Endocrine Abstracts

Introduction: A Mucocele is a collection of mucus enclosed by sinus epithelium within the paranasal sinuses. The pathogenesis is debated but a history of nasal obstruction, nasal surgery, nasal polyps or trauma is common but not universal. Mucoceles can erode local bone structure and invade the orbits. Four cases of sphenoidal mucoceles presenting with headache, 1–15 years post trans-sphenoidal pituitary surgery have previously been reported. We present two cases of fronto-ethmoidal mucocele post trans-ethmoidal surgery.

Cases: Patient 1 was found to have a right divergent squint during routine diabetic retinopathy review. The patient had noticed deviation of her eye laterally. CT scan demonstrated a large soft tissue mass arising from the fronto-ethmoidal sinus extending into the right orbit. Twenty-one years previously she had a hypophysectomy via trans-ethmoidal approach for a non-functioning macroadenoma. She had an endoscopic decompression of the mucocele. Patient two complained of soreness and protrusion of her right eye during a routine endocrine clinic. On examination she had proptosis of the right eye and mild lid lag. CT scan demonstrated a right frontal mucocele extending into the right orbit. Nineteen years previously she had a partial hypophysectomy via a right ethmoid incision for a macroadenoma. She had a right ethmoidectomy and at surgery was found to have fronto-ethmoidal mucocele. Neither patient has developed any further sinus problems.

Conclusion: A diagnosis of fronto-ethmoidal mucocele should be considered in patients who present with visual disturbance and proptosis, after trans-ethmoidal surgery for pituitary disease. A review of fronto-ethmoidal mucoceles has suggested that proptosis is present in 83% of cases. Proptosis is usually downward and lateral, which may help in distinguishing from Graves’ eye disease and was present in case 1. The complication can develop many years after the initial surgery.