Paranasal sinus mucoceles

Abstract

Mucoceles of the paranasal sinus are benign expanding lesions that primarily occur between the fourth and seventh decades of life. Sinus mucoceles may develop due to the obstruction of the normal passageway by trauma, inflammation, mass lesions, idiopathic, or iatrogenic causes. The most common site for the evolution of a mucocele is within the frontal sinuses, followed in frequency by the ethmoidal, maxillary, and sphenoid sinuses. The symptoms depend on the location and size of the mucocele. The symptoms can be classified as nasal, ophthalmologic, intracranial, and cosmetic. A mucocele can become infected, forming a mucopyocele, with a risk of infectious complications including meningitis, orbital cellulitis, and osteomyelitis. Today, the first choice of treatment is marsupialization of the mucoceles using endoscopic sinus surgery. External approaches to frontal sinus are still used, in erosion of the anterior frontal sinus wall and far lateral located lesions.

Keywords

Declarations

References

1. Oliverio PJ, Zinreich SJ. Radiology of the nasal cavity and paranasal sinuses. In: Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Richardson MA, Schuller DE, eds. Otolaryngology: Head and Neck Surgery. 3rd ed. Missouri: Mosby; 1998:1065-1091.
   PubMed · Google Scholar
2. Iannetti G, Cascone P, Valentini V, et al. Paranasal sinus mucocele: diagnosis and treatment. J Craniofac Surg. 1997;8:391-398. doi:10.1097/00001665-199708050-00011
   Article · PubMed · Google Scholar
3. Fu CH, Chang KP, Lee TJ. The difference in anatomical and invasive characteristics between primary and secondary paranasal sinus mucoceles. Otolaryngol Head Neck Surg. 2007;136(4):621-625.
   PubMed · Google Scholar
4. Lai PC, Liao SL, Jou JR, et al. Transcaruncular approach for the management of frontoethmoid mucoceles. Br J Ophthalmol. 2004;88(5):725.
   PubMed · Google Scholar
5. Chahed H, Romdhane N, Zainine R, et al. Pediatric mucoceles: clinical aspects and therapeutic approaches. Rev Stomatol Chir Maxillofac. 2012;113(6):437-441.
   PubMed · Google Scholar
6. Shah A, Meyer DR, Parnes S. Management of frontoethmoidal mucoceles with orbital extension: is primary orbital reconstruction necessary? Ophthalmic Plast Reconstr Surg. 2007;23(4):267-271. doi:10.1097/iop.0b013e318073d19a
   Article · PubMed · Google Scholar
7. Weitzel EK, Hollier LH, Calzada G, Manolidis S. Single-stage management of complex fronto-orbital mucoceles. J Craniofac Surg. 2002;13:739-745. doi:10.1097/00001665-200211000-00004
   Article · PubMed · Google Scholar
8. Hejazi N, Witzmann A, Hassler W. Ocular manifestations of sphenoid mucoceles: clinical features and neurosurgical management of three cases and review of the literature. Surg Neurol. 2001;56:338-343.
   PubMed · Google Scholar
9. Stankiewicz JA. Sphenoid sinus mucocele. Arch Otolaryngol Head Neck Surg. 1989;115:735-740.
   PubMed · Google Scholar
10. Steven CM, Jorge DL, Robert HM. Mucoceles of the maxillary sinus. Otolaryngol Head Neck Surg. 1997;117:18-21.
    PubMed · Google Scholar
11. Bockmühl U, Kratzsch B, Benda K, Draf W. Surgery for paranasal sinus mucocoeles: efficacy of endonasal micro-endoscopic management and long-term results of 185 patients. Rhinology. 2006;44(1):62-67.
    PubMed · Google Scholar
12. Bockmühl U, Kratzsch B, Benda K, Draf W. Paranasal sinus mucoceles: surgical management and long-term results. Laryngorhinootologie. 2005;84(12):892-898.
    PubMed · Google Scholar
13. Mineck CW, Chandra RK, Cohen N. Orbital mucopyocele after the use of alloplastic materials in the management of frontal sinus fractures. Otolaryngol Head Neck Surg. 2006;135(6):974-976. doi:10.1016/j.otohns.2005.09.011
    Article · PubMed · Google Scholar
14. Capra GG, Carbone PN, Mullin DP. Paranasal sinus mucocele. Head Neck Pathol. 2012;6:369-372.
    PubMed · Google Scholar
15. Thompson LDR, Wenig BM. Mucocele of paranasal sinus. In: Diagnostic Pathology: Head and Neck. Salt Lake City, UT: Amirsys; 2011:45.
    PubMed · Google Scholar
16. Obeso S, Llorente JL, Rodrigo JP, Sanchez R, Mancebo G, Suarez C. Paranasal sinuses mucoceles: our experience in 72 patients. Acta Otorrinolaringol Esp. 2009;60(5):332-339.
    PubMed · Google Scholar
17. Lund VJ. Fronto-ethmoidal mucoceles: a histopathological analysis. J Laryngol Otol. 1991;105:921-923. doi:10.1017/s0022215100117827
    Article · PubMed · Google Scholar
18. Pierse JE, Stern A. Benign cysts and tumors of the paranasal sinuses. Oral Maxillofac Surg Clin North Am. 2012;24:249-264. doi:10.1016/j.coms.2012.01.007
    Article · PubMed · Google Scholar
19. Bell GW, Joshi BB, Macleod RI. Maxillary sinus disease: diagnosis and treatment. Br Dent J. 2011;210:113-118. doi:10.1038/sj.bdj.2011.47
    Article · PubMed · Google Scholar
20. Ng YH, Sethi DS. Isolated sphenoid sinus disease: differential diagnosis and management. Curr Opin Otolaryngol Head Neck Surg. 2011;19:16-20. doi:10.1097/moo.0b013e32834251d6
    Article · PubMed · Google Scholar
21. Tal H, Altini M, Lemmer J. Multiple mucous retention cysts of the oral mucosa. Oral Surg Oral Med Oral Pathol. 1984;58:692-695. doi:10.1016/0030-4220(84)90036-7
    Article · PubMed · Google Scholar
22. Caylakli F, Yavuz H, Cagici AC, Ozluoglu LN. Endoscopic sinus surgery for maxillary sinus mucoceles. Head Face Med. 2006;2:29. doi:10.1186/1746-160x-2-29
    Article · PubMed · Google Scholar
23. Herndon M, McMains KC, Kountakis SE. Presentation and management of extensive fronto-orbital-ethmoid mucoceles. Am J Otolaryngol. 2007;28:145-147. doi:10.1016/j.amjoto.2006.07.010
    Article · PubMed · Google Scholar
