Mucocele is a benign and expansile cystic lesion lined with respiratory mucosa of pseudo stratified columnar epithelium. Mar 26, 2015 br edited narrated movie showing a marsupialization of an ethmoidal mucocele. Ghaed1 idiopathic expansion of a paranasal sinus containing air and without an associated mass has been termed pneumosinus dilatans 1. Sphenoid sinus mucocele comprises only 2% of all paranasal sinus mucoceles which can compress on the optic canal or inferior orbital fissure, and causing loss of vision. A 45 yearsold male was complaining of decrease in vision in the right eye and severe headache at the right. These expansile cystic masses are sometimes filled with mucopurulent secretions 1. Wilkerson 1 has traced the historical background from ancient times. Possible clinical manifestations of mucoceles, diagnostic imaging techniques and treatment used are discussed. Currently, computed tomography ct is the diagnostic method of choice for paranasal sinus pathology, while magnetic resonance imaging mri is helpful in differentiating mucoceles from meningoencephaloceles and tumors 6. Endoscopic view of a mucocele in an infraorbital ethmoid.
We conducted a retrospective study of patients with mucoceles explored by imaging and operated on in our department. It affects mostly adults, and is most common in the frontal and ethmoidal sinuses. Postcontrast coronal image shows a large left frontal sinus mass. Mucocele most commonly produces bone destruction within the paranasal sinuses. The imaging features on plain xray, computerized tomography and magnetic resonance imaging are relatively characteristic allowing distinction of the lesion from other pathologies in this area although the mucoceles may occur in association with other. An atypical presentation of sinus mucopyocele in a pediatric. Approximately twothirds of all mucoceles are commonly found in the frontal sinuses, and the majority of the remainder involves the ethmoidal sinus 4,5. Depending on its anterior andor posterior location, they can also. Frontal mucoceles are benign and curable, early recognition and management of them is of paramount importance.
Mucoceles are commonly caused due to obstruction to drainage channel of paranasal sinuses. Postoperatively with continuous pulmonary care, the patient remains free of allergic conjunctivitis and e. A mucocele may be produced by an outlet obstruction to a sinus ostium or compartmental ostium or by dilatation of an obstructed gland retention cyst. Sinus mucoceles are epithelial lined cavities containing sterile mucus which develop as the result of an outflow obstruction of a sinus ostium. T1 paranasal sinus mucocele as a late complication of dacryocystorhinostomy.
A mucocele is a chronic, epitheliallined, cystic lesion of the paranasal sinuses 1, 5. A telescopic view revealed thick greenish secretions extruding from a mucocele at the anterior ethmoid region adjacent to the left lamina papyracea figure, b. As the thin walled lamina papyracea may be displaced into the optic canal by an expanding mucocele, visual compromise is more common with posterior ethmoid and sphemoid mucoceles. Blinding orbital apex syndrome due to onodi cell mucocele. In 55% of the cases 3258 the mucocele was located in the frontal sinus or in the ethmoidfrontal region, in 14% 858 in the ethmoidal sinus, in 24% 1458 in the maxillary sinus and in 7% 458 in the sphenoid sinus. Optimum imaging for mucoceles the journal of laryngology. A frontoethmoidal mucocele with surgical correlation. Ct diagnosis of mucocele of the appendix in patients with. After the marsupialization of the mucocele via a transnasal endoscopic approach, the patients symptoms oculomotor nerve paralysis and headache resolved in 4 weeks. Ta was a 72yearold sheepherder who had not received any medical care for a number of years. As a contribution to the diagnostic workup of the mucocele, 1 hmrs demonstrates a dominant peak at 2. Mucoceles of paranasal sinuses are most commonly seen in frontal sinus followed by ethmoidal sinus. A, t1 weighted mr image 60020 shows expansile, hyperintense abnormality of anterior ethmoids bilaterally, greater on the right arrows. Paranasal sinus mucocele as a late complication of.
