The Endoscopic Management of Sinus Mucoceles following Orbital Decompression

Abstract

Sinusitis is a reported complication after orbital decompression for endocrine ophthalmopathy. Herniation of orbital fat may lead to ostiomeatal obstruction and secondary involvement of the dependent maxillary, frontal, and ethmoid sinuses. However, the occurrence of mucoceles appears to be rare, and we were unable to identify a prior report of this condition. We present three cases of maxillary and ethmoid sinus mucoceles after transantral decompressions for orbital proptosis. All three cases subsequently underwent endoscopic sinus surgery for marsupialization of the mucoceles. The diagnosis and management of these lesions is a challenging problem. The coexistence of exophthalmos and the fact that sinus disease may present many years after orbital decompression increases the difficulty of making an appropriate diagnosis. In addition, the surgical approach to this problem is difficult because the surgeon must avoid damage to the low-lying orbit and simultaneously decompress the infection and reestablish adequate sinus drainage. Physician awareness of this problem is important for timely diagnosis. We review the anatomy of this condition and describe a practical approach to diagnosis and management of this problem.