[Combined approach (endoscopic and external) for the treatment of sinusal mucoceles]

Determination of the best surgical approach in the treatment of mucocoeles of the sinuses according to their localization.

A retrospective study has been carried out including forty three cases of sinus mucocoeles, surgically treated from 1990 to 1997. These were in descending order, frontal (n = 19), maxillary (n = 10), ethmoïdo-frontal (n = 9), sphenoidal (n = 3) and ethmoidal (n = 2). Surgical treatment was achieved with an exclusive endoscopic approach in 28 cases whereas 15 of them underwent endoscopic surgery associated with an external approach (also called combined technique). Short term complications and recurrence were recorded after a minimum of 6 years follow-up, according to the type of surgery performed and the topography of the mucocoele.

Recurrence of mucocoeles is prevented in 95.8% of cases by an exclusive endoscopic treatment in ethmoïdo-frontal, maxillary, sphenoidal and ethmoidal sites. On the other hand, the recurrence rate in mucocoeles involving the frontal sinuses without ethmoidal involvement, was significantly higher when the mucocoele was operated on by an exclusively endoscopic method (25%, p < 0.001) rather than by a combined technique (0%).

Ethmoido-frontal, maxillary, sphenoidal and ethmoidal mucocoeles are excellent indications for an exclusively endoscopic endonasal surgery. An external approach, combined with endoscopic surgery, is suitable in frontal mucocoeles, especially in distal sites and in case of recurrence.