What is the cause of mucocele formation in the right sphenoid sinus?

From the Guidelines

Surgical drainage through endoscopic sinus surgery is the definitive treatment for a mucocele in the right sphenoid sinus, as it allows for marsupialization of the mucocele and widening of the natural sinus opening to prevent recurrence. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of prompt treatment to prevent serious complications such as vision loss, meningitis, or cavernous sinus thrombosis due to the proximity of vital neurovascular structures 1.

Key Considerations

• Prior to surgery, a CT scan and possibly an MRI should be obtained to assess the extent of the mucocele and its relationship to critical surrounding structures like the optic nerve and carotid artery.
• Symptoms that may indicate a sphenoid mucocele include headache (particularly behind the eyes), visual disturbances, and occasionally facial pain or pressure.
• While waiting for surgical intervention, nasal steroid sprays like fluticasone (2 sprays in each nostril daily) may help reduce inflammation, and antibiotics may be prescribed if there's evidence of infection.
• The European position paper on rhinosinusitis and nasal polyps 2020, published in Rhinology, highlights the effectiveness of endoscopic surgery in treating paranasal sinus mucoceles, including those in the sphenoid sinus 1.

Treatment Approach

• Endoscopic sinus surgery is a preferred approach due to its minimally invasive nature and the ability to perform the procedure under local anesthesia, reducing the risk of complications.
• The procedure involves marsupialization of the mucocele, which allows for the drainage of the accumulated mucus and the widening of the natural sinus opening to prevent recurrence.
• Post-operative care includes the use of nasal saline irrigations and topical corticosteroids to promote healing and reduce inflammation, as recommended by the European position paper on rhinosinusitis and nasal polyps 2020 1.

From the Research

Mucocele Formation in the Right Sphenoid Sinus

• Mucocele of the sphenoid sinus is a rare entity that can occur alone or as a result of ethmoid sinusitis and polyposis 2.
• The endoscopic sinus technique offers outstanding visualization and a safe, straightforward approach to the sphenoid sinus, allowing for successful treatment of mucocele formation 2, 3.
• Isolated sphenoid sinus disease is a rare entity that can result in serious sequelae if diagnosis and treatment are inappropriately delayed, with a reported incidence of 1-7% of all paranasal sinuses mucoceles 3, 4.

Clinical Presentation and Diagnosis

• Patients with sphenoid sinus mucocele may present with a history of persistent headache, and in some cases, paresis of the oculomotor and abducens nerves 4, 5.
• Computed tomography and magnetic resonance imaging can be used to successfully diagnose the disease, with CT imaging revealing opacification and expansion of the sphenoid sinuses 4, 5, 6.
• The clinical presentation can be variable, with some patients experiencing exophthalmos and fluctuating headache 5.

Treatment Options

• The transnasal endoscopic sphenoidectomy is the therapeutic method of choice, allowing evacuation of the mucocele and marsupialization to prevent recurrence 4, 5.
• Endonasal endoscopic approach with drainage and marsupialization of the sphenoid sinus is a safe and effective treatment modality, with reported success in treating mucocele formation in the right sphenoid sinus 3, 5.
• Surgical treatment is absolutely indicated, and early treatment avoids visual damage that can be permanent 5.