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Frontal Mucopyocoeles: The Role of Open Surgery in the Era of Endoscopic Sinus Surgery: A Report of Two Cases

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ARTICLE DOWNLOAD

Frontal Mucopyocoeles: The Role of Open Surgery in the Era of Endoscopic Sinus Surgery: A Report of Two Cases

10$

Aditya Moorthy, Sunil Narayan Dutt, Shreya Krishna, P. Subramanya Rao, H. K. Susheen Dutt & Prithvi Bachalli 

Introduction

Endonasal approach for frontal sinus pathology has become the gold standard for sinus surgery. However, cases recurrent and refractory to functional endoscopic sinus surgery (FESS) need to be dealt with conventional (open) techniques.

Mucoceles of the paranasal sinuses are “benign, chronic, expanding lesions, filled with sterile mucus and epithelial cells” [1]. The term “Mucocele” was coined by Rollet in 1896. Mucoceles of paranasal sinuses were first described by Langenback [2].

Mucoceles are caused by obstruction of the sinus ostium leading to accumulation of the mucous secretion within the sinus [3]. The two most frequent causes of frontal sinus mucoceles are trauma and inflammation [1]. An infected mucocele is termed a mucopyocele. They behave like expansile cystic lesions, eroding the surrounding bone and displacing the adjacent structures, even extending intracranially. Signs and symptoms include frontal pain, swelling, exophthalmos, diplopia and loss of vision [4]. Erosion of posterior table may lead to meningitis, meningoencephalitis, pneumocephalus, brain abscess, seizures or CSF fistulas [5].

The diagnosis of mucocele is based on clinical examination along with computed tomography (with contrast) or MRI [4].

The mainstay of management of mucocoeles is surgery, which ranges from functional endoscopic sinus surgery to craniotomy, and craniofacial exposure, with or without obliteration of the sinus [6]. Endoscopic procedures rely on establishing surgical drainage of the frontal sinus and marsupialization, whereas open techniques when employed are most frequently used for sinus obliteration.

We present two cases of frontal mucopyoceles refractory to endoscopic approach managed by external sinus surgery.

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Year 2020
Language English
Format PDF
DOI 10.1007/s12663-019-01271-4