From the Guidelines
For left-sided facial pain associated with a left maxillary mucocele seen on CT, the recommended treatment is surgical drainage or removal of the mucocele, as it is a cyst-like expansion filled with mucus that forms when the sinus drainage pathway becomes obstructed, causing pressure and pain as it expands 1. This typically involves endoscopic sinus surgery performed by an otolaryngologist (ENT specialist), which is now the standard of care for restoring patency of paranasal sinus outflow tracts, with postoperative improvement in symptoms and quality of life reported in over 75% of patients 1. While awaiting surgery, pain management can include:
- Acetaminophen 500-1000mg every 6 hours or
- Ibuprofen 400-600mg every 6-8 hours as needed. Antibiotics such as amoxicillin-clavulanate 875/125mg twice daily for 7-10 days may be prescribed if there are signs of infection like fever or purulent discharge. The mucocele can erode surrounding bone and potentially affect nearby structures including the orbit or cranial cavity if left untreated, making conservative management alone generally insufficient as the underlying obstruction must be addressed to prevent recurrence 1. Following surgery, saline nasal irrigation twice daily is recommended to maintain sinus patency during healing. It is essential to note that imaging findings, such as those seen on CT, are crucial for confirming the diagnosis and planning surgical intervention, as they provide anatomical detail necessary for identifying anatomic variants and abnormalities that can increase the risk for intracranial, intraorbital, and vascular injury 1.
From the Research
Clinical Presentation of Maxillary Sinus Mucoceles
- Maxillary sinus mucoceles are relatively rare among all paranasal sinus mucoceles, and their clinical presentation can vary 2, 3.
- Common symptoms include nasal obstruction, nasal drainage, cheek pressure or pain, and proptosis of the eye and cheek swelling 2, 3.
- In some cases, the cause of maxillary sinus mucoceles remains uncertain, with 64% of patients in one study having an unknown cause 2.
Radiological Findings and Surgical Management
- Computed tomographic (CT) studies can show maxillary sinus and ipsilateral ethmoid sinus involvement in patients with maxillary sinus mucoceles 2, 3.
- Endoscopic sinus surgery, including ethmoidectomy, middle meatal antrostomy, and marsupialization of the mucocele, is an effective treatment for maxillary sinus mucoceles with a favorable long-term outcome 2, 3.
- Surgical removal of maxillary sinus mucous retention cysts can also lead to complete symptom resolution of chronic facial pain in some cases 4.
Etiology and Treatment of Acute Bacterial Maxillary Sinusitis
- The etiology of maxillary sinus mucoceles is not well understood, but mechanical obstruction, allergy, and infection do not seem to play an important role 3.
- Acute bacterial maxillary sinusitis can be treated with antibiotics such as cefuroxime axetil and amoxicillin/clavulanate, with similar efficacy and safety profiles 5, 6.
- The treatment of maxillary sinus mucoceles and acute bacterial maxillary sinusitis requires a systematic multidisciplinary approach, considering the patient's symptoms, radiological findings, and medical history 2, 3, 4.