Presentation and management of extensive fronto-orbital-ethmoid mucoceles

Objectives: The aim of the study was to report the presentation and management of extensive fronto-orbital-ethmoid (FOE) mucoceles. Methods: This study is a retrospective chart review of 13 consecutive patients requiring surgical intervention for extensive FOE mucoceles. Patients were treated over the period from 1999 to 2003. Variables examined include chief complaint, risk factors, location of erosion, management, and complications. Follow-up ranged from 12 to 36 months. Results: Most common chief complaint was eye proptosis, followed by forehead swelling and orbital cellulitis. Four patients had previous functional endoscopic sinus surgery (FESS) and another 4 patients had history of prior trauma and frontal sinus obliteration. Eleven patients had skull base erosion and 12 had orbital wall erosion. Four patients were managed endoscopically. Of these, 1 had previously undergone FESS, whereas the other 3 had no risk factors. All patients with prior trauma/obliteration were treated with coronal flap and frontal sinus obliteration. One patient who had undergone 2 previous FESS was successfully treated with coronal flap without obliteration. One patient treated with an osteoplastic flap had cerebrospinal fluid leak that was identified and repaired intraoperatively with a pericranial flap. Conclusion: Extensive FOE mucoceles can be successfully and safely treated by endoscopic and non-endoscopic methods. The choice of surgical approach mainly depends on the anatomy of the frontal recess. Prior trauma and FESS are associated with requiring coronal flap and frontal sinus obliteration.