Frontal mucocele with an accompanying orbital abscess mimicking a fronto-orbital mucocele: case report
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Erdinc Aydin1, Guzin Akkuzu, Babur Akkuzu
1Baskent University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey. erdinca@baskent-ank.edu.tr
Background:
Mucoceles are slowly expanding cystic lesions with respiratory epithelium containing mucus most commonly affecting the frontal and ethmoidal sinuses. They are caused by obstruction of sinus ostium. Mucoceles exert pressure on the bony boundaries and due to the proximity to the brain and orbit extension to these areas are common.
Case Presentation:
A case of a frontal mucocele with an accompanying orbital abscess mimicking a fronto-orbital mucocele is reported. A 77 year old female patient suffering from left sided proptosis and pain around the left eye was admitted to our department. She had a history of left frontal sinus mucocele one year ago that was offered an osteoplastic frontal sinus surgery that the patient refused. Patient had limitation of eye movements. Fundoscopic examination revealed a minimal papilledema. Coronal computerized tomography and orbital magnetic resonance imaging showed a frontal mucocele with suspicious erosion of the orbital roof and a superiorly localized extraconal mass displacing the orbit lateroinferiorly. Frontal and orbital masses had similar intensities. Thus surgery was planned for a fronto-orbital mucocele. During surgery no defect was found on the orbital roof. Frontal mucocele and orbital cystic mass was removed separately. Pathological examination showed a frontal mucocele and an orbital abscess wall. Postoperatively eye movements returned to normal and papilledema resolved.
Conclusion:
Fronto-orbital mucoceles are commonly encountered pathologies, but frontal mucocele with an orbital abscess is a rarely seen and should be kept in mind because their treatments differ.
Insights
A rare case of a frontal mucocele with an orbital abscess, mimicking a fronto-orbital mucocele, highlights the importance of distinguishing these conditions. Accurate diagnosis is crucial as treatments for frontal mucoceles and orbital abscesses differ significantly.
Area of Science:
- Ophthalmology
- Otorhinolaryngology
- Neurosurgery
Background:
- Mucoceles are cystic lesions originating from sinus obstruction, commonly affecting the frontal and ethmoidal sinuses.
- These lesions can expand and exert pressure on adjacent structures, including the orbit and brain.
- Orbital involvement from sinus mucoceles can present with varied clinical manifestations.
Purpose of the Study:
- To report a rare case of a frontal mucocele with an accompanying orbital abscess.
- To emphasize the diagnostic challenges in differentiating this presentation from a fronto-orbital mucocele.
- To highlight the importance of distinct treatment strategies for these conditions.
Main Methods:
- A 77-year-old female presented with proptosis and periorbital pain, with a history of a refused frontal sinus surgery.
- Imaging studies (CT and MRI) suggested a fronto-orbital mucocele with orbital roof erosion.
- Surgical exploration revealed a separate frontal mucocele and an orbital abscess, which were excised.
Main Results:
- Pathological examination confirmed a frontal mucocele and an orbital abscess.
- The patient's proptosis and papilledema resolved postoperatively.
- Surgical findings contradicted the initial imaging impression of a single fronto-orbital mucocele.
Conclusions:
- Fronto-orbital mucoceles are common, but a frontal mucocele coexisting with an orbital abscess is rare.
- Accurate differentiation between these entities is critical due to differing treatment modalities.
- This case underscores the need for careful diagnostic evaluation and surgical planning.
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