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David Rand, Sydney Butts, Jaya Nath, Matthew Gorski, Renelle Pointdujour, Roman Shinder; Frontoethmoidal Sinus Mucocele Associated with Osteoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1257.
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Frontoethmoidal sinus mucocele may lead to significant proptosis, globe dystopia, & neurological sequelae from bony erosion with resultant intracranial extension. Sinus osteoma is the most common benign neoplasm of the sinuses & may cause recurrent headache or sinusitis. However, a rare association of frontoethmoidal sinus mucocele and osteoma has not yet been reported in the ophthalmic literature and may reflect more aggressive lesions with intracranial extension warranting neurosurgical evaluation.
Records of 2 patients with frontoethmoidal sinus mucocele and associated osteoma were reviewed.
The first patient is a 79-year-old man who presented with a draining right frontoethmoidal mucopyocele (Fig 1A). The second patient is a 21-year-old man with a history of bilateral frontal and nasal bone fractures who presented with 3 months of diplopia. In both cases, ophthalmic exam revealed right proptosis and inferotemporal globe dystopia. CT orbits of both patients demonstrated a frontoethmoidal mucocele and adjacent osteoma with both orbital & intracranial extension (Fig 1B, C, 2A, B). Both patients received endoscopic mucocele drainage and restoration of proper sinus outflow tracts.
Frontoethmoidal sinus mucocele may arise as a complication of sinus osteoma in the setting of trauma or inflammation with expansion leading to proptosis, globe dystopia, and potentially dramatic neurological sequelae from intracranial extension such as headache, seizure, or intracranial abscess. It appears that mucocele with associated osteoma may correlate with increased incidence of intracranial expansion and communication. This association has been cited in few neurosurgical case reports,1,2 but not in the ophthalmic literature. Prompt recognition of this association by clinicians will allow proper evaluation and timely treatment to prevent potential neurological complications.
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