A new approach to aesthetic maxillofacial surgery: surgical treatment of unilateral exophthalmos due to maxillary sinus mucocele

Abstract

Maxillary sinus mucocele, known as a rare condition, can cause major therapeutic difficulties, especially when it invades the orbit leading to exophthalmia. Treatment is very difficult because the eye globe has to be repositioned, and the facial symmetry needs to be reconstructed as a result of malar bone invasion. This article reports the case of a 54-year-old patient with unilateral exophthalmia caused by the evolution of a maxillary mucocele that extended toward the orbit after destroying the malar bone and the orbital floor. The treatment consisted of a 1-step restoration of both the orbit floor and the malar bone using a temporomandibular flap composed of 2 bone fragments. Lipostructure and a titanium mesh to reconstruct the calvarial defect were necessary to restore facial aesthetics after placing back the eye globe in its initial site. After surgery, the patient followed a complex rehabilitation program including massage kinesiotherapy and psychological consultation and support. These had an essential contribution to the successful final outcome in terms of psychological impact, functionality, and aesthetics.

Figure 1

Preoperative external anterior and superior view showing right exophthalmos shown by preoperative axial CT with maxillary region compression by the mucocele

Figure 2

Preoperative coronal MRI: note the right lateral expanding and intra-operative view of the tumor and the osteofacial flap from parietal bone.

Figure 3

External appearance of the reconstructed orbit with the titanium mesh used for the reconstruction of the calvarial defect.

Figure 4

Postoperative external appearance. CT post-operative three year's post-surgery the appearance of the calvarial bone in the reconstructed malar region was identical to that of the bone near the harvested area