Journal of American Science 2012

7/29/2019 Journal of American Science 2012

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Ethmoid mucocele and nasal deformity

Abdullah Musleh

Department of Otolaryngology, Head and Neck Surgery, Armed Forces

Hospital, South Region, Saudi Arabia

[email protected]

Abstract: Objective:

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Fronto-ethmoid sinus mucocele: a case report.

Optometry. 2006; 77(9):450-8 (ISSN: 1529-1839)

Malloy KA

Pennsylvania College of Optometry, Elkins Park, Pennsylvania 19027, USA.

[email protected]

BACKGROUND: Mucoceles are epithelium-lined cavities in the paranasal

sinuses filled with mucus. They develop because of scarring and obstruction

of the sinus ostium, whether from chronic sinusitis, trauma, or surgery. They

commonly erode the bony sinus wall and can have serious complications of

brain and orbital invasion, with potential for abscess and rupture. CASE

REPORT: A 39-year-old woman had diplopia in left gaze and a hard nodule

above the right eye for 1 year. She recently noted a bulging right eye, nasal

congestion, and occasional headaches. She was 9 years post-sinus surgery.
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All aspects of the afferent optic nerve function were intact. Right-sided

proptosis was evident as was a right adduction and supraduction deficit,

prompting immediate imaging, both with a computed tomography scan and

magnetic resonance imaging of the orbits. These results showed a large right

ethmoid sinus mucocele, with bony erosion and orbital invasion, prompting

an immediate surgical referral. CONCLUSION: Mucoceles may arise from

any of the paranasal sinuses and, because of the close proximity of these

spaces to the orbit, may initially manifest with visual and ocular signs and

symptoms. Therefore, eye care providers need to be aware of this entity and

the need for immediate referral or workup if a mucocele is suspected.

[Pyocele of the posterior ethmoidal cell as the cause of

visual loss]

Otolaryngol Pol. 2006; 60(2):171-4 (ISSN: 0030-6657)

Matyja G; Kawczyski M; Tarnowska C

Katedra i Klinika Otolaryngologii i Onkologii Laryngologicznej, Pomorskiej Akademii

Medycznej w Szczecinie.

INTRODUCTION: Mucocele is a cystic slow-growing lesion of paranasal

sinuses with sterile content. Pyocele contains purulent substance.

Muco-/pyocele is rarely localised in ethmoid or sphenoid sinus and may

involve the orbit and cause ophthalmic complications including visual loss.

MATERIAL AND METHODS: We report the case of a 25-year-old woman

who suffered from sudden visual loss of her left eye. She was treated for

optic nerve papillitis by neurologists and ophthalmologists with steroids and

recovered after about 6 weeks. Magnetic resonance imaging was ordered to

find the cause of visual disturbance and revealed an oval-shaped lesion in

the left posterior ethmoid sinus. The patient underwent functional
http://reference.medscape.com/viewpublication/8077http://reference.medscape.com/viewpublication/8077


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endoscopic surgery and transethmoidal marsupialisation of the

muco-/pyocele. RESULTS: After endoscopic microsurgery the patient

recovered without complications, she is under follow-up and has no

symptoms of any disease. Because there were no evidence of any other

causes of optic nerve affection, the muco-/pyocele was regarded as the cause

of visual loss. CONCLUSIONS: The posterior ethmoid muco-/pyocele can

present with ophthalmic manifestations including blindness. Endonasal

operation and steroids administration are the treatment of choice in such

cases.

[Fronto-ethmoidal mucocele: a case report]

Rev Laryngol Otol Rhinol (Bord). 2009; 130(4-5):289-91 (ISSN: 0035-1334)

Arena P; Boudard P

L'Institut G. Portman, So Paulo, Brsil.

Paranasal sinus mucoceles can present ophthalmic disturbances. Our aim is

to discuss the treatment and the endoscopic sinus surgery indication in the

fronto-ethmoidal sinus mucoceles. We describe here a case of fronto-

ethmoidal sinus mucocele in a patient with an important fronto-ethmoidal

tumefaction and an increased prominence of his left eyeball. An endoscopic

approach was done after explain to the patient the eventual risks and

complications of the procedure, especially to his left eye.
http://reference.medscape.com/viewpublication/8899http://reference.medscape.com/viewpublication/8899


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. Material &Methods:

.

Results:

Conclusion:

[A. Musleh. Ethmoid mucocele and nasal deformity. Key Words: ,

,

1. Introduction

A mucocele is a chronic cystic lesion of the paranasal sinuses lined by

respiratory epithelium, which results from obstruction of the draining ostia.1

This obstruction leads to effacement of the normal septa, expansion of the

sinus, thinning of the bony wall, and ultimately extension through the

wall into the adjacent orbit, nasopharynx, or cranial cavity. The cysts are

usually filled with clear to slightly yellowish, thick mucoid secretions.2

Mucoceles constitute 2% to 8.3% of all sinus tumors and 2.7% of

nonendocrine exophthalmos cases.3 Because of the close anatomic

relationship between the orbit and the paranasal sinuses, orbital involvement

might occur. Orbital mucoceles manifest similar signs and symptoms, such

as orbital displacement, proptosis, diplopia, ophthalmoplegia, and decreased

visual acuity. Ophthalmic involvement may be the first sign of the

mucocele. Management of orbital mucoceles includes complete removal of

the cystic lining, reestablishment of normal drainage, or obliteration of the


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sinus by mucosal stripping and packing with bone or fat. This is usually the

domain of the otorhinolaryngologist, but ophthalmologic expertise may play

an important role in the management of orbital mucoceles.2

Th e numerous bony partitions within the ethmoid sinus are at risk of

mucocele development in the postsurgical cavity as scarring and secondary

obstruction may develop. In isolated mucoceles along the ethmoid skull

base, another entity that should be entertained especially in patients with

prior sinus surgery is an encephalocele (Fig. 16.6). Review of prior operative

reports should be performed to determine if there was any violation of the

ethmoid roof. A MRI scan is recommended in the preoperative evaluation as

well. Once the presence of a mucocele is confi rmed, endoscopic

marsupialization of these lesions is performed by initial entry into the lesion

followed by removal of surrounding osteitic bony partitions. In cases

where there is signifi cant scarring along the ethmoid roof, identifi cation of

the skull base may be diffi cult. In these cases, the skull base is identifi ed

within the sphenoid sinus at its lowest point, and is then skeletonized in a

posterior to anterior direction. Th e dissection progresses to the region of the

mucocele. As mentioned earlier, the use of through-cutting instruments

along the skull base cannot be emphasized enough in order to avoid

inadvertent skull base injury.

2. Material and methods:

l

repairs.

3. Results:


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Patients

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Fig.7:

4. Discussion:

5. Conclusion:

Correspondence author

Abdullah Musleh

Department of Otolaryngology, Head and Neck

Surgery, Armed Forces Hospital, South Region,

Saudi Arabia

[email protected]

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Journal of American Science 2012