The patient underwent functional endoscopic sinus surgery, with successful marsupialization of the ethmoidal mucocele, which was found on culture to be infected with e. Thrita unilateral frontal and ethmoidal mucoceles of the. Oculomotor paralysis is a rare symptom of an ethmoidal mucocele. Mucocele of the paranasal sinuses are well described complication of chronic sinusitis in adults but they rarely occur in the pediatric population. In our series, fronto ethmoidal sinuses were the most frequently affected 81%. Appropriate therapy of the mucocele may correct the associated complications, such as exophthalmos, and may prevent visual loss. Jan 10, 2016 diagnostic imaging of paranasal sinuses and nose 1. Mucoceles are benign lesions, expansile and locally destructive, causing erosions of the bony walls of the sinus 3. A mucocele, a benign, expansile, cystlike lesion of the paranasal sinuses, may uncommonly involve the onodi cell causing compression of the optic nerve and nearby structures. We describe a rare case of a posttraumatic fronto ethmoidal mucocele that developed 49 years after initial trauma. Paranasal sinus mucoceles opthalmic manifestations. Imaging of paranasal sinus mucoceles page 94 research abstract introduction. Pdf frontal sinus mucocele with orbital complications. Computerised tomographic findings in mucoceles of the.
The diagnosis was frontal sinus mucocele with intracranial and intraorbital extension. Paranasal sinus mucoceles are quite rare and a comprehensive study regarding their incidence, presentations, management and complications is significantly lacking in our geographical area which led to our prospective study. They may also involve the orbital space and cause a downward and lateral globe displacement with proptosis. With the assistance of computer image guidance, a microdebrider was used to carefully open the mucocele and suction its contents figure, c. Mucoceles occur most frequently in the frontal and ethmoidal sinuses, without gender prevalence. Clinical presentation of the mucoceles varies from asymptomatic to incapacitating. Mucocele of the frontal sinus is most common, followed by anterior ethmoidal sinus. Ct imaging revealed isolated opacification and expansion of both sphenoid sinuses with bony continuity along the periphery of the sinuses features consistent with mucocele. Twenty ethmoidal mucoceles were treated and observed for a minimum of two years after surgery. Prepare the title page, covering letter, acknowledgement etc. The rarity of sphenoidal sinus mucocele made our case interesting to report. Introduction paranasal sinus mucocele is a benign, expansive lesion associated with paranasal sinus obstruction. The authors describe a patient with frontal giant mucocele involving the orbit. Giant frontal mucocele world journal of surgical research.
Frontoethmoidal sinus mucoceles may cause masseffect upon the orbit and present with pain and ophthalmic symptoms such as proptosis, diplopia and periorbital swelling. One case with sphenoidal sinus mucocele is reported and discussed. Webmd explains the causes, symptoms, and treatment of a mucocele a type of cyst that forms in your mouth when salivary glands become blocked. Imaging of a giant frontal sinus mucocele with orbital. This paper reports the case of a 74yearold woman with ethmoid mucocele penetrating into. A 79yearold man presents with signs of an orbital mass.
Diagnostic ct and mri imaging revealed a mucocele originating from the posterior ethmoid and sphenoid sinuses. Most simple mucoceles are formed by clear thick mucus. A mucocele of a paranasal sinus is an accumulation of mucoid secretion and desquamated epithelium within the sinus with distension of its walls and is regarded as a cyst like expansile and destructive lesion. In 1955, lambert defined fronto ethmoidal mucoceles as the most common nasal condition to cause proptosis. This is a prospective study of 25 cases of patients. Mucocele is an epithelium lined mucous containing sac that usually develops following blockage of ostium of paranasal sinuses. Sinus secretions accumulate over a long period with resultant sinus expansion, bone remodeling and thinning with local mass effect. Surgical drainage of the mucocele and conservative postoperative care, returned all ophthalmic signs to normal and bony remodelling of the orbital floor was demonstrated. Right maxillary, sphenoid and left ethmoid sinusitis.
