Trauma induced complete sinonasal separation and subsequent frontoethmoid mucocele formation

Educational Objective: At the conclusion of this presentation, the participant should be able to recognize trauma as a potential cause of sinus mucoceles and discuss the options for management. Objectives: To highlight a unique presentation and subsequent management of a frontoethmoid mucocele caused by trauma. Study Design: Case report and literature review. Methods: The patient chart, including history, physical examination, radiologic imaging, operative report and pathologic results, was reviewed. A literature search was performed; appropriate Englishlanguage papers were identified and reviewed. Results: The patient is a 40-year-old woman who suffered a gunshot wound to the nasal region 15 years prior to presentation. At that time, she was managed surgically, including enucleation of one eye. She presently developed preseptal cellulitis of the remaining eye; a CT scan demonstrated a large frontoethmoid mucocele with complete sinonasal separation caused by scarring. Using a combined endoscopic and open approach, a drainage pathway was successfully created to the nasal cavity and a stent placed, with subsequent resolution of the infection. Although trauma is a known etiology of mucoceles, a literature review failed to find any other reported cases caused by such distinct separation of the nasal cavity and sinuses. Conclusions: This case represents a unique illustration of the pathogenesis of mucocele formation in the setting of complete separation of the frontal and ethmoid sinuses from nasal cavity. It emphasizes the importance of thorough evaluation and management of craniofacial trauma involving the paranasal sinuses. Surgical obliteration or serial imaging to monitor for mucocele formation should be performed for cases resulting in such significant derangement of the normal drainage pathways.

Duke Scholars

Author Jeffrey Cheng Pediatric Otolaryngology