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08-DECEMBER-2010  ATTALLAH HASAN AL-SHBEKAT  54 YEARS  INFECTED MASS IN THE FRONTAL SINUS WITH RIGHT INTRAORBITAL EXPANSION AND COMPRESSION.

Anamnesis

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The patient is a doctor came to the clinic 04-December-2010 complaining of throbbing pain of the right eye for 10 days. He had similar episode 5 years ago and was treated for sinusitis.

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MRI of the brain performed 27-November-2010 showing huge mass in the frontal sinus, filling the right side and destroying the right orbital roof and pushing the globe down and lateral. CT-scan performed showing the bone defect between the frontal sinus and the right orbit.

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On examination: The patient  has right ophtalmalgia  with double vision and the right eye is pushed down and lateral with oedema of the eye lids, more the superior. There is hypalgesia of the right supratrochlear nerve territory. He has also hyposmia in the right.

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Bifrontal skin incision was performed 3 cm posterior to the hair line and reflected to the face. Modified bifrontal craniotomy was done, preserving the frontal sinus in the left and violating the right part. The dura was severely adherent to the bone that it was necessary to separate it stepwise.  The dural tears were stitched.  A huge amount of pus came out  and the mucocele was removed totally. The wall of the mucocele was removed from the dura through the bone defect in anterior fossa and the wall also removed from the periorbita right eye through the bone defect in the superior orbital wall. The mucosa was removed entirely from the sinus. The involved frontal sinus part was a closed cavity and it had no communication with other sinuual parts, for what a tunnel was created to obtain passage to the nasal sinuses.

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Routine closure of the wound. Redy-Vac drain under the skin. Smooth postoperative recovery.


Comments

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The patient has persistent mass in the frontal sinus right side and it caused destruction of the bone between the frontal sinus and the right orbit. Mucocele could do that, but another benign tumors could do that also.

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The cause of such destruction is the absence of communication between the involved cavity and other sinuses. Creating such communication is the important step to prevent future recurrence of such mucocele.

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