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Pyocele of the middle turbinate: a case report
Uğur Cinar1, Ozgür Yiğit, Berna Uslu
1Department of Otolaryngology, Sişli Etfal Training and Research Hospital, Istanbul, Turkey. u_cinar@yahoo.com
Abstract:
Mucoceles are uncommon and the majority of cases occur in the frontoethmoidal complex. The accumulation of mucous secretion and eventual secondary infection may result in the formation of a pyocele of the middle turbinate, which is exceptionally rare. This case report presents a patient with a large pyocele of the middle turbinate invading the orbit. A 48-year-old woman presented with a three-week history of nasal obstruction, slight rhinorrhea, and headache. There was an external swelling of the nasal pyramid just near the medial canthus and right exophthalmos with bulging of the medial canthus of the ipsilateral eye. A computed tomography scan revealed a rounded, expansive lesion of soft tissue density. There was a thin compact bone at the margin. Under general anesthesia, resection of the lateral and inferior walls of the middle turbinate was performed. The large cystic mass was filled with pus. Exophthalmos and bulging of the medial canthus immediately disappeared. Histologic examination showed the mucocele wall with a ciliary respiratory epithelium.
Insights
This case report details an exceptionally rare pyocele of the middle turbinate, a mucus sac that developed into an infected cyst invading the eye socket. Surgical removal successfully resolved the patient's symptoms and orbital protrusion.
Area of Science:
- Otolaryngology
- Ophthalmology
- Pathology
Background:
- Mucoceles, uncommon cysts, typically affect the frontoethmoidal complex.
- Pyocele formation in the middle turbinate is exceptionally rare, often resulting from secondary infection of a mucocele.
- Orbital invasion by a middle turbinate pyocele presents unique diagnostic and management challenges.
Observation:
- A 48-year-old woman presented with nasal obstruction, rhinorrhea, headache, and a visible swelling near the medial canthus.
- The patient exhibited right exophthalmos and medial canthus bulging, indicative of orbital involvement.
- Computed tomography revealed a rounded, soft tissue density lesion with a thin bony margin.
Findings:
- Surgical resection of the middle turbinate walls exposed a large cystic mass filled with pus.
- Histologic examination confirmed the presence of a mucocele wall lined with ciliary respiratory epithelium.
- Immediate resolution of exophthalmos and medial canthus bulging occurred post-surgery.
Implications:
- This case highlights the potential for middle turbinate mucoceles to develop into pyoceles with significant orbital complications.
- Prompt diagnosis and surgical intervention are crucial for managing orbital pyoceles and preventing vision loss.
- Understanding the pathology of these rare lesions aids in refining treatment strategies for sinonasal and orbital pathologies.