Mucocele of the frontal sinus: An external approach with frontonasal passage reconstruction.In 1959, a 43-year-old pregnant woman complained of persistent right frontal headaches, for which she had taken analgesics and antibiotics. On examination, the patient had no focal neurologic deficits. Anterior rhinoscopy showed that the turbinates were hypertrophied hy·per·tro·phy
n. pl. hy·per·tro·phies
A nontumorous enlargement of an organ or a tissue as a result of an increase in the size rather than the number of constituent cells: muscle hypertrophy. . A Caldwell' s view x-ray of the paranasal sinus showed a large soft-tissue mass in the right frontal sinus that extended to the contralateral contralateral /con·tra·lat·er·al/ (-lat´er-al) pertaining to, situated on, or affecting the opposite side.
adj. side (figure, A). The radiologic appearance of this expansive soft-tissue density was consistent with that of a frontal sinus mucocele.
The mucocele was removed from the right frontal sinus via an external approach with a Lynch incision. Its contents were evacuated, and its sac was carefully excised. The mucosa outlining the frontal sinus was not disturbed. The right frontonasal duct was enlarged and cannulated can·nu·late also can·u·late
tr.v. can·nu·lat·ed, can·nu·lat·ing, can·nu·lates
To insert a cannula into (a bodily cavity, duct, or vessel), as for the drainage of fluid or the administration of medication.
adj. with a stent fashioned from a #3 Jackson metal tracheotomy tube (an inner cannula cannula /can·nu·la/ (kan´u-lah) a tube for insertion into a vessel, duct, or cavity; during insertion its lumen is usually occupied by a trocar.
can·nu·la or can·u·la
n. pl. shortened with a metal saw). The lower end of the stent was transnasally visualized, and its position was adjusted after the anterior end of the middle turbinate turbinate /tur·bi·nate/ (-nat)
1. shaped like a top.
2. any of the nasal conchae.
tur·bi·nate or tur·bi·nat·ed
1. Shaped like a top.
2. was amputated. The metal stent was placed at the right frontonasal duct intraoperatively (figure, B). The stent was removed transnasally 6 weeks later. Postoperatively, the patient was followed closely. She reported that her headaches had resolved, and she had no further sinonasal complaints.
Thirty-eight years after her surgery, the patient returned with a complaint of otalgia otalgia /otal·gia/ (o-tal´jah) pain in the ear; earache.
Pain in the ear; earache.
o·tal . Nasal endoscopy with a 4-mm, O[degrees] telescope revealed a well-healed right nasal cavity (figure, C). The reconstructed frontonasal passage was clearly patent and lined with healthy-appearing mucosa (figure, D). There was an adhesion between the right middle turbinate and the lateral nasal wall, but it did not interfere with sinonasal function. There was no visible scar from the Lynch incision, and there was no frontal numbness.
This long-term followup of 38 years illustrates the successful treatment of a frontal sinus mucocele via an external approach with a Lynch incision. In 1959, the two treatment options for frontal sinus mucocele were an external approach with frontonasal duct reconstruction and an osteoplastic os·te·o·plas·tic
1. Of or relating to osteoplasty.
2. Relating to or functioning in bone formation. procedure with sinus obliteration A destruction; an eradication of written words.
Obliteration is a method of revoking a Will or a clause therein. Lines drawn through the signatures of witnesses to a will constitute an obliteration of the will even if the names are still decipherable. with fat. Today, thanks to the advent of functional sinus surgery, intranasal endoscopic removal of such a mucocele is another option. The successful treatment of frontal sinus mucocele via the transnasal endoscopic approach has been well documented. 
Computer assistance allows for a more precise anatomic approach to the frontal sinus. When such advanced technology is not available or when the surgeon is less experienced with endoscopic frontal sinus surgery, an external frontal sinusotomy with reconstruction of the frontonasal passage is still a safe and effective method of excising a mucocele (including its sac) of the frontal sinus, as was shown in this case. This procedure is best performed under close endoscopic observation of the frontal recess during reconstruction of the frontonasal passage. 
From the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group, New Haven, Conn., the Section of Otolaryngology, Hospital of St. Raphael, New Haven, and the Section of Otolaryngology, Yale University School of Medicine, New Haven (Dr. Yanagisawa); the Memorial Sloan-Kettering Cancer Center The Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City is a cancer treatment and research institution founded in 1884 as the New York Cancer Hospital. The main campus is located at 1275 York Avenue, between 67th and 68th Streets, with other locations in New , New York City New York City: see New York, city.
New York City
City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. (Dr. Joe); and the Department of Otolaryngology, Columbia University School of Medicine, New York City (Dr. Smith).
(1.) Kuhn FA. Surgery of the frontal sinus. In: Kennedy DW, ed. Diseases of the Sinuses. London: B.C. Decker, 2000.
(2.) Bent JP III, Spears RA, Kuhn FA, Stewart SM. Combined endoscopic intranasal and external frontal sinusotomy. Am J Rhinol 1997;11:349-54.