Recurrent bilateral fronto-ethmoidal mucocoele with intracranial extension: a case report

Mucocoeles of the paranasal sinuses are relatively uncommon and rarely bilateral, the frontal and ethmoidal sinuses being most commonly affected. Rarely, fronto-ethmoidal mucocoeles expand and extend into the anterior cranial fossa producing mass effect. We report a 66-year-old woman, who presented with a 20-year history of recurrent bilateral progressive proptosis and supra orbital swellings with blindness in the left eye. Ultrasound scan of the left eye showed a large cystic mass in the orbit due to extension of ipsilateral frontal mucocoele. Computed tomographic brain scan showed large bilateral fronto-ethmoidal mucocoeles, erosion of the right orbital roof, right posterior and left anterior sinus walls, and extension of the right frontal sinus into the anterior cranial fossa with mass effect. The patient had a bicoronal craniotomy and bilateral fronto-ethmoidectomy with direct drainage of independent right mucocoele and left mucopyocoele. This case illustrates complications that may result from chronicity and treatment failure in patients with sinus mucocoeles.