Roentgen Features of Nasal Accessory Sinus Mucoceles

Mucoceles of the paranasal accessory sinuses are relatively uncommon lesions which, though their etiology is still controversial and incompletely understood, are generally attributed to some form of local obstruction. Although histologically benign and slow in growth, they are prone to result in facial and ocular deformities and may on occasion produce alarming, if not ultimately serious, symptoms. Roentgenologically, they may present rather “characteristic” though not pathognomonic features. Recognition of these roentgen signs can assist the radiologist in making the correct diagnosis. This report attempts a discussion of the clinical and roentgen features of sinus mucoceles and presents 13 cases. Included in this series are 2 instances of sphenoid sinus mucoceles, The clinical histories will be limited to the essential features, and routine blood and urine studies, where normal, will not be mentioned. Case I: L. H., a 45-year-old white female, was referred to Mr. Terence Cawthorne at the National Hospital for treatment of a left frontal mucocele. For three months she had suffered from left-sided frontal headaches, prominence of the left eye, and pain in the region of the left supraorbital ridge. On examination, the patient showed a mild proptosis of the left eye. A small, tender, hard mass could be palpated just beneath the left orbital ridge in the region of the inner canthus. Roentgenograms of the paranasal sinuses revealed destruction of the medial three-fourths of the left superior orbital rim, with slight depression of the orbital roof, bulging of the posterior wall of the frontal sinus into the space of the anterior cranial fossa, loss of the normal marginal serrations of the frontal sinus, and homogeneous increase in the density of bone adjacent to the expanded left frontal sinus. The abnormal findings were interpreted as changes secondary to a left frontal sinus mucocele (Figs. 1 and 2). At surgery a large left frontal sinus mucocele was removed. There were bony defects in the anterior and posterior sinus walls, and the dura of the anterior fossa was exposed over a wide area. Culture of the mucocele contents was reported as “no growth.” Histologic examination of the surgical specimen showed the mucocele wall to be composed of thick fibrous tissue infiltrated with round cells, plasma cells, polymorphonuclear leukocytes, and some eosinophils. The fibrous tissue wall was covered in a few places by stratified polygonal or flattened cells and sometimes by tall columnar cells. The patient made an uneventful postoperative recovery. Case II: H. C., a 58-year-old white male, was admitted to St. Bartholomew's Hospital under the care of Mr. F. C. Capps, because of progressive swelling of the left eyelid, “watering” of the left eye, and double vision, all of one year duration.