Mucoceles are cystlike lesions lined with respiratory epithelium that most commonly produce bone destruction within the paranasal sinuses. Paranasal sinus mucocele is an expanded, airless, mucusfilled sinus caused by. Endoscopic surgical treatment of paranasal sinus mucocele. Mucocele of right frontal and anterior ethmoid sinuses with extension into right medial orbit. These lesions occur as the result of trauma or obstruction to the salivary gland excretory duct and spillage of mucin into the surrounding soft ti. The set of images showed a corticalized lesion measuring, on. Ethmoidal mucoceles are the second most common type after frontal mucoceles and usually due to an obstruction of the sinus ostium e. Giant ethmoid mucocele presenting as an orbital mass. The rhinologic literature contains many contributions to the study of mucoceles of the paranasal sinuses. The tumor is noted to involve the orbit, the ethmoid and frontal sinuses. The radiologist should be familiar with the imaging findings as well as take special care for the differential diagnoses and the rare possibility of an underlying tumour or tumourlike lesion.
Mucoceles commonly involve ethmoidal and frontal sinuses. Pneumatization of middle turbinate called concha bullosa is the commonest anomaly. Delayed posttraumatic frontoethmoidal sinus mucocele. The ct examination of the orbitssinuses showed a welldefined ovoid mass that was homogenous in appearance, expanding and obliterating the right ethmoid cells. The most common causes of paranasal sinus mucocele reported in literature are chronic infection, allergic sino nasal disease, tumor, trauma, and previous surgical manipulation4. Paranasal sinus mucocele occurs most frequently in frontal sinus followed by the ethmoid, maxillary, and sphenoid sinuses6. An ethmoid mucocele is a form of a paranasal sinus mucocele involving the ethmoid air cells. Ethmoidal mucocele presenting as oculomotor nerve paralysis. Clinical analysis and surgical results of 58 paranasal.
Frontoethmoidal mucocele presenting as progressive. International journal of pediatric otorhinolaryngology, 10 1985 8186 81 elsevier por 00296 case reports mucocele of the ethmoid sinus stuart g. They most commonly originate from the frontal and ethmoidal sinuses and can erode through neighboring structures such as the orbital walls. Mucoceles are cystic masses developing after obstruction of the sinus ostium. There are several fissures on the medial side in front of the crista galli, one of them extending into the middle of the sella turcica. Possible ocular manifestations of mucoceles and the diagnostic imaging. There are some fissured fractures of the paperlike orbital plate of the frontal bone on the riglxt side only. A 60yearold nondiabetic, nonhypertensive male patient, farmer by occupation, presented with a 1month history of left periorbital headache, which became severe for the last 3 days, along with. Pdf a mucocele of a paranasal sinus is an accumulation of mucoid secretion and.
Jan 24, 2015 orbital imaging disclosed a mucocele in the right ethmoid sinus. Computed tomography ct and magnetic resonance imaging mri are the imaging techniques of choice. If the mucocele has been infected pyocele then the content is similar to pus. Endoscopic view of a mucocele in an infraorbital ethmoid cell. Fronto ethmoidal mucoceles are the most common expansile lesions of the paranasal sinuses. Sphenoid and ethmoid mucoceles can cause divisional oculomotor palsies. In a majority of patients, mucoceles involve the frontal sinuses and the ethmoidal labyrinth. These magnetic resonance imaging mri studies demonstrate displacement of the optic nerve, a bright t1 tumor image, and a variably bright t2 tumor image. Frontoethmoidal mucoceles are cystic, slowly expanding lesions that usually originate from the frontal or ethmoidal sinuses. We describe an unusual case of posttraumatic fronto ethmoidal mucocele, evaluated with computed tomography ct, magnetic resonance imaging mri and proton mrspectroscopy 1 hmrs. Mucoceles are the most common benign lesions that produce expansion of the paranasal sinuses. Endoscopic drainage of pediatric paranasal sinus mucoceles.
