Mucoceles

The majority of mucoceles can be marsupialized en-doscopically with minimal morbidity and with long-term results that are as good as, if not better than, those done by a conventional external approach. Concerns that the marsupialization of mucoceles may not halt their expansion have been found to be unwarranted. Mucoceles accessible with the endoscope should be opened as widely as possible using through-cutting forceps in order to minimize the amount of scar tissue that forms around the edges, and which might lead to a recurrence (Fig. 15.30a-d). The wider a mucocele is marsupialized, the better (Fig. 15.31 a, b).

Mucocele Scars

Fig. 15.30 a Displacement of the left orbit due to a mucocele. b Coronal CT scan—note typical lateralized remnant of the middle turbinate after previous surgery for polyposis. c Postoperative view after endoscopic marsupialization of the muco-cele. d Postoperative CT scan following endoscopic drainage of the mucocele.

Fig. 15.30 a Displacement of the left orbit due to a mucocele. b Coronal CT scan—note typical lateralized remnant of the middle turbinate after previous surgery for polyposis. c Postoperative view after endoscopic marsupialization of the muco-cele. d Postoperative CT scan following endoscopic drainage of the mucocele.

Mucocele Scar TissueMarsupialization

Fig. 15.31 a Displaced left eye due to a frontoethmoidal mucocele. b Coronal CT scan of a left frontoethmoid mucocele. c Endoscopic view into the marsupialized mucocele once its contents have been aspirated.

Images Maxillary Sinus Mucocele
Fig. 15.32 a Preoperative and b postoperative coronal CT scans of a left maxillary sinus mucocele.

Maxillary sinus mucoceles are less common. Most mucoceles can be marsupialized well with the endoscope except for those lying in the lateral aspect of the frontal sinus (Figs. 15.32 a, b; 15.33), those that are secondary to malignancy (which will require an en bloc resection and a craniofacial resection), and those that are secondary to pathology such as Paget disease or fibrous dysplasia that makes an endoscopic approach technically difficult or puts the eye or dura at an increased risk (Beasley and Jones, 1995 b). Once a frontal and/or ethmoidal mucocele has been marsupialized, the expanded "shell" of bone that remains can often be pushed manually in order to correct any bony swelling that may cause a cosmetic defect or displacement of the orbit. Some posteriorly placed mucoceles leave the orbit displaced even after marsupiali-zation, and then the orbit will need to be decompressed by removing its lateral wall as in an orbital decompression (Conboy and Jones, 2003). 10

Accordingly, mucoceles that are unsuitable for an endoscopic approach include:

• Hypertrophic bone in the area of the frontal recess.

• Revision surgery where the previous operation was an external fronto-ethmoidectomy, and if the recurrence is located lateral to the area that is accessible even via a median drainage procedure.

• A laterally placed frontal mucocele.

• Malignancy associated with a mucocele.

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  • bungo smallburrow
    Can mucoceles form around maxillary canine?
    6 years ago

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