A challenging case of recurrent fronto-ethmoidal sinus mucocele
Author: Mumta Kanda
Base Hospital / Institution: Queen’s Hospital, Romford
ePoster presentation
Abstract ID: 24-525
Purpose
To outline the presentation and management of a third recurrence of fronto-ethmoidal sinus mucocele
Methods
Case report
Results
A 48-year-old male had a 3-year history of right recurrent fronto-ethmoidal sinus mucocele with 2 previous sinus surgeries. The most recent was performed 3 months before he presented to our unit with worsening right proptosis with inferior and lateral displacement of the globe, restriction in elevation, and a large palpable cystic mass in the superomedial orbit. Remaining ocular examination was normal. CT scan demonstrated a large right fronto-ethmoidal mucocele eroding into the roof of the orbit and sclerosed bone on the posterior wall of the mucocele, making a standard endoscopic sinus surgery approach difficult. The patient was offered external approach sinus surgery but refused. He had a Draf IIc procedure under the ENT surgeons, in which the septum between frontal sinuses was drained in addition to the right frontal sinus. 2 months post-procedure the patient was asymptomatic, and the proptosis and elevation defect had resolved. However, nasal endoscopic assessment suggested the frontal sinus opening may already be closing by scarring.
Conclusion
Mucoceles of the frontal and ethmoidal sinuses are an uncommon cause of unilateral proptosis, but they have characteristic features which enable a diagnosis to be established without undue difficulty. The characteristic radiological features of a mucocele are of considerable value in establishing a diagnosis, as long as proper views of the paranasal sinuses are taken. Endoscopic sinus surgery and marsupialisation should be the treatment of choice for simple frontal mucoceles, although more radical approaches are required if the size of mucocele is large. Recurrence of fronto-ethmoidal sinus mucocele is common if sinus marsupialisation is inadequately done and can be challenging to treat. Careful investigation and a multidisciplinary team approach between ophthalmology and ENT is essential in management and treatment of these cases.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Anna | Gkountelia | Queen’s Hospital, Romford |
