Mucocele of the frontal sinus is a cystic expansion of the frontal sinus, which occurs as a result of stretching of accumulated serous fluid or pus. Usually this disease is accompanied by pain, which is constantly increasing in the forehead or eyes.
The content of the article:
Causes of the appearance of mucocele of the frontal sinus
Symptoms of mucocele of the frontal sinus
Diagnosis of frontal sinus mucocele
Complications of the frontal sinus mucocele
Treatment of frontal sinus mucocele
Prognosis and prevention of mucocele of the frontal sinus
Mucocele of the frontal sinus
The manifestation of the mucocele of the frontal sinus may also be a characteristic protrusion in the inner corner of the eye, exophthalmos or a downward displacement of the eyeball itself may also be observed. Visual impairment, namely, a decrease in its acuity, a violation of color perception and the appearance of lacrimation — all these are characteristic manifestations of this disease. As a diagnostic method for detecting the mucocele of the frontal sinus, X-rays, rhinoscopy, CT, ultrasound, MRI, as well as diaphanoscopy are used. In some cases, diagnostic puncture is used, as well as probing of the frontal sinus. As for the treatment of the mucocele of the frontal sinus, it is always a surgical type of treatment.
As you know, the frontal sinus is located in the medial part of the frontal bone itself and behind the brow arches. Its lower wall is also the upper part of the eye socket, while the posterior wall separates the frontal sinus and the brain. Anatomically, the right and left frontal sinuses are located so that they are adjacent, but at the same time separated from each other by a special thin partition. The frontal sinus is connected to the middle nasal passage of the nasal cavity by means of the frontal-nasal canal. The inner part of the frontal sinus is a mucous membrane, whose cells are able to secrete a special fluid. Usually, the outflow of fluid is carried out through the frontal-nasal canal. If this outflow is disrupted, then fluid accumulates in the sinus cavity, which leads to the formation of a mucocele of the frontal sinus. If it accumulates not liquid, but pus, then we are talking about a pyocele.
Usually this diagnosis is inherent in school-age children. The mucocele of the frontal sinus is not inherent in children under 7 years of age, because at this time only the formation of the frontal sinuses occurs, which continues until the age of seven years of the child. In the case of slow development of the mucocele of the frontal sinus, the very first symptoms may appear several years after the onset of pathological changes in the frontal sinus itself. In practice, there is a known case when a mucocele was diagnosed in a patient 15 years after its occurrence. The latter was due to his nose injury.
Causes of the appearance of mucocele of the frontal sinus
One of the main causes of mucocele of the frontal sinus is complete obturation or partial violation of the patency of the frontal-nasal canal. The development of mucocele may be affected by the appearance of curvature of the nasal septum, as well as exostoses, foreign bodies in the nose, nasal injuries, and more. As a result of all of the above, periostitis may develop. The overlap of the frontal-nasal canal may occur due to adhesions that have formed as a result of sinusitis of the frontal sinus.
The process of infection of the fluid mucocele of the frontal sinus with the further occurrence of pyocele occurs due to the spread of infection, which began in the nasal cavity. The spread of infection occurs lymphogenically or hematogenically. As a rule, the source of infection is such infectious and inflammatory diseases of the nasopharynx as sinusitis, rhinitis, sore throat, pharyngitis, laryngitis and chronic tonsillitis.
Symptoms of mucocele of the frontal sinus
As you know, the mucocele of the frontal sinus has no symptoms for a long time. Before the first clinical signs appear, the mucocele already exists, as a rule, for a year or two. The manifestation of the mucocele of the frontal sinus is associated with increasing headaches in the frontal region. Later, such pain spreads to the area above the eye sockets and around the eyeballs. Another symptom of the mucocele of the frontal sinus is the protrusion of a rounded shape in the inner corner of the eye. If you press on such a protrusion, the patient will not feel anything, but he will hear a sound that resembles a crunch. Strong pressure can lead to further formation of a fistula, from which a mucous fluid (with mucocele) or purulent fluid (with pyocele) will eventually come out.
Over time, in the case of a frontal sinus mucocele, the lower part of the frontal sinus wall may be lowered. In this regard, there is a displacement of the eyeball downward and outward at the same time. Often the patient experiences a split in the eyes. Characteristic symptoms of the mucocele of the frontal sinus are also impaired color perception, decreased visual acuity and deterioration in the quality of the perceived image. If you put pressure on the tear ducts, a patient with this ailment will experience lacrimation. If a significant amount of fluid accumulates in the mucocele, it can break through, followed by the formation of a fistula inherent in one wall of the frontal sinus. If an outpouring of pus occurs in the fistula, this will lead to purulent complications.
Diagnosis of frontal sinus mucocele
The diagnosis of the mucocele of the frontal sinus is carried out by an otolaryngologist. In case of complications appearing on the side of the eye, consultation with an ophthalmologist is mandatory. In case of suspected meningitis, a consultation with a neurologist is necessary. Diagnosis of the mucocele of the frontal sinus begins with the detected complaints of the patient, as well as during examination, rhinoscopy and various studies of the paranasal sinuses.
Interestingly, rhinoscopy may not reveal any pathological changes in a patient with a frontal sinus mucocele. It happens that in the process of rhinoscopy, a smooth protrusion is detected in the area of the middle nasal passage.
If we talk about X-ray studies, they are designed to determine the increase in the size of the sinus, a decrease in its transparency and the degree of stretching of its bottom. The most accurate type of diagnosis is CT of the frontal sinus. MRI of the paranasal sinuses and ultrasound are often used. In some cases, in order to determine the air frontal sinus, doctors perform diaphanoscopy. If the diagnosis of mucocele is difficult, then a diagnostic puncture is used. Not so often, but the sinus is also probed with a Lansberg probe.
Complications of the frontal sinus mucocele
All complications arising from the mucocele of the frontal sinus are associated with the formation of pus in its contents and the further spread of the purulent process to other formations adjacent to the sinuses. A breakthrough of pus is also considered a complication. This happens through the lower wall of the frontal sinus. If a purulent infection gets into the cavity of the eye socket, the development of panophthalmitis, phlegmon of the eye socket and endophthalmitis will begin. Very rarely, but there are cases of fistula formation with a location in the posterior sinus, which can lead to the formation of meningitis.
Treatment of frontal sinus mucocele
Mucocele and pyocele of the frontal sinus require mandatory surgical treatment. Doctors perform a radical operation to remove the lower wall of the frontal sinus, expanding the frontal-nasal canal. A fronotomy (or opening of the frontal sinus) is performed after an incision of the skin along the eyebrows. The operation consists in cleansing the sinus cavity from mucus and pus, after which drainage is installed into the wound. Usually the operation is performed under local anesthesia. As for the period of sinus drainage after surgery, it is at least two weeks until scars form on the skin. The latter is necessary to create a space between the nasal cavity and the frontal sinus.
Medical treatment is carried out simultaneously with surgical treatment. The doctor prescribes anti-inflammatory, decongestant drugs and antibiotics to the patient.
Prognosis and prevention of mucocele of the frontal sinus
If the mucocele of the frontal sinus was surgically eliminated in time, then complications, as a rule, do not occur. Of course, in the presence of complications, the prognosis for recovery worsens.
Prevention of this disease consists, first of all, in the effective treatment of any infectious and inflammatory diseases inherent in the nasopharynx, as well as in preventing injury to the nose. Prevention of mucocele of the frontal sinus is also the prevention of hypothermia, removal of tumors, removal of foreign bodies, correction of the nasal septum if it is curved.
