Longstanding giant frontoethmoidal mucocele with orbital and intracranial extension: challenges of surgical approach in a developing nation
Keywords:Rare giant mucocele, Frontoethmoidal, Paranasal sinuses, Nigeria
Mucoceles of the paranasal sinuses are expansile, benign mucus filled epithelial lined cystic-like lesion resulting from chronic obstruction to sinus ostia. They erode bony walls by pressure and bony resorption with the frontal and ethmoid sinuses predominately affected. The expansile lesion can involve surrounding structures like the orbit, intracranium or nasopharynx. Diagnosis is based on history, examination and radiological assessment with Computerized tomography scan being the imaging of choice. Surgery is the mainstay of treatment and would require collaboration with the neurosurgeons or the ophthalmologist when it extends to the brain or orbit respectively. It can be done via an external approach, endoscopic approach or a combination of both. If left without intervention, it may cause morbidity and potential mortality due to its proximity to the brain and orbit. We report a rare case in our setting of a 65-year-old male farmer with a painless huge left sided cystic fronto-orbital swelling of 8 years that mimicked a benign orbital tumor. The mass was non-tender and not pulsatile measuring about 20×18 cm with normal visual acuity. Computed tomography (CT) scans of the brain and paranasal sinus revealed a large well-defined non-contrast enhancing homogenous lesion involving the left fronto-ethmoidal sinuses with orbital and intracranial extension as well as inferolateral displacement of the left eye globe. He was reviewed by the ENT surgeons, neurosurgeons and ophthalmologists and subsequently had frontoethmoidectomy via an external approach.
Scangas GA, Gudis DA, Kennedy DW. The natural history and clinical characteristics of paranasal sinus mucoceles: a clinical review. Int Forum Allerg Rhinol. 2013;3(9):712-7.
Cansiz H, Yener M, Güvenç MG, Canbaz B. Giant frontoethmoid mucocele with intracranial extension: case report. Ear, Nose Throat J. 2003;82(1):50-2.
Bakshi SS. Image diagnosis: Frontoethmoidal mucocele. Perm J. 2019;23:18-8.
Koike Y, Tokoro K, Chiba Y, Suzuki SI, Murai M, Ito H. Intracranial extension of paranasal sinus mucocele: two case reports. Surg Neurol. 1996;45(1):44-8.
Saldana M, Wearne M, Beigi B, Petrarca R. Inverted papillomas of the nasal and paranasal sinuses that involve the ocular/adnexal region. Orbit. 2013;32:366-9.
Courson AM, Stankiewicz JA, Lal D. Contemporary management of frontal sinus mucoceles: A meta-analysis. Laryngoscope. 2014;124(2):378-86.
Stokken J, Wali E, Woodard T, Recinos PF, Sindwani R. Considerations in the management of giant frontal mucoceles with significant intracranial extension: A systematic review. Am J Rhinol Allerg. 2016;30(4):301-5.
Voegels RL, Balbani AP, Santos Jr RC, Butugan O. Frontoethmoidal mucocele with intracranial extension: a case report. Ear, Nose Throat J. 1998;77(2):117-20.
Lund VJ. Frontoethmoidal mucoceles: a histopathological analysis. J Laryngol Otol. 1991;105:921-3.
Lund VJ, Henderson B, Song Y. Involvement of cytokines and vascular adhesion receptors in the pathology of fronto-ethmoidal mucoceles. Acta Otolaryngol. 1993;113:540-6.
Lai PC, Liao SL, Jou JR, Hou PK. Transcaruncular approach for the management of frontoethmoid mucoceles. Br J Ophthalmol. 2003;87(6):699-703.
Gupta M, Chauhan B, Gupta M. Large Frontoethmoidal Mucocele: Treatment and Review. Clin Rhinol. 2013;6(3):126-8.
Campbell R, Kamat A, Schipor I, Palmer J. Frontal-orbital-ethmoid mucoceles. In The Frontal Sinus. Springer, Berlin, Heidelberg. 2016;189-202.
Sen DK, Puri ND, Majid A. Fronto-ethmoidal mucocele as a cause of unilateral proptosis. Indian J Ophthalmol. 1979;27(2):45.
Hartley BEJ, Lund VJ. Endoscopic drainage of pediatric paranasal sinus mucoceles. Int J Pediatr Otorhinolaryngol. 1999;50:109-11.
Galie M, Mandriali S, Tieghi R, Clauser L. Giant mucocele of the frontal sinus. J Craniofac Surg. 2005;16:933-5.
Thiagarajan B, Arjunan K. Mucoceles of Paranasal Sinuses. WebmedCentral: ENT Scholar. 2012;3(4):WMC003263.
Srinivasa R, Dadlani R, Hegde AS. Incidental giant frontal sinus mucocele with intracranial extension. Neurology India. 2013;61(4):447.
Bosmans F, Vanhoenacker F. Giant frontal paranasal mucocele: case report and review of the literature. J Belgian Soc Radiol. 2020;104(1).
Shady JA, Bland LI, Kazee AM, Pilcher WH. Osteoma of the frontoethmoidal sinus with secondary brain abscess and intracranial mucocele: case report. Neurosurgery. 1994;34(5):920-3.
Alshoabi S, Gameraddin M. Giant frontal mucocele presenting with displacement of the eye globe. Radiol Case Rep. 2018;13(3):627-30.
Beigi B, Vayalambrone D, Kashkouli MB, Prinsley P, Saada J. Combined external and endonasal approach to fronto-ethmoidal mucocele involving the orbit. J Curr Ophthalmol. 2016;28(1):37-42.