24. Chao-Jung L, Chuan-Hsiang K, Bor-Hwang K, et al. Frontal sinus mucocele presenting as oculomotor nerve palsy. Otolaryngol Head Neck Surg. 2002;126(5):588-590.
    PubMed · Google Scholar
25. Malhotra R, Wormald PJ, Selva D. Bilateral dynamic proptosis due to frontoethmoidal sinus mucocele. Ophthalmic Plast Reconstr Surg. 2003;19(2):156-157. doi:10.1097/01.iop.0000055829.79494.37
    Article · PubMed · Google Scholar
26. Lee TJ, Li SP, Fu CH, et al. Extensive paranasal sinus mucoceles: a 15-year review of 82 cases. Am J Otolaryngol. 2009;30:234-238. doi:10.1016/j.amjoto.2008.06.006
    Article · PubMed · Google Scholar
27. Kim YS, Kim K, Lee JG, Yoon JH, Kim CH. Paranasal sinus mucoceles with ophthalmologic manifestations: a 17-year review of 96 cases. Am J Rhinol Allergy. 2011;25:272-275. doi:10.2500/ajra.2011.25.3624
    Article · PubMed · Google Scholar
28. Har-El G. Endoscopic management of 108 sinus mucoceles. Laryngoscope. 2001;111:2131-2134.
    PubMed · Google Scholar
29. Soon SR, Lim CM, Singh H, Sethi DS. Sphenoid sinus mucocele: 10 cases and literature review. J Laryngol Otol. 2010;124:44-47. doi:10.1017/s0022215109991551
    Article · PubMed · Google Scholar
30. Trimarchi M, Bertazzoni G, Bussi M. Endoscopic treatment of frontal sinus mucoceles with lateral extension. Indian J Otolaryngol Head Neck Surg. 2013;65(2):151-156. doi:10.1007/s12070-012-0611-9
    Article · PubMed · Google Scholar
31. Bockmühl U. Osteoplastic frontal sinusotomy and reconstruction of frontal defects. In: Kountakis S, Senior B, Draf W, eds. The Frontal Sinus. Berlin: Springer; 2005:281-289. doi:10.1007/3-540-27607-6_31
    Article · PubMed · Google Scholar
32. Weber R, Draf W, Keerl R, et al. Osteoplastic frontal sinus surgery with fat obliteration: technique and long-term results using magnetic resonance imaging in 82 operations. Laryngoscope. 2000;110:1037-1044.
    PubMed · Google Scholar
33. Kennedy DW, Josephson JS, Zinreich SJ, Mattox DE, Goldsmith MM. Endoscopic sinus surgery for mucoceles: a viable alternative. Laryngoscope. 1989;99:885-895. doi:10.1288/00005537-198909000-00002
    Article · PubMed · Google Scholar
34. Chiu AG, Vaughan WC. Management of the lateral frontal sinus lesion and the supraorbital cell mucocele. Am J Rhinol. 2004;18:83-86. doi:10.1177/194589240401800203
    Article · PubMed · Google Scholar
35. Yanagisawa E, Scher DA. Laterally positioned mucocele of the frontal sinus. Ear Nose Throat J. 2002;81:202-204. doi:10.1177/014556130208100404
    Article · PubMed · Google Scholar
36. Molony NC, Ah-See K, Rachmanidou A, Draf W. A survey of contemporary management of frontal sinus disease in the United Kingdom. Eur Arch Otorhinolaryngol. 2000;257(5):247-250. doi:10.1007/s004050050232
    Article · PubMed · Google Scholar
37. Correa AJ, Duncavage JA, Fortune DS, Reinisch L. Osteoplastic flap for obliteration of the frontal sinus: five years’ experience. Otolaryngol Head Neck Surg. 1999;121(6):731-735. doi:10.1053/hn.1999.v121.a98218
    Article · PubMed · Google Scholar
38. Weber R, Draf W, Keerl R, Kahle G, Schinzel S, Thomann S, et al. Osteoplastic frontal sinus surgery with fat obliteration: technique and long-term results using magnetic resonance imaging in 82 operations. Laryngoscope. 2000;110(6):1037-1044.
    PubMed · Google Scholar
39. Draf W. Endonasal micro-endoscopic frontal sinus surgery: the Fulda concept. Oper Tech Otolaryngol Head Neck Surg. 1991;2:234-240. doi:10.1016/s1043-1810(10)80087-9
    Article · PubMed · Google Scholar
40. Draf W. Endonasal frontal sinus drainage type I-III according to Draf. In: Kountakis S, Senior B, Draf W, eds. The frontal sinus. Berlin: Springer; 2005:219-232. doi:10.1007/3-540-27607-6_24
    Article · PubMed · Google Scholar
41. Busaba NY, Salman SD. Maxillary sinus mucoceles: clinical presentation and long-term results of endoscopic surgical treatment. Laryngoscope. 1999;109:1446-1449. doi:10.1097/00005537-199909000-00017
    Article · PubMed · Google Scholar
42. Martin RJ, Jackman DS, Philbert RF, McCoy JM. Massive proptosis of the globe. J Oral Maxillofac Surg. 2000;58:794-799. doi:10.1053/joms.2000.7268
    Article · PubMed · Google Scholar
43. Busaba NY, Siegel N, Salman SD. Bacteriology of nontraumatic maxillary sinus mucoceles versus chronic sinusitis. Laryngoscope. 2000;110:969-971. doi:10.1097/00005537-200006000-00016
    Article · PubMed · Google Scholar
44. Khong JJ, Malhotra R, Selva D, Wormald PJ. Efficacy of endoscopic sinus surgery for paranasal sinus mucocele including modified endoscopic Lothrop procedure for frontal sinus mucocele. J Laryngol Otol. 2004;118:352-356. doi:10.1258/002221504323086534
    Article · PubMed · Google Scholar
45. Busaba NY, Kieff D. Endoscopic sinus surgery for inflammatory maxillary sinus disease. Laryngoscope. 2002;112:1378-1383. doi:10.1097/00005537-200208000-00010
    Article · PubMed · Google Scholar
46. Kosling S, Hintner M, Brandt S, Schulz T, Bloching M. Mucoceles of the sphenoid sinus. Eur J Radiol. 2004;51:1-5.
    PubMed · Google Scholar
47. Hadar T, Shvero J, Nageris BI, Yaniv E. Mucus retention cyst of the maxillary sinus: the endoscopic approach. Br J Oral Maxillofac Surg. 2000;38:227-229. doi:10.1054/bjom.1999.0160
    Article · PubMed · Google Scholar
48. Rejab E, Said H, Saim L, Thim L. Sphenoid sinus mucocele: a possible late complication of radiotherapy to the head and neck. J Laryngol Otol. 1991;105:959-960. doi:10.1017/s002221510011792x
    Article · PubMed · Google Scholar
49. Sethi DS. Isolated sphenoid lesions: diagnosis and management. Otolaryngol Head Neck Surg. 1999;120:730-736. doi:10.1053/hn.1999.v120.a89436
    Article · PubMed · Google Scholar

