Clinicopathologic, ophthalmic, visual profiles and management of mucoceles in blacks

The study aimed at finding out the clinicopathologic, ophthalmic and visual profiles, management and outcome of mucoceles of the paranasal sinuses in Nigerians. The study was a retrospective review of 20 cases of mucoceles who presented to the ENT clinic and referred to the eye clinic of the University College Hospital Ibadan, Nigeria. These included nine males and 11 females with a male:female ratio of approximately 1:1. Mucoceles commonly involved more than one sinus on the same side. The sinuses commonly involved were the frontoethmoidal sinuses, frontal sinus and maxillary sinuses. The preoperative visual acuity in 16 (80%) patients was 6/4-6/9, three (15%) had between 6/9-6/18, and one (5%) patient was CF ("count fingers") in the affected eyes. The majority (90%) of our patients presented with multiple ophthalmic features; however, proptosis was the most popular and ophthalmic presentation and occurred in 15 (75%) patients. Proptosis was nonaxial in all cases with inferior, lateral or inferolateral displacement. Degree of proptosis ranged from 1-20 mm. Other presentations were squint (leading to diplopia) observed in one (5%) patient and epiphora in another [one (5%)] patient. Poor vision appeared to be the main problem in one (5%) patient, while in another [one (5%)] patient, the affected eye was completely immobilized. One (5%) patient presented with orbital cellulitis. Common radiological findings included classical expansive appearance with loss of the normal scalloping appearance with dehiscence of the wall of the affected sinus as was observed in nine (45%) of our patients. All 20 patients had excision of mucoceles (frontoethmoidectomies). At surgery, 11 (55%) patients had a combination of dehiscence of medial and/or posterior walls, and/or floor of the orbit. Materials evacuated were mucopurulent in 15 (75%) cases, moldy in three (15%) and cheesy in two (10%). Nine (45%) patients had intact walls. Three (15%) patients developed orbital cellulitis as postoperative complication. Postoperatively, proptosis regressed spontaneously within one week of surgery in 17 (85%) patients. By six weeks, all the patients had a complete regression of proptosis and visual acuity returned to preoperative visual acuity level except the patient with preoperative visual acuity of CF. This patient later deteriorated and became NPL (no perception of light) in the affected eye. This was a peculiar case in that operative findings in this patient were suggestive of another coexisting pathology, which was later confirmed to be a non-Hodgkin's lymphoma of the orbit. After two months, only three (15%) reported back for follow-up. The study concluded that proptosis is a common feature of mucoceles of the paranasal sinuses and that visual affectation was rather uncommon. Also whilst mucopurulent materials formed the content of most mucoceles, surgical intervention caused proptosis to regress dramatically. However, due to the high default rate in our study, no categorical statement can be made about recurrence rate of these swellings.