Clinicopathologic, Ophthalmic, Visual Profiles and Management of Mucoceles in Blacks. DISCUSSION

Mucoceles in Blacks DISCUSSIONOnly few cases of mucoceles were seen during the six-year study period. This confirms what has been documented in the literature concerning the rarity of these lesions in Nigerians and elsewhere. It has been observed that mucoceles, when encountered amongst Nigerians, usually present as a complication of chronic sinusitis. The little or no gender bias has also been confirmed by our study. However, from our study, more than half of our patients did not fall within the age bracket of 30-70 years reported in the literature; all cases except one isolated case of a one-year-old infant were >10 years of age. This may probable be due to the fact that the frontal sinus becomes well developed at age 7-8 years and full size at adulthood. The frontal sinus is also known to possess a complicated drainage pathway.

It is well known that any of the paranasal air sinuses can develop mucocele, with the frontal and the ethmoidal mostly commonly affected, followed by the maxillary and the sphenoid in descending order of occurrence. Our experience is similar to what is documented in the literature, as the majority of our mucoceles were those of the frontoethmoidal sinuses. However, the side of involvement is at variance with that reported in the literature since the left sinuses were found to be more affected in our study. Although we did not encounter any bilateral case in our study, bilateral sinus involvement has however been reported. Buy celecoxib 200

The majority of our patients presented with proptosis. This is not surprising because proptosis has been documented to be a common ophthalmic presentation of mucoceles in the literature, where it has been noted to be usually unilateral, nonaxial and nonpulsatile. However, the first bilateral spontaneous pul-satile proptosis was recently reported. The orbit bears the brunt of the mass effect or invasion by fron-toethomoidal mucoceles because of the thin (lamina papyracea) and vulnerable anatomical walls surrounding the orbit medially and superiorly. This is compounded by the presence of sutures, fissures and foramina. The orbital volume of 30 ml is contained in relatively rigid structure that makes proptosis, common in the presence of a space-occupying lesion. The addition of 4 ml into the orbit can cause a proptosis of 6 mm. Any proptosis of >20 mm for a long period that is capable of stretching the optic nerve may engender blindness. Also, vision may also be impaired as a result of compression of the optic nerve. The popularity of proptosis as a presenting symptom may probably be due to aesthetic reasons and not due to visual impairment, whish was very uncommon in our study. Even the single patient with visual impairment, which later deteriorated to blindness in the affected eye, was later confirmed to have non-Hodgkin’s lymphoma. It may therefore be erroneous to infer that the poor vision was due to the mucocele in the first instance.

Other ophthalmic features, like epiphora, ophthalmoplegia and orbital cellulitis/abscess, have been previously documented by other workers. If, for any reason, patients do not seek help because of aesthetic or visual symptoms, long-standing mucoceles may rupture, releasing their content into the orbit and causing orbital cellulitis or abscess. Orbital cellulitis could also occur as a complication of surgery if there was spill-over of the content of the mucocele into the orbit during evacuation, as was our experience in this study.
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The overall pattern of presentation might be difficult to determine. While cases of frontoethmoidal mucoceles may likely present to the ophthalmologist due to frequent ophthalmic symptoms, other cases of mucoceles may present to the ENT surgeon or the radiologist, while the sphenoidal mucocele may present to the neurosurgeon secondary to likely intracranial involvement.
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CONCLUSIONS
Mucoceles of the paranasal sinuses are relatively rare among Nigerians. They commonly involved more than one sinus on the same side, and the sinuses commonly involved were the frontoethmoidal sinuses. Ophthalmic presentations are common with proptosis as a leading feature of mucoceles; visual involvement was rather uncommon. Common radiological findings included classical expansive appearance with loss of the normal scalloping appearance and dehiscence of the walls of the affected sinus. Mucopurulent materials formed the content of most mucoceles. Surgical intervention caused proptois to regress dramatically. Due to high default rate in our study, no categorical statement can be made about recurrence rate of these swellings

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