Two anomalous localizations of mucocele: clinical presentation and retrospective review

Abstract

Two Caucasian males (57 and 70 years old) were referred to our attention with parasinus mucoceles, maxillary and frontal mucocele, respectively, that had eroded the orbital rim and caused swelling of the eyelids and brow. Invasion of the orbital space caused several ophthalmic symptoms such as diplopia, proptosis, ptosis, and the formation of a palpable mass. Ophthalmic involvement was the first sign of the mucocele. The mucoceles were completely excised through a skin incision and the diseased mucosa of the sinuses was removed: endonasal fibre optic surgery and the Caldwell-Luc procedure were used in the patient with maxillary mucocele. The cases are described with retrospective review.

Fig. 1

Patient 1: a large cyst appeared under lower lid.

Fig. 2

Patient 1: (left) T1-weighted MRI revealed a well-encapsulated right cyst homogeneously filled with liquid and an extensive heterogeneous lesion measuring approximately 5 cm involving the ipsilateral maxillary sinus; (right) axial CT shows a clearer picture of the maxillary bone with a better outline. Bone of medial and anterior wall appeared eroded and displaced by the tu-mour inside.

Fig. 3

Patient 1: wall of the cyst appeared under the orbicularis muscle.

Fig. 4

Patient 2: (left) axial CT showing a large homogeneous mass, with max diameter 3.5 cm, involving left frontal sinus and extending into the orbital cavity; (right) sagittal scan: NB relationship between sinus cavity and brain (arrow) with eggshell bone erosion.

Fig. 5

Patient 2: 3D reconstruction with well-defined erosion of orbital roof.