Chernov M.F., Maslova L.N., Kalakutsky N.V.
(Neurooncologic Department of the Polenov Research Neurosurgical Institute Chair of Maxillofacial Surgery of the Saint Petersburg State Medical University)
Female patient G. (30 years old) was admitted to the Neurooncologic Department of the Polenov Research Neurosurgical Institute with complaints of the right-sided exophthalmos and pain in the right eyeball.
Asymmetry of the face appeared at the age of 10. There was augmentation the right-sided exophthalmos after delivery (1992). Examination revealed the right-sided exophthalmos; reduction of vision acuity in the right eye up to 0.3; bitemporal narrowing of visual field margin, more marked in the right eye; limited inward movements of the right eyeball; hyperesthesia of the first branch of the right fifth cranial nerve; edema of the middle turbinated bone on the right and septal deformity to the left. CT and MRI examinations showed the mass, localized in projection of the right maxillary sinus, superior nasal passage, right orbit, frontal and ethmoid sinuses. One could suspect esthesioneuroblastoma and carcinoma from a histological point of view. It was planned to perform craniofacial resection.
The patient was operated on January 18, 2000. Bifrontal single-graft osteoplastic trephination of the skull was made. The front sinus was opened. Its right side was greatly hypertrophied and filled with jelly-like viscous yellow substance, having no vessels and connection with the mucous membrane. This pathologic substance, spreading to the ethmoidal labyrinth, right orbit (due to destruction of its medial wall) and maxillary sinus, was removed completely through the frontal sinus. The intervention ended in plasty of the frontal sinus.
A postoperative course had no peculiarities. The right-sided exophthalmos was less marked.
To inform about a rare clinical case of giant mucocele of accessory sinuses, causing local atrophy of the skull base bones. It resulted in preoperative misdiagnosis, when mucocele was taken for malignant tumor.