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Chronic Complications

Mucocele / Pyoceles : is a complication of chronic frontal sinusitis.

Definition: Epithelial - linked; mucus - containing sac completely filling the sinus and capable of expansion.
Enteropathogenesis: Obstruction and subsequent sinus infection/ inflammation

Features Common in patients: 40-70 years
  1. Shows a male preponderance
  2. The bone- resorbing factors produced : PGE2, collagenase, and cytokines : IL-1 and TNF
  3. Sinuses affected in order of frequency : Frontals > ethmoids > maxillary > sphenoids
Symptoms :
Frontal sinus mucocele:-
  1. Site : Superomedial quadrant of the orbit
  2. Displacement of the eyeball: forward, downward and laterally
  3. Features of the swelling : cystic, non-tender, egg- shell cracking
  4. X-ray : Expanded frontal sinus with loss of the scalloped margins and Translucence
Mucocele of anterior ethmoids :-
  1. Seen in young children
  2. Compress the nasolacrimal region → Epiphora
Mucocele of the posterior ethmoids/sphenoid:-
- Retro - orbital headaches
- Facial pain
- Orbital symptoms : diplopia, proptosis, ophthalmoplegia and visual loss
- Frontoethmoidal mucoceles ] :- Radical fronto-ethmoidectomy using an external modified lynch-
  • Howarth’s incision (Some can be removed endoscopically) 

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