Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2003 Jun;87(6):699-703.
doi: 10.1136/bjo.87.6.699.

Transcaruncular approach for the management of frontoethmoid mucoceles

P-C Lai  1 , S-L Liao, J-R Jou, P-K Hou
Affiliations
Case Reports

Transcaruncular approach for the management of frontoethmoid mucoceles

P-C Lai et al. Br J Ophthalmol. 2003 Jun.

Abstract

Aims: To present transcaruncular medial orbitotomy as the preferred approach to manage frontoethmoid mucoceles.

Methods: 11 patients with frontoethmoid mucoceles received transcaruncular orbitotomy from 2000 to 2002 at the National Taiwan University Hospital. The incision was made through the caruncle to explore the medial wall periosteum. Then the periosteum was opened and extended to provide adequate surgical field exposure. Frontoethmoid mucoceles could be viewed and removed directly. A transnasal drainage tube was inserted before closure of the caruncle wound.

Results: The mean follow up period was 12 (SD 9.1) months (range 1-26). Both functional recovery and cosmetic outcome were excellent. There was no recurrence of mucoceles. One patient complained of diplopia, which subsided after 2 months.

Conclusion: Transcaruncular orbitotomy provides a wide exposure and a safe access to the medial orbital extraperiosteal space. Furthermore, there is less damage to skin and muscle layer and less manipulation of other ocular adnexal structures, such as medial canthal tendon and lacrimal sac. It can be an excellent approach for the management of frontoethmoid mucoceles.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The anatomy related to the transcaruncular medial orbitotomy. The caruncle was divided to dissect a plane between Horner’s muscle and the medial orbital septum to expose the medial orbit, avoiding manipulation of lacrimal sac.
Figure 2
Figure 2
(A) The first incision was made through the caruncle using Westcott scissors. (B) Gentle dissection with the tips of the scissors passed along the plane between Horner’s muscle and the medial orbital septum. (C) Retraction of the orbital contents with a malleable ribbon retractor resulted in exposure of the medial orbit and some mucoid material encountered (arrow). (D) The eggshell-like, rounded mucocele was shown (arrow).
Figure 3
Figure 3
(A) The outer wall of the mucocele was removed by forceps. (B) Yellowish mucoid material (arrows) was found after removal of outer shell of the mucocele. (C) The inner wall of the mucocele was shown (arrow). (D) A rubber catheter with a balloon (arrow) was inflated after excision of the mucocele.
Figure 4
Figure 4
A 31 year old woman (A) with a tender mass in the left superior medial orbit before operation, (B) CT scan findings showing a frontoethmoid mucocele, (C) a transnasal drainage tube in position.
Figure 5
Figure 5
A 58 year old man (A) with left proptosis and exotropia before operation, (B) CT scan findings showing a mucocele extending to the orbital cavity, (C) a transnasal drainage tube in position.
See this image and copyright information in PMC

Comment in

References

    1. Evans C. Aetiology and treatment of frontoethmoidal mucocele. J Laryngol Otol 1981;95:361–75. - PubMed
    1. Valerie JL, Muriel ER. Ophthalmic considerations in fronto-ethmoid mucoceles. J Laryngol Otol 1989;103:667–9. - PubMed
    1. Lynch RC. The technique of a radical sinus operation which has given me the best result. Laryngoscope 1921;31:1–5.
    1. Balch KC, Goldberg RA, Green JP, et al. The transcaruncular approach to the medial orbit and ethmoid sinus. A cosmetically superior option to the cutaneous (Lynch) incision. Facial Plast Surg Clin North Am 1998;6:71–7.
    1. Garcia GH, Goldberg RA, Shorr N. The transcaruncular approach in repair of orbital fracture: a retrospective study. J Cranio Maxillofac Trauma 1998;4:7–12. - PubMed

Publication types