Facial mucocele and brain complications: diagnostic priorities

Abstract

We present the case of a male with a history of nasal polyposis underwent bilateral nasosinusal endoscopic surgery. He went to the emergency department because of having behavioral changes and left frontal headache. An emergency CT showed nasal-sinus polyposis and several nodular lesions with a characteristic "ring" enhancement and perilesional edema. These findings were compatible facial mucocele complicated with rupture of the bone wall of the left frontal sinus and frontal abscess. Urgent surgery was performed, with left frontal craniectomy and drainage of the abscesses. Mucoceles are benign slowly growing lesions which can associate important complications. The most frequent are abscesses and the invasion of neighboring structures. It is very important to remember that frontal mucoceles can cause intracranial invasion when there is an erosion of the internal osseous table.

Figure 1.

Axial scans cerebral CT without intravenous contrast (A) and after administration of intravenous contrast (B). Several frontal left hypodense nodular lesions (red arrow in A) with “ring” enhancement (red arrow in B) are visualized. They associate perilesional edema (blue arrows in A, B).

Figure 2.

Axial scan cerebral CT in A and B (bone window) shows occupation of both frontal sinuses by soft tissue, which cause erosion of its left posterior wall (arrow in C). These features are compatible with frontal mucocele. In addition, polyposis at bilateral ethmoid sinus was associated.