Treatment Guidelines

Until the 1980s, mucocele was invariably treated by an external approach, which was meant not only to drain the mucus or pus collection, but also to completely remove the affected sinus mucosa. In 1989, Kennedy et al. (1989) published a series of 18 sinus mucoceles treated by endoscopic mar-supialization without recurrences after a mean follow up of 18 months. The philosophy behind microendoscopic operation is to marsupialize the lesion leaving untouched its epithelial-lined sac. Most surgeons are currently approaching mucoceles with a microendoscopic technique, which avoids any facial incision and gives similar results compared to transfacial operations (Lund 1998; Busaba and Salman 1999; Hartley and Lund 1999; Ikeda et al. 2000; Har-El 2001; Ichimura et al. 2001).

However, a limited opening may not always warrant a steady drainage of mucocele, particularly in patients with a frontal localization who present one or more unfavorable conditions (diffuse polypoid rhinosinusitis, small frontal sinus, presence of abundant scar tissue due to previous surgery, facial trauma). In these cases, resorting to a type III drainage according to Draf (1991), which involves the removal of the floor of both frontal sinuses together with the superior third of the nasal septum and drilling of the intrasinusal septum, may ensure a wider permanent drainage. Finally, mucoceles located in the far lateral extremity of a hyperpneumatized frontal sinus may be difficult to reach transnasally and require an external approach through an osteoplastic frontal sinusotomy. Whenever a mucocele is secondary to a tumor, selection of the surgical approach is obviously dictated by the nature, site, and extent of the tumor.

Diagnosis and treatment of a mucocele located in the sphenoid sinus and impairing visual acuity or causing visual loss must be considered an emergency, since only a prompt drainage within a few hours from the onset of symptoms may revert the deficit.

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