Wednesday, March 28, 2012

Mucoceles in paranasal sinuses

Mucoceles in paranasal sinuses

The obstructed sinus ostium causes vicious lesions called mucocele. These lesions are also referred to as mucopyoceles and pyoceles. Trauma, bony neoplasams, polyps and intra-antral inflammation contribute to the development of mucoceles. These mucus filled mucoceles feature mucoperiosteum of the sinus affected. The symptoms of sinus include forehead-specific trauma, the frontal sinus fracture, obstruction in the frontonasal duct, prolonged allergic rhinitis and nasal obstruction. The symptoms may persist up to several years.




The lesions are commonly found in the frontal sinuses, followed by ethmoid sinuses and sphenoid and maxillary sinuses.
Mucoceles in frontal sinus
These mucoceles are commonly found within the superomedial part of the orbit. The lesions displace eyeball downward, forward and sideways. Consequent swelling lacks tenderness. The patient may complain about nasal obstruction, nasal voice, proptosis, diplopia and headache.
The affected frontal sinus will appear as a cloud with rounded, ovoid or smooth contours on the radiograph. The slim mucoperiosteal white line will be unclear. In case of mucoceles related to chronic sinusitis, the reactive bone will surround the sinus. Erosion of frontal bone’s vertical plate will be recorded on the image.
Mucoceles in ethmoid sinus
The mucoceles expands the orbit’s medial wall. As a result, the eyeball moves sideways and forward, expanding the middle meatus of nose and causing nasal voice.
Mucoceles in sphenoid sinus
Damage to and expansion of the posterior ethmoid and sphenoid sinuses cause mucoceles. The symptoms of sinusresembles to that of superior orbital fissure syndrome. Vision of the patient decreases. Localized pain in forehead or orbit occurs.
Mucoceles in maxillary sinus
Mucoceles in the maxillary sinus are generally without symptoms of sinus. These lesions are spotted on standard radiographs. Occasionally, the mucoceles put pressure on the superior alveolar nerves, causing pain and swelling and fullness of the cheeks. The lesion expanding in the back may loosen the posterior teeth. Lesion expansion in superior direction leads to proptosis and diplopia. When lesion expands sinus’ medial wall, the nasal cavity’s lateral wall deforms, obstructing the nasal airway.  Infected lesions are called mucopyoceles or pyoceles.
On a radiograph, the maxillary sinus containing mucoceles will appear circular. The sinus will be radiopaque. Erosion of bony walls and septa, and resorption and displacement of teeth will be recorded on the image.
Treatment
Mucoceles shall be excised. However, the treatment of the lesions depends on ability of the surgeon and extent and location of the disease. The surgeon can choose between external and intranasal methods.

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