The sites of occurrence of mucoceles are the maxillary sinus, frontal sinus, anterior ethmoidal sinus, and rarely the posterior ethmoidal sinus and the sphenoidal sinus. Frontal sinuses are the most common site for mucocoeles, and these can be frontoethmoidal or frontal only, but bilateral frontal involvement is rare. The pathophysiology of frontoethmoid mucoceles has been lightened in experimental studies and by clinical observations that the trapped mucosa in the frontal and ethmoidal sinuses after obstruction of sinus ostia becomes inflamed leading to the accumulation of mucus.

Earlier mucocele was thought of as a retention cyst due to the cystic degeneration of seromucinous gland. It is now proposed that the infection of frontal sinus following the obstruction of frontal recess leads to the stimulation of lymphocytes and monocytes leading to the production of cytokines by the lining fibroblasts which in turn promote the bone reabsorption and mucocele expansion. Since mucocele expands in the direction of least resistance, frontal mucocele tends to erode the thin bone of the superior orbital wall extending into the orbit and displacing the globe inferiorly.

The etiology of mucocoeles is multifactorial, which involves inflammation, allergy, trauma, anatomic abnormality, previous surgery, fibrous dysplasia, osteoma, or ossifying fibroma. Nasal polyposis is associated with the chronic inflammation and causes obstruction, and hence, is related to the occurrence of spontaneous or nonsurgical-related mucocoeles. They may occur at any age, but most of them are seen between the fourth and seventh decades. They are seen similarly in both sexes. Gradual distension, thinning, and erosion of the bony wall of the sinus are caused by the progressive accumulation of mucoid material. The mucocele can extend into the orbit or intracranial compartment by eroding the bony limits and producing bony defects. Frontoethmoid mucoceles cause outward and downward displacement of the globe and are often associated with a palpable mass in the superonasal and medial canthal region. The expanding mass lesion may cause proptosis, restriction of eye movements, diplopia, visual loss, retro-orbital pain, or a headache.

Destruction of the posterior frontal sinus results in a direct connection between the mucocele and the epidural space. Although, the dura can resist against the pressure exerted by the mucocele and a possible infection, intra-dural growth or a ruptured intracranial mucocele can present with meningitis, meningoencephalitis, brain abscess, seizures, or cerebrospinal fluid fistula. The mucoceles of the frontal sinus may disrupt the medial canthal ligament and the orbital roof in which the surgical interventions should include the reconstruction of these anatomic structures. The diagnosis of mucocoele is based on a clinical investigation conducted with the aid of CT and magnetic resonance (MR) imaging. CT is used in determining the regional anatomy and extent of the lesion, specifically the intracranial extension and the bony erosion. MR imaging is useful in differentiating mucocoeles from neoplasms via the contrast enhancement. Management of mucocoeles is done mainly by surgery, which ranges from functional endoscopic sinus surgery (FESS) to craniotomy, and craniofacial exposure, with or without the obliteration of the sinus. The main strike in our study is the early diagnosis and early management of the patient. The pit fall of this study – as it was a less extensive disease, the diagnosis towards malignancy was missed.

Patient Perspective: Satisfactory.

Informed Consent: Informed Consent Was Taken Prior Ct Scan And Prior To Operating The Patient.