however, hard to be adopted for maxillary mucoceles when the cyst is situated in the anterior and/or lateral portion of the maxillary sinus, has a thick bony lateral wall of the inferior nasal meatus, and when the patients develop compartmentalized cysts following facial trauma or sinus operation. We devised an endoscopic approach via the vestibule of the nose to reach any part of the maxillary sinus and applied it for the treatment of postoperative maxillary mucoceles, which could not be opened following the usual endoscopic approach with favorable outcomes.

Endoscopic management of 108 sinus mucoceles

OBJECTIVES/BACKGROUND

Traditional teaching has emphasized the need for complete removal of sinus mucoceles to achieve a cure. However, with the introduction of endoscopic sinus surgical instruments and techniques, there has been a trend toward transnasal endoscopic management of sinus mucoceles. The aim of this study is to establish the efficacy of endoscopic management of sinus mucoceles.

STUDY DESIGN

Retrospective review.

PATIENTS AND METHODS

Between 1988 and 2000, 103 patients with 108 paranasal sinus mucoceles were treated endoscopically. This series includes 66 frontal and frontoethmoid, 17 ethmoid, 7 sphenoethmoid, 12 sphenoid, and 6 maxillary mucoceles. Ninety patients (83.3%) had intraorbital extension and 85 of them presented with some degree of proptosis or eye displacement. Sixty patients (55.5%) had erosion of the skull base with varying degrees of intracranial extension of the mucocele. Follow- up ranged from 1 to 131/2 years with a median of 4.6 years.

INTERVENTION

All patients underwent endoscopic-wide marsupialization of the mucocele cavity. Stents were used in frontal mucoceles only.

RESULTS

Recurrence of a frontal mucocele was seen in 1 patient (0.9%). In 5 patients, out of 23 patients who presented with massive pansinus polyposis in addition to the mucocele, recurrent polyposis required revision surgery. However, the mucoceles did not recur in those patients.

CONCLUSIONS

There is increasing evidence in the literature that endoscopic management of sinus mucoceles results in long-term control with recurrence rates at or close to 0%. Rhinologic surgeons should consider the endoscopic technique as the surgical treatment of choice.