Mucocele frontal complicado con celulitis preseptal en paciente intervenido previamente por vía externa

Abstract

Introduction and objective: The objective of the present work is to present the case of a frontal relapsing mucocele. Paranasal sinus mucoceles are cystic benign lesions, slowly expansive, that occur as a consequence of an obstruction of the nasosinusal ostium. They tend to remain asymptomatic until they debut with ocular symptomatology like a preseptal edema, proptosis or even intracranial complications. It can also be an incidental finding when performing an image test for another motive. Aetiology includes infections, trauma, previous surgery or benign neoplasms. The frontal sinus is the most common location, followed by the etmoidal sinus. With the introduction of antibiotic therapy, the morbimortality rates have declined importantly, nevertheless, to cure a mucocele, a surgical approach with marsupialization is necessary.

Method: The following is the case of a 60-year-old man, who was intervened of a complicated sinusitis that debuted with a preseptal cellulitis with a left frontal-etmoidectomy done by a Lynch approach 16 years before. In this occasion, he presents again with a frontal pain associated to oedema of the left eyelid suggestive of preseptal cellulitis. No mucus or pus is seen at the opening of the frontal sinus when examined initially. A paranasal sinus CT scan is performed, showing an occupation of the left frontal sinus. A first approach with medical treatment is given. Clinical data, together with complimentary tests orient the diagnosis to a frontal mucocele, for which a surgical endoscopic approach is proposed to the patient.

Results: During the surgery, a fibrotic tissue closing the drainage orifice of the left frontal sinus is identified. This sinus extends towards the right side and is filled with pus. A DRAF IIB is performed. At the end, a silicone sheet is placed in the opening of the sinus to avoid its closure. Currently, this patient is examined periodically to make sure the sheet is in its position.

Discussion: Frontal mucoceles are a benign pathology, that could result in ophthalmologic and cerebral complications, hence they should have an early surgical approach. Medical treatment with antibiotics and corticosteroids doesn’t avoid relapses.

Conclusions: Endoscopic approach allows to provide a wide opening of the sinus, decreasing the probability of a new mucocele, contrary to external surgery in which the sinus isn’t approached by its natural opening, tending to close again given that its exposed to factors that favour fibrosis like inflammation. Endoscopic approaches have replaced external ones. These allow an approach of all frontal mucoceles with less damage than with external ones. When performing them, a close follow up checking the position of the silicone sheet is very important to avoid closing of the sinus.