Abstract
Type III frontal recess air cell as a cause of frontal sinus pneumocele has not been previously reported in literature. A 31-year-old woman with chronic history of sinusitis presented with pressure in the left eye on blowing the nose. Computed tomography examination of the orbits and paranasal sinuses with coronal and sagittal reformatted images showed abnormal collection of gas in the soft tissues at the superior aspect of the left orbit contiguous with the overlying left frontal sinus through a large defect in the orbital roof and a type III frontal recess air cell narrowing the left frontal recess.
1
Introduction
Pneumocele (also known as pneumatocele) of the paranasal sinuses is a rare entity that results from dilatation of either a part or the whole of the sinus beyond the margins of the containing bone with marked osseous thinning and dehiscence. However, the mucosa remains intact . We present a case of a large left frontal sinus pneumocele caused by a type III frontal recess air cell. To our knowledge, this has not been previously reported in literature.
2
Case report
A 31-year-old female patient with a chronic history of sinusitis presented with loss of smell and taste and thick nasal discharge. Over the preceding 3 months, she had experienced an acute increase in her left frontal pain, which was not relieved by nonsteroidal anti-inflammatory medications. She had also noticed drooping of her left upper eyelid and complained of a sensation of pressure in her left eye when she blew her nose. She had no history of asthma or other allergies. Physical and nasal endoscopic examination revealed evidence of significant nasal inflammation with streaming mucus, enlarged congested turbinates, and mucosal edema in the region of the middle meatus.
Computed tomography examination of the orbits and paranasal sinuses was performed using axial images of 0.625 mm section thickness. Coronal and sagittal reformatted images were performed with 1.0 cm section thickness. There was an abnormal collection of gas in the soft tissues at the superior aspect of the left orbit, in an extraconal location ( Fig. 1 ). This collection of gas was contiguous with the overlying left frontal sinus through a fairly large defect in the roof of the orbit ( Fig. 2 ). There was slight flattening of the superior rectus-levator palpebrae superioris complex due to mass effect from the collection of gas. The patient’s left frontal sinus was enlarged as compared to the right, and the frontal intersinus septum was displaced toward the right. The anterior wall of the sinus was relatively intact; however, the posterior wall of the sinus was markedly thinned and expanded into the anterior cranial fossa. Sagittal reformatted images clearly demonstrated a type III frontal recess air cell narrowing the left frontal recess ( Fig. 3 ) abutting an intersinus septal cell. There were no inflammatory changes in the orbit. The patient underwent a large left frontal endoscopic sinusotomy and resection of the obstructing air cells to relieve the pneumocele. A frontal sinus stent was inserted to establish drainage.
2
Case report
A 31-year-old female patient with a chronic history of sinusitis presented with loss of smell and taste and thick nasal discharge. Over the preceding 3 months, she had experienced an acute increase in her left frontal pain, which was not relieved by nonsteroidal anti-inflammatory medications. She had also noticed drooping of her left upper eyelid and complained of a sensation of pressure in her left eye when she blew her nose. She had no history of asthma or other allergies. Physical and nasal endoscopic examination revealed evidence of significant nasal inflammation with streaming mucus, enlarged congested turbinates, and mucosal edema in the region of the middle meatus.
Computed tomography examination of the orbits and paranasal sinuses was performed using axial images of 0.625 mm section thickness. Coronal and sagittal reformatted images were performed with 1.0 cm section thickness. There was an abnormal collection of gas in the soft tissues at the superior aspect of the left orbit, in an extraconal location ( Fig. 1 ). This collection of gas was contiguous with the overlying left frontal sinus through a fairly large defect in the roof of the orbit ( Fig. 2 ). There was slight flattening of the superior rectus-levator palpebrae superioris complex due to mass effect from the collection of gas. The patient’s left frontal sinus was enlarged as compared to the right, and the frontal intersinus septum was displaced toward the right. The anterior wall of the sinus was relatively intact; however, the posterior wall of the sinus was markedly thinned and expanded into the anterior cranial fossa. Sagittal reformatted images clearly demonstrated a type III frontal recess air cell narrowing the left frontal recess ( Fig. 3 ) abutting an intersinus septal cell. There were no inflammatory changes in the orbit. The patient underwent a large left frontal endoscopic sinusotomy and resection of the obstructing air cells to relieve the pneumocele. A frontal sinus stent was inserted to establish drainage.
