Endoscopic sinus surgery treatment for a frontal-ethmoid-maxillary mucocele complicated homolateral preseptal cellulitis

Mucoceles are epithelial lined mucus-containing sac completely filling a paranasal sinus cavity. They are relatively unusual, occurring most frequently in the frontal-ethmoidal region. The obstruction of mucociliary drainage is central to their development and the retention of mucus within a confined space leads them to expansion with remodeling of the bone surrounding it. The imaging features on computerized tomography and magnetic resonance are relatively characteristic although a correct diagnosis requires a careful radiological assessment because the mucoceles may occur in association with other pathologies such as nasal polyposis or neoplastic lesion. We report on a case of a right frontal-ethmoid-maxillary mucocele presenting with nasal respiratory obstruction, right frontal headache and homolateral medial canthus swelling. The patient has undergone a double endoscopic endonasal surgery due to an initial post-operative restenosis conditioning the recurrence of the symptoms. This evidence confirms the complexity of frontal sinus surgerywhich requires a deep anatomic knowledge, a long experience and dedicated instrumentation, all inevitably conditioned by the clinical and biological profile of each individual patient.