Clinical and Endoscopic Findings
The clinical presentation of a mucocele varies in relation to the anatomical area involved. Occasionally, patients may present vague and non-specific complaints similar to those of chronic rhinosinusitis, but there are indeed symptoms and signs suggesting the diagnosis. When the frontal sinus is involved, frontal headache and proptosis may be the heralding manifestations; displacement of the ocular globe in a downward and outward direction may result in diplopia (Ikeda et al. 2000). If an erosion of the anterior or posterior wall of the frontal sinus is present, a Pott's puffy tumor or neurological symptoms may occur, respectively. When a mucocele arises in the ethmoid and/or sphenoid sinus the most frequent complaints are vertex or occipital headache, associated to various ophthalmologic symptoms (Moriyama et al. 1992; Benninger and Marks 1995). Among these, one should bear in mind that sudden loss of vision may be the first symptom of a mucocele involving the sphenoid sinus. Finally, a lesion localized into the maxillary sinus may present with cheek pressure or pain, maxillary nerve hyperesthesia, dental pain, unilateral nasal obstruction, mucous or purulent rhinorrhea (Busaba and Salman 1999).
At endoscopy, the appearance varies according to the phase of growth and to the site of the lesion. In fact, while in the intrasinusal phase no alterations are generally visible, expansion of the mucocele may lead to bony alterations of the lateral nasal wall, as anterior dislocation of the uncinate process, me-dialization of middle turbinate, bulging of the agger nasi cells or of the infundibular area. Furthermore, in a mucocele of the sphenoid sinus, a submucosal remodeling or a bulging in the sphenoethmoid recess or in the posterior ethmoid may be appreciated. In a purely frontal mucocele, endoscopy is usually negative.
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