Sphenoid sinus mucocele: a review


  • Santosh Kumar Swain Department of Otorhinolaryngology and Head and Neck Surgery, IMS and SUM hospital, Siksha “O” Anusandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha, India




Sphenoid sinus, Sphenoid sinus mucocele, Headache, Visual disturbance, Endoscopic sinus surgery


Sphenoid sinus mucocele (SSM) is a benign, encapsulated, expansile, locally destructive mass within the sphenoid sinus, filled with mucous and lined by epithelium. The exact etiology of the sphenoid sinus mucocele is still not known. The proximity of the SSM to the orbit and brain may cause morbidity and potential mortality if left without intervention. SSM has varied clinical manifestations. Headache and visual disturbances are common symptoms. Diagnostic nasal endoscopy and computed tomography (CT) scan and/or magnetic resonance imaging (MRI) are important pre-operative investigations. Diagnosis of SSM is done by computed tomography (CT) scan of the nose and paranasal sinus which shows a hypodense cystic lesion in the sphenoid sinus. MRI is helpful to detect the extension of the mucocele to orbit and cranium. Treatment of SSM is surgical which include endoscopic transnasal sphenoidotomy with sufficient removal of anterior and inferior walls of the sphenoid sinus for allowing adequate drainage and to avoid recurrence. The endoscopic approach is a safe and effective method of treatment for SSM with fewer recurrences than an open approach. Marsupialization of the mucocele via transnasal transsphenoidal approach is another option with a good outcome. The literature review for sphenoid sinus mucocele was performed from the database of Pub Med, Medline, Scopus, and Google scholar search with the term sphenoid sinus mucocele. Here, this review article is attempting to discuss the details of the sphenoid sinus mucocele including its history, epidemiology, etiopathology, clinical presentations, investigations, and current treatment.  


Makihara S, Kariya S, Okano M, Naito T, Tsumura M, Nishizaki K. Orbital complications of infected mucocele in the paranasal sinuses. Auris Nasus Larynx. 2020;47(6):990-5.

Friedman A, Batra PS, Fakhri S, Citardi MJ, Lanza DC. Isolated sphenoid sinus disease: Etiology and management. Otolaryngol Head Neck Surg. 2005;133:544-50.

Swain SK, Das A, Samal R, Behera IC, Sahu MC. An unusually giant frontoethmoidal mucopyocele in a child–A case report. Pediatria Polska. 2015;90(6):511-4.

Kosling S, Hinter M, Brandt S, Schulz T, Bloching M. Mucoceles of the sphenoid sinus. Eur J Radiol. 2004; 51:1-5.

Lee LA, Huang CC, Lee TJ. Prolonged visual disturbance secondary to isolated sphenoid sinus disease. Laryngoscope. 2004;114:986-99.

Swain SK, Sahu MC. An unusual presentation of nasofacial NK/T-cell lymphoma–A case report. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2017;18(3):299-302.

Shukla A, Dudeja V. Large frontal sinus mucocele. Clin Rhinol Int J 2013;6(3):131–135.

Moriyama H, Hesaka H, Tachibana T. Mucoceles of ethmoid and sphenoid sinus with visual disturbance. Arch Otolaryngol Head Neck Surg. 1992;118:142-6.

Coca Pelaz A, Lisa C, Pendás JL, Tapia JP. Reversible retrobulbar optic neuritis due to sphenoidal sinus disorders: two case studies. Acta Otorrinolaringol Esp. 2008;59(6):308-10.

Gupta AK, Menon V, Sharma P, Saxena R, Kumaran S. A sphenoid sinus mucocele simulating as retro bulbar optic neuritis. Indian J Ophthalmol. 2012;60(3):216-18.

Selvakumar A, Mahalaxmi B, Ananth V, Gautam C. Spheniodal mucocele causing bilateral optic neuropathy and ophthalmoplegia. Indian J Ophthalmol. 2014;62(4):515-7.

Gulati R, Soni SK, Kumar A. Giant ethmoid mucocele presenting as an orbital mass. Indian J Otolaryngol Head Neck Surg. 2015;67(1):97-99.

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(5):338-43.

Righini CA, Darouassi Y, Boubagra K, Schmerber S, Reyt E. Sphenoid sinus mucocele of unusual aetiology and location. Revue de laryngologie-otologie-rhinologie. 2006;127(3):165-70.

Lawson W, Reino AJ. Isolated sphenoid sinus disease: an analysis of 132 cases. Laryngoscope. 1997;197:1590-15.

Hickman SJ, Dalton CM, Miller DH, Plant GT. Management of acute optic neuritis. Lancet. 2002;360:1953-62.

Sethi DS, Lau DP, Chan C. Sphenoid sinus mucocoele presenting with isolated oculomotor nerve palsy. J Laryngol Otol. 1997;111:471-3.

Yokoyama T, Inoue S, Imamura JI, Nagamitsu T,Jimi Y,Katoh S, et al. Sphenoethmoidal Mucoceles with Intracranial Extension-Three Case Reports. Neurologia medico-chirurgica. 1996;36(11):822-8.

Bhandary SK, Bhat VS, Khana RA. Frontal sinus mucocele following facial trauma presenting a pyocele. NUJHS. 2013;3:90-92.

Chobillion MA, Jankowski R. Relationship between mucoceles, nasal polyposis and nasalization. Rhinology. 2004;43:219-24.

Lund VJ, Henderson B, Song Y. Involvement of cytokines and vascular adhesion receptors in the pathology of fronto-ethmoidal mucocoeles. Acta Otolaryngol. 1993;113(4):540-6.

Stankiewicz JA. Sphenoid sinus mucocele. Arch Otolaryngol Head Neck Surg. 1989;115:735-40.

