Paranasal sinus mucoceles in a tertiary center, Southwestern Nigeria: A 10-year review of ophthalmic features, management, and outcome

Oluyemi Fasina; Sule Samuel Okoh

doi:10.4103/jcls.jcls_34_18

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ORIGINAL RESEARCH REPORT

Year : 2018 | Volume : 15 | Issue : 4 | Page : 183-185

Paranasal sinus mucoceles in a tertiary center, Southwestern Nigeria: A 10-year review of ophthalmic features, management, and outcome

Oluyemi Fasina¹, Sule Samuel Okoh²
¹ Department of Ophthalmology, University College Hospital, University of Ibadan, Ibadan, Nigeria
² Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria

Date of Web Publication

3-Dec-2018

Correspondence Address:
Dr. Oluyemi Fasina
Department of Ophthalmology, University College Hospital, University of Ibadan, Ibadan
Nigeria

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jcls.jcls_34_18

Abstract

Background and Objective: Paranasal sinus mucoceles result from obstruction of the ostium of the affected paranasal sinus which becomes filled with secretions from the mucosal lining. We report the clinical features, management, and outcome of treatment in patients with paranasal sinus mucoceles in a tertiary health facility. Patients and Methods: Retrospective chart review of all patients with paranasal sinus mucoceles was conducted. Results: A total of 12 cases of paranasal sinus mucoceles were managed during the study period with equal gender distribution and mean age of 37.7 ± 5 years. The mean duration of symptoms before presentation was 2.5 ± 2.2 years, and all the patients presented with nonaxial proptosis, with 7 (58.3%) patients having orbital extension of the mucocele. The frontal and ethmoidal sinuses were most affected and frontoethmoidectomy was performed in 5 (41.7%) patients, while this was combined with medial orbitotomy in 5 (41.7%) patients and orbital exenteration in 2 (16.6%) patients. Conclusion: Paranasal sinus mucoceles are relatively uncommon in our region but still associated with significant ocular morbidity.

Keywords: Clinical profile, management, outcome, sino-orbital mucocele, Southwestern Nigeria

How to cite this article:
Fasina O, Okoh SS. Paranasal sinus mucoceles in a tertiary center, Southwestern Nigeria: A 10-year review of ophthalmic features, management, and outcome. J Clin Sci 2018;15:183-5

How to cite this URL:
Fasina O, Okoh SS. Paranasal sinus mucoceles in a tertiary center, Southwestern Nigeria: A 10-year review of ophthalmic features, management, and outcome. J Clin Sci [serial online] 2018 [cited 2018 Dec 15];15:183-5. Available from: http://www.jcsjournal.org/text.asp?2018/15/4/183/246765

Introduction

Mucoceles are epithelial-lined cystic lesions usually resulting from obstruction of the ostia of the paranasal sinuses (PNS) usually from inflammatory and infective conditions, polyps, and trauma, and they contain sterile mucoid secretions which completely fill the cavity.^[1],[2] They are chronic, slow-growing, expansive, and osteolytic lesions which can extend into the orbit and intracranial cavity.^[3] They are relatively uncommon benign lesions affecting mostly the frontal and ethmoidal sinuses, although rarely, the maxillary and sphenoid sinuses may be affected.^[4] A study of the cases of PNS mucoceles^[5] was carried out in our health facility over a decade ago; hence, this review of surgically managed and histologically confirmed cases of PNS mucoceles over a 10-year period. The aim of this study is to describe the clinical features, management, and outcome of treatment of patients seen with PNS mucoceles in a tertiary health facility.

Patients and Methods

A retrospective chart review of all patients who presented with clinical features suggestive of paranasal sinus mucocele including nasal blockade, nasal discharge, facial pain, headaches, hyposmia, and anosmia, and the specimen was confirmed at histopathology after surgical intervention between July 2007 and June 2017 at a tertiary health facility, southwestern Nigeria was carried out. The information retrieved from the medical records included patients' sociodemographics, presenting complaints, and detailed ocular examination including visual acuity before and after surgery, radiological investigations carried out, treatment, and outcome of treatment in the patients. Ethical approval was obtained from the Institution's Ethical Review Board and the study was conducted according to the tenets of Declaration of Helsinki.

