Frontal mucocele causing ophthalmoplegia and proptosis

Abstract

Mucoceles are known to occur as a result of chronic accumulation of mucoid secretions within a sinus as a result of long-standing outflow obstruction secondary to inflammation. This can lead to extension into the orbital and intracranial cavities. It can also get infected to cause mucopyocele. The frontal sinus is the most common site for mucocele. Long-standing symptoms of chronic rhinosinusitis, if ignored, can lead to such complications. Clinical features include frontal pain and swelling. It may displace the orbit inferiorly and laterally. If neglected, it can progress to cause osteomyelitis and erode the posterior wall of the sinus to cause intracranial complications. Imaging is paramount in assessing the lesion's type and extent. Computed tomography can be used to delineate the bony erosions, whereas Magnetic Resonance Imaging helps characterize the lesion’s nature. Surgery remains the mainstay of treatment with the aim of draining the mucocele and removing the mucosa to prevent a recurrence. Surgical approaches can be both endoscopic and open, with the advantages and disadvantages of each.