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Clinical Note |

Frontal Bullosa Diagnosis and Management of a New Variant of Frontal Mucocele

Douglas D. Reh, MD; Carol M. Lewis, MD, MPH; Ralph Metson, MD
Arch Otolaryngol Head Neck Surg. 2010;136(6):625-628. doi:10.1001/archoto.2010.82.
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Ostial obstruction of the paranasal sinus may result from inflammatory, neoplastic, or traumatic causes. If such obstruction persists, mucus collection within the sinus can lead to mucocele formation with expansion of the sinus boundaries and displacement of adjacent structures.1,2

Mucoceles are seen on computed tomographic (CT) images as expansile, homogeneous masses with surrounding osseous changes. They are most commonly observed in the frontal sinus, where the presence of heterogeneity or calcification may be suggestive of a fungal process.35 Acute infections within mucoceles typically respond to antibiotic therapy, although definitive treatment requires wide surgical drainage to prevent recurrence.

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Figure 1.

Preoperative sinus computed tomographic image from patient 1 demonstrates a mineralized ribbon of increased density lining the opacified frontal sinus on axial view. This finding was initially interpreted to represent inflammatory changes within the opacified sinus.

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Figure 2.

Patient 1. A, Intraoperative view shows the osteoplastic flap elevated anteriorly to reveal a large, mucosa-covered mass (black arrow) filling the frontal sinus; a portion of the interfrontal septum is also visible (white arrow). B, The excised mucosa-lined bony mass that completely filled the left frontal sinus (scale units represent centimeters).

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Figure 3.

Hematoxylin-eosin–stained specimen from the frontal sinus mass of patient 1 (original magnification ×25). The lack of spiculated trabeculae in the presence of lamellar bone indicates that this bone is endogenous and not reactive. Polypoid mucosa seen lining the bony shell resembles middle turbinate concha bullosa.

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Figure 4.

Preoperative computed tomographic scan of patient 2 demonstrates bilateral frontal sinus opacification on coronal view. A mineralized ribbon of increased density resembling a cast of the right frontal sinus is seen lining the sinus perimeter. This finding was interpreted as either inflammation at the margin of an intrafrontal air cell or a fibroosseous lesion.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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