138 Case Report: Frontal Sinus Mucocele Following Frontal Bone Fracture

Introduction

Giant frontal mucocele of the frontal sinus is a rare benign pathology caused by retention of mucous secretions. They develop when the opening of a paranasal sinus becomes obstructed due to trauma, infection, chronic sinusitis, polyps, malignancy, bony tumours, or congenital anomalies.

This case reports a giant mucocele of the frontal sinus caused by conservative management of frontal bone fracture 30 years ago.

Presenting case

64 –year- old male was referred by his GP to the maxillofacial department after noting a slow growing lesion between his eyebrows resulting in him not being able to wear his glasses. He reported a history of horse-riding trauma 30 years ago, resulting in a frontal bone fracture, which was managed conservatively. This lesion has been slowly growing over 30 years.

Medically he suffers from uncontrolled hypertension and has had a metallic aortic valve replacement and coronary artery bypass grafting.

MRI and CT imaging demonstrates a 2cm cystic lesion consistent with a mucocele with proteinaceous or hyperdense fluid.

Discussion

Fractures of the frontal bone, which involves the frontal sinus, are relatively uncommon injuries, comprising up to 5% of all maxillofacial injuries.

Mucocele development is a long-term complication, which can arise or persist 6 months to decades after. Management of these cases require a joint surgical approach with Ear, Nose and Throat for removal of the mucocele and Maxillofacial for reconstruction of the frontal sinus and frontal bone via endoscopically using a frontal balloon or an osteoplastic flap/spectacle incision.