Kajal Smile, Verma Hitesh
Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Natl J Maxillofac Surg. 2022 Sep-Dec;13(3):484-487. doi: 10.4103/njms.njms_476_21. Epub 2022 Dec 10.
Giant mucocele of frontal sinus following facial trauma is not uncommon. It can lead to the gradual erosion of anterior and posterior bony walls and may extend to the orbital and intracranial structures leading to visual compromise or intracranial complications. A 52-year-old man presented with a history of swelling above the right eye, right eye proptosis, and decreased vision. He had a history of a road traffic accident 30 years ago following which he had lost vision in his left eye and had undergone surgery twice earlier for right frontal mucocele. Computed tomography showed cranialization of the right frontal sinus and a well-defined mass lesion in the region of frontal sinus compressing on the right eye globe. Naso-orbital meningoencephalocele was considered as a differential but magnetic imaging resonance confirmed the lesion as a mucocele. As this was the second recurrence and there was an endangered vision in the only functional eye, he underwent emergency excision of mucocele and recreation of the frontal sinus outflow tract (FSOT) with silastic stenting to maintain its patency. Post-operatively, the patient's vision returned to normal at a 1-week interval. There was a reduction in swelling and proptosis in a 6-month period and the stent was removed after 1 year. Treatment of recurrent frontal sinus mucocele can be challenging. Frontal sinus stenting can be considered in such cases to maintain the patency of FSOT for a prolonged period. Regular follow-up, inspection, and cleaning of the nasal cavity and the stented area are important to prevent any stent-related complications.
面部创伤后发生的额窦巨大黏液囊肿并不罕见。它可导致前后骨壁逐渐侵蚀,并可能延伸至眼眶和颅内结构,导致视力受损或颅内并发症。一名52岁男性,有右眼上方肿胀、右眼突出及视力下降的病史。他30年前有道路交通事故史,之后左眼失明,此前曾因右额黏液囊肿接受过两次手术。计算机断层扫描显示右额窦颅骨化,额窦区域有一个边界清晰的肿块压迫右眼眼球。曾考虑鼻眶脑膜脑膨出作为鉴别诊断,但磁共振成像证实该病变为黏液囊肿。由于这是第二次复发,且唯一功能眼的视力受到威胁,他接受了黏液囊肿紧急切除术,并使用硅橡胶支架重建额窦流出道(FSOT)以维持其通畅。术后1周患者视力恢复正常。6个月内肿胀和突出有所减轻,1年后取出支架。复发性额窦黏液囊肿的治疗具有挑战性。在此类病例中可考虑进行额窦支架置入,以长期维持FSOT的通畅。定期随访、检查以及清洁鼻腔和支架区域对于预防任何与支架相关的并发症很重要。