Results

A total of 12 patients were managed during the study period, comprising six males, (M:F; 1:1) and age range of 31 years to 45 years, (mean, 37.7 ± 5.0 years) [Table 1]. The most frequent symptomatology was proptosis, orbital swelling or mass, and tearing, with a mean duration of symptoms before presentation of 2.5 ± 2.2 years [Table 1]. Proptosis was nonaxial in all patients with inferolateral globe deviation and a mean eyeball protrusion of 8.7 ± 3.4 mm using the Hertel's exophthalmometer [Figure 1]. Visual acuity of the patients at presentation was ≥6/18 in 8 (66.7%) patients, while 4 (33.3%) patients had acuity <6/18, two of whom had “no perception of light.” The frontoethmoidal sinus was affected in 7 (58.3%) patients, while five patients (41.7%) had pure frontal sinus affectation. Five (41.7%) patients underwent external frontoethmoidectomy alone, while external frontoethmoidectomy was combined with medial orbitotomy in 5 (41.7%) patients and orbital exenteration in 2 (16.6%) patients [Table 1]. The patients were managed as in-patients between 7 days and 21 days (mean, 14 ± 4 days) with complete resolution of symptoms, and subsequently followed up in the outpatient clinic for an average period of 4.0 ± 2.0 months.

Table 1: Summary of the patients managed for paranasal sinus mucoceles

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Figure 1: (a) Preoperative clinical picture of a patient with right frontoethmoidal mucocele with orbital extension and resultant nonaxial proptosis. (b) Postoperative clinical picture of the same patient showing resolved proptosis and the frontoethmoidectomy scar. (c) Computed tomography scan picture (axial view) of the patient showing an expansile isodense lesion filling the right ethmoid with destruction of the medial wall of the orbit and extension into the orbit. (d) Computed tomography scan picture of the same patient (coronal view) showing orbital extension of the mucocele

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Discussion

Paranasal sinus mucoceles are the most common benign expansile lesions of the PNS.^[6] However, there appears to be a reduction in the number of cases managed in this series in comparison with a previous study by Ajaiyeoba et al.^[5] This could possibly be due to better management of paranasal sinusitis with resultant fewer complications or, the establishment of more otorhinolaryngology centers in the region, might have resulted in a change in the referral pattern of patients to our facility. Ogunleye et al.^[7] in their 10-year review of 90 cases of paranasal sinusitis found 6 (6.7%) cases with mucocele and attributed the small number of cases in their series to better management of paranasal sinusitis with antibiotics resulting in fewer complications.

Mucoceles affect all age groups, but they are commonly reported in the third and fourth decades of life. Thus, the mean age of 37.7 years in this series agrees with previous studies.^{[5],[6],[8],[9]} Similarly, we found no difference in the gender distribution in this series as reported in some studies.^[10],[11] Some authors,^[5],[6] however, reported a slightly higher female affectation, while others^[9],[12] reported a slightly higher male preponderance.

In this series, the frontal sinus was involved in all patients either as pure frontal sinus mucocele or together with the ethmoid sinus. Similar pattern of PNS affectation has been described by previous authors.^[9],[12] The mean duration of symptoms of 2½ years before presentation by the patients in this series is, however, higher than reported in some studies,^{[6],[11],[13]} and this could be attributed to the pattern of prehospital consultations among patients in the locality with delayed presentation of patients to the appropriate health facility.^[14] The most common symptomatology in the patients was proptosis, found in all patients, followed by tearing. Noted also is that four of the patients in this series had reduced vision from exposure keratopathy with two of them having “no perception of light” in the eye at presentation due to orbital extension of the mucocele, distorted orbital anatomy and possibly, optic nerve compression, for which orbital exenteration was carried out. These findings are slightly different from the report of Jaswal et al.^[6] where proptosis was found in less than one-third of the cases. The delayed presentation of our patients could possibly explain this disparity.

Following clinical suspicion of PNS mucocele, a greater proportion of patients was evaluated with computed tomography (CT) scan which showed typical expansile, nonenhancing, isodense lesion filling the paranasal sinus, and pressure effect on the bony wall with or without orbital extension [Figure 1]. CT scan is the imaging modality of choice for PNS mucocele as it clearly demonstrates the bony walls of the PNS and any extension into the intracranial or orbital spaces.^[6],[15]

However, two patients had plain radiographs due to financial constraints. Diagnosis of mucocele in our patients was confirmed by the histopathological examination of the specimen taken at surgery which showed pseudostratified and pseudo-columnar epithelium, goblet cells, and cellular infiltrates with neutrophils, macrophages, and monocytes. All patients underwent frontoethmoidectomy which was combined with medial orbitotomy or orbital exenteration in some patients in line with the involved PNS and associated orbital complications. They fared well postoperatively with resolution of symptoms and were discharged to the outpatient Clinic.

Conclusion

Paranasal sinus mucoceles remain relatively uncommon presentation in our region, and delayed presentation to the appropriate health facility with significant ocular morbidity is still present in some patients. Factors that promote early presentation of patients and prompt and appropriate intervention for paranasal sinusitis will probably reduce the associated morbidity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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