Do Variations in Frontal Recess Anatomy Predispose to Mucocele Formation?

Abstract

Introduction Mucoceles are benign expansile cystic lesions commonly seen in the frontoethmoidal region.

Objective To see if the distribution of frontal air cells predisposes to mucocele formation.

Methods Retrospective review of all cases of paranasal sinus mucocele from 2011 to 2021. Data on demographics, history of surgery or trauma, clinical features, radiological findings, and outcome were collected and analyzed.

Results Of the 28 cases, 19 (67.9%) were male and 9 (32.1%), female, with a mean age of 40.75 years. Mucocele was unilateral in 26 (92.9%) patients. Twenty patients (71.43%) presented with primary mucocele. The distribution of mucocele was frontal and frontoethmoidal in 8 (28.6%) patients each, maxillary in 6 (21.4%), and ethmoid and sphenoid sinus in 3 (10.7%) patients each. Sixteen (57.1%) patients had frontal sinus involvement. At presentation, 13 (46.4%) patients had nasal symptoms, 17 (60.7%) had orbital symptoms, while 16 (57.1%) had headache. Pain (12; 70.59%) was the predominant orbital symptom, followed by proptosis and diplopia (8; 47.06%). The most common sites of bony erosions were along the frontal sinus floor (14; 50%), followed by lamina papyracea (13; 46.43%), and frontal sinus anterior wall (10; 35.71%). The agger nasi and suprabullar cells were the most common frontal cells encountered in mucoceles involving the frontal sinus, with no significant difference in frontal cell distribution between involved and uninvolved sides. The frontal cell distribution was similar in mucoceles with and without frontal sinus involvement too.

Conclusion Though frontal and frontoethmoidal mucoceles were the most encountered, the type and distribution of frontal cells did not predispose to mucocele formation.

Keywords

paranasal sinus - mucocele - frontal cell - frontal sinus

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Institutional review board approval was obtained prior to commencement of the study (IRB number: 14401).

Publication History

Received: 09 October 2023

Accepted: 01 May 2024

Article published online:
22 January 2025

• References

• 1 Lund VJ, Milroy CM. Fronto-ethmoidal mucocoeles: a histopathological analysis. J Laryngol Otol 1991; 105 (11) 921-923
• 2 Scangas GA, Gudis DA, Kennedy DW. The natural history and clinical characteristics of paranasal sinus mucoceles: a clinical review. Int Forum Allergy Rhinol 2013; 3 (09) 712-717
• 3 Bockmühl U, Kratzsch B, Benda K, Draf W. Surgery for paranasal sinus mucocoeles: efficacy of endonasal micro-endoscopic management and long-term results of 185 patients. Rhinology 2006; 44 (01) 62-67
• 4 Lee TJ, Li SP, Fu CH. et al. Extensive paranasal sinus mucoceles: a 15-year review of 82 cases. Am J Otolaryngol 2009; 30 (04) 234-238
• 5 Bouatay R, Aouf L, Hmida B. et al. The role of imaging in the management of sinonasal mucoceles. Pan Afr Med J 2019; 34: 3
• 6 Kim YS, Kim K, Lee JG, Yoon JH, Kim CH. Paranasal sinus mucoceles with ophthalmologic manifestations: a 17-year review of 96 cases. Am J Rhinol Allergy 2011; 25 (04) 272-275
• 7 Davies K, Wallace J, Abelardo E, Jaramillo M. Unusual metachronous presentation of bilateral frontoethmoid sinus mucoceles. BMJ Case Rep 2021; 14 (07) e243620
• 8 Caylakli F, Yavuz H, Cagici AC, Ozluoglu LN. Endoscopic sinus surgery for maxillary sinus mucoceles. Head Face Med 2006; 2: 29
• 9 Morita S, Mizoguchi K, Iizuka K. Paranasal sinus mucoceles with visual disturbance. Auris Nasus Larynx 2010; 37 (06) 708-712
• 10 Busaba NY, Kieff D. Endoscopic sinus surgery for inflammatory maxillary sinus disease. Laryngoscope 2002; 112 (8 Pt 1): 1378-1383