Figures

Fullscreen

Figure 1. Frontal sinus mucocele due to nasal polyposis

Fullscreen

Figure 2. The coronal plane CT image showing a mucocele (asteriks) in the right frontal sinus base that thinned the bone structure (A). In addition, thinning (arrows) and deformation can be observed in the right sinus roof (B) and anterior wall of the left frontal sinus (C).

Fullscreen

Figure 3. Frontal sinus trephination in a patient that cannot be entubed due to giant hemangioma of the tongue

Fullscreen

Figure 4. Endoscopic marsupialization of fronto-ethmoid mucocele

Fullscreen

Figure 5. A huge fronto-ethmoidal located mucocele (asterisk) is shown. In the coronal CT (A) and T1 (B) and T2-weighted MR images (C, D) the expansile mucocele (arrows) causes thinning (arrowheads) of the frontal sinus walls.

Fullscreen

Figure 6. The coronal T1-weighted MR image after surgery (E). Air (asterisk) is observed in the left fronto-ethmoidal cavity

Fullscreen

Figure 7. In the photograph, expansion of the maxillary bone and in CT scan; medial expansion of the wall of the maxillary sinus is seen.

Fullscreen

Figure 8. Endoscopic marsupialization of the maxillary sinus mucocele.

Additional Information

Publisher’s Note
Bayrakol MP remains neutral with regard to jurisdictional and institutional claims.

Rights and Permissions

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of the license, visit https://creativecommons.org/licenses/by-nc/4.0/

View full license details →