Management of patients with paranasal sinus mucocele

Mucocele is a cystic distension of the walls of the paranasal sinuses. Persistent obstruction of the natural sinus passages due to a variety of reasons (trauma, allergic edema, etc.) contributes to the development of this condition. Mucoceles can develop in any paranasal sinus, occurring more frequently in the frontal sinus, followed by the sphenoid and maxillary sinuses. They are characterized by slow growth, except for cases of secondary infection and the development of mucopyocele. Postoperative mucocele may form within a few years after surgery. Purpose of the Study. Literature review to define diagnostic procedures in patients with mucocele using modern methods of endoscopic examination, laboratory, and radiological techniques, as well as to consider the specific features of patient management depending on the localization of nasal mucocele.

Material and Methods. Fifty publications were reviewed, and data from 37 publications were included in the review. Literature search was performed using Scopus, Web of Science, PubMed, Google Scholar, and Cochrane Library databases. The manuscript includes clinical case descriptions of 5 patients aged 43-74 years who were treated in the Clinic of Otorhinolaryngology, FSBEI HE Academician I.P. Pavlov First St. Petersburg State Medical University, with localization of mucocele in the frontal, maxillary, ethmoid, sphenoid sinuses, and nasal septum. The diagnosis in these patients was established based on clinical data, results of laboratory and radiologic investigations, intraoperative findings, and pathologic report.

Conclusions. The average terms of mucocele formation vary from 4 to 8 years from the moment of surgical intervention to the development of clinical manifestations. Mucoceles are characterized by nonspecific symptoms and mask tumor lesions in some cases. Contrast-enhanced computed tomography is recommended to improve differential diagnosis. Approaches to surgical treatment can range from gentle endoscopic drainage and wide marsupialization of the mucocele to its complete removal, which is possible to perform using modern endoscopic techniques without external access or serious postoperative cosmetic defects.

Key words: mucocele, paranasal sinuses, endoscopic endonasal sinus surgery
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. The study was supported by the Russian Science Foundation grant No. 23-25-00305, https://rscf.ru/ project/23-25-00305/.