journal of american science 2012
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Ethmoid mucocele and nasal deformity
Abdullah Musleh
Department of Otolaryngology, Head and Neck Surgery, Armed Forces
Hospital, South Region, Saudi Arabia
shahrani99@hotmail.com
Abstract: Objective:
MEDLINE Abstract
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Fronto-ethmoid sinus mucocele: a case report.
Optometry. 2006; 77(9):450-8 (ISSN: 1529-1839)
Malloy KA
Pennsylvania College of Optometry, Elkins Park, Pennsylvania 19027, USA.
kmalloy@pco.edu
BACKGROUND: Mucoceles are epithelium-lined cavities in the paranasal
sinuses filled with mucus. They develop because of scarring and obstruction
of the sinus ostium, whether from chronic sinusitis, trauma, or surgery. They
commonly erode the bony sinus wall and can have serious complications of
brain and orbital invasion, with potential for abscess and rupture. CASE
REPORT: A 39-year-old woman had diplopia in left gaze and a hard nodule
above the right eye for 1 year. She recently noted a bulging right eye, nasal
congestion, and occasional headaches. She was 9 years post-sinus surgery.
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All aspects of the afferent optic nerve function were intact. Right-sided
proptosis was evident as was a right adduction and supraduction deficit,
prompting immediate imaging, both with a computed tomography scan and
magnetic resonance imaging of the orbits. These results showed a large right
ethmoid sinus mucocele, with bony erosion and orbital invasion, prompting
an immediate surgical referral. CONCLUSION: Mucoceles may arise from
any of the paranasal sinuses and, because of the close proximity of these
spaces to the orbit, may initially manifest with visual and ocular signs and
symptoms. Therefore, eye care providers need to be aware of this entity and
the need for immediate referral or workup if a mucocele is suspected.
[Pyocele of the posterior ethmoidal cell as the cause of
visual loss]
Otolaryngol Pol. 2006; 60(2):171-4 (ISSN: 0030-6657)
Matyja G; Kawczyski M; Tarnowska C
Katedra i Klinika Otolaryngologii i Onkologii Laryngologicznej, Pomorskiej Akademii
Medycznej w Szczecinie.
INTRODUCTION: Mucocele is a cystic slow-growing lesion of paranasal
sinuses with sterile content. Pyocele contains purulent substance.
Muco-/pyocele is rarely localised in ethmoid or sphenoid sinus and may
involve the orbit and cause ophthalmic complications including visual loss.
MATERIAL AND METHODS: We report the case of a 25-year-old woman
who suffered from sudden visual loss of her left eye. She was treated for
optic nerve papillitis by neurologists and ophthalmologists with steroids and
recovered after about 6 weeks. Magnetic resonance imaging was ordered to
find the cause of visual disturbance and revealed an oval-shaped lesion in
the left posterior ethmoid sinus. The patient underwent functional
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endoscopic surgery and transethmoidal marsupialisation of the
muco-/pyocele. RESULTS: After endoscopic microsurgery the patient
recovered without complications, she is under follow-up and has no
symptoms of any disease. Because there were no evidence of any other
causes of optic nerve affection, the muco-/pyocele was regarded as the cause
of visual loss. CONCLUSIONS: The posterior ethmoid muco-/pyocele can
present with ophthalmic manifestations including blindness. Endonasal
operation and steroids administration are the treatment of choice in such
cases.
[Fronto-ethmoidal mucocele: a case report]
Rev Laryngol Otol Rhinol (Bord). 2009; 130(4-5):289-91 (ISSN: 0035-1334)
Arena P; Boudard P
L'Institut G. Portman, So Paulo, Brsil.
Paranasal sinus mucoceles can present ophthalmic disturbances. Our aim is
to discuss the treatment and the endoscopic sinus surgery indication in the
fronto-ethmoidal sinus mucoceles. We describe here a case of fronto-
ethmoidal sinus mucocele in a patient with an important fronto-ethmoidal
tumefaction and an increased prominence of his left eyeball. An endoscopic
approach was done after explain to the patient the eventual risks and
complications of the procedure, especially to his left eye.
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. Material &Methods:
.
Results:
Conclusion:
[A. Musleh. Ethmoid mucocele and nasal deformity. Key Words: ,
,
1. Introduction
A mucocele is a chronic cystic lesion of the paranasal sinuses lined by
respiratory epithelium, which results from obstruction of the draining ostia.1
This obstruction leads to effacement of the normal septa, expansion of the
sinus, thinning of the bony wall, and ultimately extension through the
wall into the adjacent orbit, nasopharynx, or cranial cavity. The cysts are
usually filled with clear to slightly yellowish, thick mucoid secretions.2
Mucoceles constitute 2% to 8.3% of all sinus tumors and 2.7% of
nonendocrine exophthalmos cases.3 Because of the close anatomic
relationship between the orbit and the paranasal sinuses, orbital involvement
might occur. Orbital mucoceles manifest similar signs and symptoms, such
as orbital displacement, proptosis, diplopia, ophthalmoplegia, and decreased
visual acuity. Ophthalmic involvement may be the first sign of the
mucocele. Management of orbital mucoceles includes complete removal of
the cystic lining, reestablishment of normal drainage, or obliteration of the
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sinus by mucosal stripping and packing with bone or fat. This is usually the
domain of the otorhinolaryngologist, but ophthalmologic expertise may play
an important role in the management of orbital mucoceles.2
Th e numerous bony partitions within the ethmoid sinus are at risk of
mucocele development in the postsurgical cavity as scarring and secondary
obstruction may develop. In isolated mucoceles along the ethmoid skull
base, another entity that should be entertained especially in patients with
prior sinus surgery is an encephalocele (Fig. 16.6). Review of prior operative
reports should be performed to determine if there was any violation of the
ethmoid roof. A MRI scan is recommended in the preoperative evaluation as
well. Once the presence of a mucocele is confi rmed, endoscopic
marsupialization of these lesions is performed by initial entry into the lesion
followed by removal of surrounding osteitic bony partitions. In cases
where there is signifi cant scarring along the ethmoid roof, identifi cation of
the skull base may be diffi cult. In these cases, the skull base is identifi ed
within the sphenoid sinus at its lowest point, and is then skeletonized in a
posterior to anterior direction. Th e dissection progresses to the region of the
mucocele. As mentioned earlier, the use of through-cutting instruments
along the skull base cannot be emphasized enough in order to avoid
inadvertent skull base injury.
2. Material and methods:
l
repairs.
3. Results:
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Patients
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Fig. 2:
Fig. 3:
Fig. 4:
Fig. 5
Fig. 6
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Fig.7:
4. Discussion:
5. Conclusion:
Correspondence author
Abdullah Musleh
Department of Otolaryngology, Head and Neck
Surgery, Armed Forces Hospital, South Region,
Saudi Arabia
shahrani99@hotmail.com
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