Swain SK, Sahu MC. An extensive fibrous dysplasia of anterior skull base area of a 12-year-old boy–A case report. Pediatria Polska. 2016;91(6):636-9.

Lloyd G, Lund VJ, Savy L, Howard D. Optimum imaging for mucoceles. J Laryngol Otol. 2000;114:233-6.

Lee DH, Jang WY, Yoon TM, Lee JK, Jung S, Lim SC. Sphenoid sinus mucocele caused by complications after transsphenoidal pituitary surgery. J Craniofacial Surg. 2018;29(7):1859-61.

Swain SK, Samal R, Sahu MC. Isolated nasal septal neuroglial heterotopia–A case report. Pediatria Polska. 2015;90(4):323-7.

Ashwin PT, Mahmood S, Pollock WS. Sphenoid sinus mucocoele mimicking aneurysmal oculomotor nerve palsy. Eye. 2001;15:108-10.

Johnson LN, Hepler RS, Yee RD, Batzdorf U. Sphenoid sinus mucocele (anterior clinoid variant) mimicking diabetic ophthalmoplegia and retrobulbar neuritis. Am J Ophthalmol. 1986;102:111-5.

Swain SK, Mohanty JN. Chondroma of the nose. Libyan J Med Sci. 2020;4(2):87-9.

Swain SK, Sahu MC. An unusual giant isolated mucosal malignant melanoma of nasal cavity–A case report. Egyptian J Ear Nose Throat Allied Sci. 2017;18(2):151-3.

Kataria R, Gupta S, Chopra S, Bagaria H, Sinha VD. Mucocele of the sphenoid sinus: A rare caus of reversible 3rd nerve palsy. Annals of Indian Academy of Neurology. 2012;15(2):158-60.

Mundra RK, Gupta Y. Unusual case of frontoethmoid mucopyocele with intracranial and orbital extension. Indian J Otolaryngol Head Neck Surg. 2011;63(3):295-7.

Kosling S, Hinter M, Brandt S, Schulz T, Bloching M. Mucoceles of the sphenoid sinus. Eur J Radiol. 2004;51:1-5.

Alba AA, Maroon JC, Wilberger JE Jr, Kennerdell JS, Deeb ZL. Intrasellar mucocele simulating pituitary adenoma. Case report. Neurosurgery. 1986;18:197-9.

Friedman A, Batra PS, Fakhri S, Citardi MJ, Lanza DC. Isolated sphenoid sinus disease: etiology and management. Otolaryngology—Head and Neck Surgery. 2005;133(4):544-50.

Swain SK, Behera IC, Mohanty S, Sahu MC. Rhinogenic contact point headache–Frequently missed clinical entity. Apollo Medicine. 2016;13(3):169-73.

Swain SK, Behera IC, Sahu MC. Primary sinonasal tuberculosis: Our experiences in a tertiary care hospital of eastern India. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2017;18(3):237-40.

Prepageran N, Subramaniam KN, Krishnan GG, Raman R. Ocular presentation of sphenoid mucocele. Orbit. 2004;23(1):45-7.

Swain SK, Panda SS. Primary Sinonasal non-hodgkin's lymphoma: Our experiences at a tertiary care teaching hospital of Eastern India. Medical Journal of Babylon. 2021;18(2):69-73.

Swain SK, Lenka S, Das SR. Rhino-orbital Mucormycosis-A Dreaded Clinical Entity. Int J Cur Res Rev. 2020;12(24):197-202.

Li E, Howard MA, Vining EM, Becker RD, Silbert J, Lesser RL. Visual prognosis in compressive optic neuropathy secondary to sphenoid sinus mucocele: A systematic review. Orbit. 2018;37(4):280-6.

Cossu G, Daniel RT, Francois P, Destrieux C, Messerer M. Sphenoid mucocele with intracranial extension: an anatomic perspective. World neurosurgery. 2018;113:40-6.

Swain SK, Debta P, Samal S, Mohanty JN, Debta FM, Dani A. Endoscopic Treatment of Sinonasal Ossifying Fibroma: A Case Report. Indian Journal of Public Health. 2019;10(09):1697-700.

Snow RB, Lavyne MH, Lee BCP, Morgello S, Patterson RH Jr. Craniotomy versus transsphenoidal exci- sion of large pituitary tumours: the usefulness of magnetic resonance imaging in guiding the operative approach. Neurosurgery. 1986;19:59-64.

Akan H, Cihan B, Celenk C. Sphenoid sinus mucocele causing third nerve paralysis: CT and MR findings. Dentomaxillofac Radiol. 2004;33:342-4.

Swain SK, Dattatreya K. A Giant Nasal Septal Schwannoma-A Case Report. Int J Cur Res Rev. 2021;13(10):70-2.

Swain SK. Middle turbinate concha bullosa and its relationship with chronic sinusitis: a review. International Journal of Otorhinolaryngology and Head and Neck Surgery. 2021;7(6):1062-67.

Diaz F, Latchow R, Duvali AJ III, Quick CA, Erick DL. Mucoceles with intracranial and extracranial extensions. Report of two cases. J Neurosurg. 1978;48:284-8.

Dunya IM, Frangieh GT, Heilman CB, Miranda MR, Rand LI, Hedges TR. Anterior clinoid mucocele masquerading as retrobulbar neuritis. Ophthalmic Plastic Reconst Surg. 1996;12(3):171-3.

Sharifi G, Jalessi M, Erfanian D, Farhadi M. Sudden blindness due to isolated sphenoid sinus mucocele and retention cyst. Braz J Otorhinolaryngol. 2013;79(1):120.






Review Articles