Superadded infection can lead to extension of the inflammatory process to nearby anatomical structures with formation of subcutaneous abscess potts puffy tumor, epidural abscess or subperiosteal orbital abscess. It may expand and erode the surrounding structures such as bones and cerebral parenchyma. A mucocele is defined as mucous filled epithelium lined sac. Selkin dioision of otorhinolarvngology, massapequa general hospital, sea ford, n y u. Orbital imaging disclosed a mucocele in the right ethmoid sinus. Mucocele definition mucocele, also known as a mucous cyst, is the development of a painless sac of mucous in the mouth, most commonly on the interior of the lower lip, which form following blockage of salivary ducts or from the rupture of a salivary gland. N2 a 50yearold female presented with a slowly enlarging painless mass of the right medial. Tomographic findings in mucoceles of the frontal and ethmoid sinuses 171 fig. Full text an atypical presentation of sinus mucopyocele in. Diagnostic imaging of paranasal sinuses and nose 1. Unilateral exophthalmos was the initial complaint in all cases and nasal polyposis was a noteworthy finding in more than half of the patients. Radiological imaging includes ctscan and sometimes mri when intracranial complications are suspected.
Mucocele can be associated with ophthalmic complications or intracranial complications. This issues installment presents the technical background for hardware and software image fusion and provides examples of how these techniques are applied. Axial ct revealed a large mass in sphenoid sinus with extension into the right ethmoidal with. The mucocele can also be known as a collection of fluids or extravasation phenomenon and can occur when the swelling of the connective tissue due to irritation, inflammation or unknown causes results in mucin protein that can be found in an individuals salvia and in mucus collecting in the mucocele formation. Based on clinical findings and imaging, the most likely diagnosis. These mucoceles may be accompanied by ophthalmic manifestations such as displacement of the eyeball, proptosis, restricted ocular movement, diplopia. Magnetic resonance imaging may differentiate between certain soft tissues but does not give the bony detail that is available from ct. Article exophthalmos caused by an ethmoidal mucocele. Imageguided endoscopic excision of ethmoid sinus mucocele. Lambert defined fronto ethmoidal mucoceles as the most common nasal condition to cause proptosis 1. Orbital mucocele can occur when sinus mucoceles cannot naturally drain through the nose. Giant frontal mucocele,paranasal sinus mucocele,mucocel. Oral mucocele is a clinical term for two related phenomena. In this poster, we added a third case of craniofacial fibrous dysplasia, complicated by a sphenoid mucocele.
Paranasal sinus mucocele radiology reference article. In this paper, we report a rare case of onodi cell mucocele causing. Maxillary mucoceles should be assessed by both ent and ophthalmic surgeons. Mucocele is a descriptive term referring to a dilated appendix with abnormal intraluminal accumulation of mucus 1, 2. The content of the mucocele is variable, and this impacts on the imaging appearances see below.
It mostly involves the frontal sinus followed by ethmoid and rarely sphenoid and maxillary sinuses. Understanding multimodal fusion imaging this is the first in a new series of articles focusing on evolving radiology technologies and their clinical applications. The lesion was predominantly hypodense and measured 3. Obstruction may follow trauma, infection, or occlusive pressure from new growths. The magnetic resonance imaging mri examination performed on a 3t field.
An oral mucocele is a harmless, fluidcontaining cystlike swelling of the lip or mouth lining mucosa due to mucus from the small salivary glands of the mouth leaking into the soft tissue, usually from injury trauma or blockage of the gland. Ethmoid sinus is the second most common site for paranasal sinus mucocele after frontal sinus. Sinus secretions accumulate over a long period with resultant sinus expansion, bone. Mucocele and pyocele of concha bullosa radiology imaging. A mucocele of the right posterior ethmoid sinus was observed with radiology. Mucocele and pyocele of concha bullosa it is due to migration of ethmoidal air cells. Frontal sinus mucocele with intracranial and intraorbital. A similar lesion, the mucusretention cyst, occurs from blockage and backup of saliva in the gland. Sinus mucocele collection of fluids or extravasation phenomenon.
