Mucoceles of the Maxillary and Sphenoid Sinuses

ALTHOUGH mucoceles of the frontal and ethmoidal sinuses are not unusual, they are rarely found in the maxillary and sphenoidal sinuses (1, 4, 6, 10, 12, 13, 23, 27, 30). Some authors suggest that mucoceles of the maxillary antrum never (26, 27) or rarely ever occur (4, 10). A survey of the literature reveals only 39 reported cases of antral mucoceles, at least 6 of which are doubtfully included (3, 5, 6, 8, 9, 14–16, 19, 21, 22, 24, 29, 30). A recent report by Pincus and Daroff indicated that less than 60 sphenoidal sinus mucoceles have thus far been documented (20). With full realization that the clinical presentation of these two lesions is usually quite dissimilar, none the less their grouping under one heading is useful in familiarizing radiologists with the rather typical appearance of these benign, slowly expanding lesions in sites other than the commonly depicted frontal and ethmoidal sinuses. This report presents two sphenoid mucoceles (one previously reported, 20) and one maxillary mucocele. Definition For radiologic purposes the abacterial and the infected mucoceles, the pyoceles, are sufficiently similar in presentation to require no separation. Both will be considered under the term mucocele. This entity can most simply be described as a gradually expanding collection of fluid within a paranasal sinus, initiated by the obstruction of an ostium and typified by expansion and thinning of sinus walls and destruction or compression of adjacent structures. Illustrative Case Reports CASE I: A 28-year-old Negro male was admitted with a thick purulent left nasal discharge persistent for several months. Left nasal obstruction had been progressive for the last few months. During a previous admission in 1956 a left frontal arteriovenous malformation had been successfully removed. Examination revealed swelling of the left face as well as swollen and medially displaced left turbinates occluding the left airway. Roentgen examination showed opacity of the left antrum with thinning and bulging of its walls in all directions, markedly enlarging the sinus and encroaching on the nasal passage, teeth, orbit, ethmoidal air cells, and zygoma (Fig. 1,A to E). A diagnosis of maxillary mucocele was proposed by the X-Ray Department but received with great reservations by the clinical staff until both air and positive contrast material had been introduced into the cavity, outlining all the margins once again (Fig. 1,F to H). A Caldwell-Luc procedure and an intranasal antrostomy were performed on the left antrum. A large pyomucocele was encountered, which was lined by pseudo stratified ciliated respiratory type epithelium. Chronic inflammation was evident. Fifteen cubic centimeters of thick purulent mucoid material was drained. The immediate postoperative course was excellent. Three weeks after surgery the patient was asymptomatic without nasal discharge or obstruction. The nasal antrostomy was widely patent.