Therapy of invasive mucoceles of the frontal sinus

Mucoceles of the frontal sinus that extend into the orbits and the anterior cranial fossa can, in certain cases, be difficult to manage therapeutically and may lead to lethal complications. The surgeon will have to make a decision between an endonasal and an extranasal, transfacial procedure to provide an adequate access. Between 1995 and 1998 we treated 12 patients suffering from invasive mucoceles of the frontal sinus. The mucocele was localized medially in 7 cases and in the lateral part of the frontal sinus in 5 cases. Five of the patients exhibited destruction of the orbital roof and in 7 cases combined destruction of the orbital roof and the floor of the frontal sinus were noted. The posterior wall of the frontal sinus was destructed in 6 patients, with one patient additionally showing partial destruction of the anterior frontal sinus wall. The causes of mucocele formation were previous frontal sinus operations (n = 8) and frontal sinus fractures (n = 3). In one case the cause remained unknown. In 7 cases with a medially localized mucocele the mucocele was marsupialized using an endonasal access. The mucoceles with a lateral localization were osteoplastically operated via an external access. Here we performed median drainage in 3 cases and, in one case each, obliteration and cranialization of the frontal sinus. The follow-up period was 2.8 years on average. All patients were free of complaints immediately after the operation. Mucocele recurrence or other complications did not arise. The cosmetic results were satisfactory in all cases.