Image-guided endoscopic marsupialization technique for frontal sinus mucocele with orbital extension: A case report

Manuele Casale; Andrea Costantino; Lorenzo Sabatino; Michele Cassano; Antonio Moffa; Vittorio Rinaldi

doi:10.1016/j.ijscr.2019.07.069

Image-guided endoscopic marsupialization technique for frontal sinus mucocele with orbital extension: A case report

Int J Surg Case Rep. 2019:61:259-262. doi: 10.1016/j.ijscr.2019.07.069. Epub 2019 Jul 31.

Authors

Manuele Casale¹, Andrea Costantino², Lorenzo Sabatino³, Michele Cassano⁴, Antonio Moffa⁵, Vittorio Rinaldi⁶

Affiliations

¹ Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy. Electronic address: m.casale@unicampus.it.
² Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy. Electronic address: andrea.costantino94@libero.it.
³ Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy. Electronic address: l.sabatino@unicampus.it.
⁴ Department of Otolaryngology, University of Foggia, Foggia, Italy. Electronic address: michele.cassano@unifg.it.
⁵ Department of Otolaryngology, University of Foggia, Foggia, Italy. Electronic address: moffa.antonio1@gmail.com.
⁶ Department of Otolaryngology, Integrated Therapies in Otolaryngology, University Campus Bio-Medico, Rome, Italy. Electronic address: v.rinaldi@unicampus.it.

Abstract

Introduction: Frontal sinus mucocele with intra-orbital extension represents a rare benign cyst-like lesion. Surgical management could be summarized in an open approach, an endoscopic marsupialization or a combined procedure. The present study reports a case of frontal mucocele with wide intra-orbital invasion treated with endoscopic marsupialization assisted by an image-guided navigation system.

Presentation of case: A 34-year-old African male was referred to the otolaryngology clinic for unilateral supraorbital swelling and post-nasal drip. A clinical ophthalmic assessment showed normal ocular movement, the absence of diplopia and normal visual acuity. CT scan showed a large soft tissue density lesion originating from the right frontal sinus with a supero-medial orbital erosion. The mass invaded the orbital cavity compressing and dislocating the eyeball forward and laterally. An image-guided ESS was performed according to Draft type IIa. Frontal mucocele's inferior wall was open in order to drain muco-purulent content. No complications were detected and the patient was completely recovered with open frontal sinus drainage at 4 months follow-up visit.

Discussion: We have successfully treated a wide intra-orbital frontal mucocele with an endoscopic marsupialization thanks to image-guided navigation system support. This technology prevented an external approach with associated morbidity and longer hospitalization.

Conclusion: Navigated assisted endoscopic approach with marsupialization can be considered a safe treatment for FM with orbital extension. In particular, the image-guided system could be useful if bony landmarks are missing, if orbital erosion is present, and to completely drain lateral and multi-cystic lesions.

Keywords: Case report; Image-guided; Mucocele; Navigation system; Sinus surgery; Surgery.