The onodi cell is a posterior ethmoidal cell that is pneumatized laterally or superiorly to the sphenoid sinus with close proximity to the optic nerve. Developed by renowned radiologists in each specialty, statdx provides comprehensive decision support you can rely on sinonasal mucocele. Ipreceptor, medical residence program in otorhinolaryngology, instituto cema. Pathology outlines mucocelelike lesion mll of breast. Mucoceles of the frontoethmoidal sinuses radiology. Head of the oral and maxillofacial surgery and trauma program. The lesions always extended into the orbit and usually eroded the floor of the frontal sinus.
Endoscopic drainage is safe and effective in eradication of disease. A frontal mucocele may be fronto ethmoidal or strictly frontal. Keywords mucoceles, paranasal sinuses, frontal, ethmoid, ct, mri. Giant mucocele of the frontal sinus is a rare pathology of benign entity caused by retention of mucous secretions in the sinus. Ethmoid mucocele can cause proptosis as in this case or orbital apex compression. Paranasal sinuses, frontal sinus and ethmoidal sinus are most often involved 70% to 90%. Discussion a mucocele of a paranasal sinus is an accumulation of mucoid secretion and desquamated epithelium within the sinus, with distension of its walls. It can cause compression of the orbit with proptosis, as in this ca. Appendiceal mucocele can be caused by chronic obstruction of the appendix simple mucocele or result from mucosal hyperplasia and benign or malignant neoplasms of the appendix 3, 4.
Lund, ms, frcs, frcsed a mucocele is an epitheliallined mucuscontaining sac, completely filling the sinus and capable of expansion, in contradistinction to a sinus cavity, which simply contains mucus. Mar 08, 2012 a mucocele is defined as mucous filled epithelium lined sac. Optic neuritis caused by ethmoidal mucocele eurorad. Sphenoid sinus mucoceles devarasetty international. It is due to obstruction of the sinus ostium by secretions, inflammation or mass lesion. Characterized by extravasated acellular mucin in periductal stroma although there is variable associated hyperplasia of the cyst lining in mucocele like lesion, there are no epithelial cells floating within the luminal or extravasated mucin, which is a is critical finding in distinguishing mucocele like lesion from mucinous carcinoma of the breast. Although mucoceles of the frontal and ethmoidal sinuses are not unusual, they are rarely found in the maxillary and sphenoidal sinuses 1, 4, 6, 10, 12, 23, 27, 30. Ethmoid mucoceles are considered the second most commonest in location 2. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid, and. Approximately 90% occur in the frontoethmoidal sinuses. Sometimes associated bone destruction is also evident 2.
Expansion of the right anterior ethmoid air cells by high density contents with thinned bony boundaries and eroded lamina papyrcea, associated soft part are seen occupying the right nasal cavity and right orbit compressing the right medial rectus and right globe laterally. Rombaux found that paranasal sinus mucoceles predominantly occur in the fronto ethmoidal region 64%, followed by maxillary sinus 18. They are relatively unusual, occurring most frequently in the fronto ethmoidal region. Apr 16, 2018 collectively, the mucocele, the oral ranula, and the cervical, or plunging, ranula are clinical terms for a pseudocyst that is associated with mucus extravasation into the surrounding soft tissues. Received october 29th, 1984 accepted january 30th, 1985 key words. Mucocele appears like a hypodense non enhancing mass that fills and distorts the sinus cavity on ct, and with a low signal on t1 weighted mri and a high signal on t2weighted mri due to their high water content 15. Other names include mucous extravasation cyst, mucous cyst of the oral mucosa, and mucous retention and extravasation phenomena. Systems and image archiving and management system program. It showed an operation for a mucocele of the right ethmoidal cells made two days ago.
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