Tiirkis/i Neiirosiirgeni 6: 28 - 32, 1996 Frontoethmoidal Report of Sinus Mucoceles Two Cases Dösog/ii: Ml/coeei,' MURAT DÖSOGLU, FUAT M. MUTLU, SERDAR ARMAGAN, FÜGEN AKER, LEVENT ÇELIK, MAHIR TEVRÜZ Haydarpasa Numune Hospital, Department of Neurosurgery (MD, FMM, SA, MT), Pathology (FA) and Radiology (LÇ), Istanbul, Türkiye. Abstract: Mucoceles are chronic and benign lesions caused by accumulation and retention of mucus secretion in a sinus due to partial or complete occlusion of the ostium which causes progressive distention of the bony waii because of increased pressure. They occur most commonly in the frantal and ethmoidal sinuses. We present two patients with anterior frantoethmoidal mucoceles who were treated surgicaiiy in our clinic. The clinical presentation was pain and deformation of the frantal region and medial canthus in both cases. Chronic sinusitis was detected as a predisposing factor in one case. A transfrontat approach and INTRODUCTION Ocelusion of the sinus ostium due to various pathologies can cause slow and progressive accumulation of secretions. The obstmetion may be caused primarily by eystic dilatation of the goblet ceii gland besides secondary reasons (2, 7). Congenital pathologies such as agenesis of the ostium (8), tumoral pathologies such as osteoma, fibrous dysplasia, bone !ipoma, osteoclastoma, haemangioma, epidermoid, metastatic tumours, craniopharyngioma, cyst formation by embryonic pituitary rests and nasal polyps (3,4, 15) are primary reasons, while secondary reasons are inflammatory diseases such as asthma, all ergi es and chronic sinusitis, traumatic causes such as displaced fraeture fragments and iatrogenic reasons such as surgery (6, 12). For it is possible mucocele to develop with or without occlusion (8). it has been reported that calcifying fibroma, meningioma and acoustic neurinoma may accompany mucoceles (4, 9). Osteoma may be seen in 12.5 - 50 % of cases during surgery (15). A previous history of sinusitis and rhinitis occurs in 35 - 50 % of cases, trauma in 10 - 28 28 obliteration of the ostium foiiowed by aspiration of the sinus content was the treatment of clioice in both cases. No recurrence \Vas observed in a one-year foiiow-up. Although mucoceles are often see n in ENT praetice, intracranial and/or orbital extension may be see n in neurosurgery. But recurrence may occur despite surgical intervention. Surgery offers the only effective treatment; the type of procedure selected depends on the location and extent of the mucocele and the nature of any existing complication. Key word s: Ethmoid sinus, frontal sinus, mucocele, paranasal sinus % and allergies in 11 % (4,5). Although retention cysts resulting from obstruction and dilatation of tubuloacinar glands are used synonymously with mucocele, theyare different in origin and clinical progress. Usually asymptomatic, they do not require treatment (16). CASE REPORTS Case 1 A 55-year-old woman was admitted with swelling of the medial side of the left orbit and frontal region, epiphora, frontal and periorbital headache. She had been treated for sinusitis for three years prior to admission. Deformation of the orbital region had developed and progressed in the last eight months. On physical examination, inferomedial displacement of left eye and hyposmia in the right side were observed. The nasolacrimal canal was open. Eye movements, visual acuity and fundus were normal and there was no loss of sensation on the face. Skull x-rays demonstrated selerotic bone lesions in the frontoethmoidal region, irregularity in the superior and medial orbital wall, lateral displacement of the