Isolated ethmoid sinus mucocele. (Rhinoscopic Clinic).

A 50-year-old man complained of several months of increasing right facial pain and pressure medial to the right eye. His primary care physician had obtained computed tomography (CT) of the sinuses and referred the patient to us when he found a mass in the right ethmoid sinus (figure, A). Findings on nasal endoscopy were unremarkable. A right endoscopic ethmoidectomy was performed, and a well-encapsulated mucocele was found in the right ethmoid sinus. The mass was filled with thick yellowish fluid, and it was carefully removed with a microdebrider (figure, B). The mucocele had dissected the ethmoid sinus and had left a clean ethmoid cavity. The patient's postoperative course was uneventful, and his symptoms resolved. Postoperative CT (figure, C) and an endoscopic clinical examination (figure, D) showed complete resolution and healing in the right ethmoid sinus.

Although the precise etiology of mucoceles remains unclear, these lesions are known to be associated with the scarring and obstruction caused by chronic sinusitis. (1) They occur equally in males and females, and the nature of symptoms is related to the mucocele's anatomic location. (2) Symptoms often include headache, along with vision disturbances if the orbit becomes involved. Mucoceles have been found in all the paranasal sinuses, although they usually occur in the frontal sinus. Ethmoid sinus mucoceles are usually accompanied by frontal or sphenoid sinus mucoceles. (1)

The case described here involved an isolated ethmoid mucocele. Clinically, ethmoid mucoceles can cause symptoms typically associated with chronic sinusitis--particularly, headache and orbital pain. (3) Complications of mucoceles can be serious; among them are invasion of the surrounding brain and orbital structures. (1) Mucoceles become symptomatic when they exert pressure and cause obstruction. A mucopyocele occurs when a mucocele becomes infected and behaves as an abscess, which can rupture into the brain or the orbit with catastrophic results. Mucopyoceles have been associated with osteomyelitis in surrounding bony structures. (1)

The treatment of sinus mucoceles has included excision and marsupialization via external approaches. (2) More recently, minimally invasive endoscopic surgery, aided by computer imaging as appropriate, has been advocated as a viable alternative to traditional open procedures. (2,3)

References

(1.) Stankiewicz JA, Newell DJ, Park AH. Complications of inflammatory diseases of the sinuses. Otolaryngol Clin North Am 1993; 26:639-55.

(2.) Kennedy DW, Josephson JS, Zinreich SJ, et al. Endoscopic sinus surgery for mucoceles: A viable alternative. Laryngoscope 1989; 99:885-95.

(3.) Fortgang P, Joe JK, Yanagisawa E. Image-guided endoscopic excision of ethmoid sinus mucocele. Ear Nose Throat J 2000; 79: 10, 13.

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante); and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group, New Haven, Conn., and the Section of Otolaryngology, Yale University School of Medicine, New Haven (Dr. Yanagisawa).