Occurrence of a postoperative maxillary mucocele 20 years after orbital wall reconstruction

Mucoceles of the paranasal sinus are epithelial-lined cystic structures filled with mucus and have multiple etiologies, including recurrent inflammation, trauma, or intrinsic disease. Particularly, a postoperative maxillary mucocele (POMM) is a delayed complication of radical surgery of the maxillary sinus, and most cases occur after Caldwell-Luc operations. Patients mainly complain of facial swelling, toothache, and tenderness. POMM has rarely been reported from other causes; however, there have been no reports on the occurrence of POMM following orbital wall reconstruction. Herein, we report a case of a patient with a POMM that developed 20 years after the aforementioned surgery. The patient complained of facial pain with visual disturbance, and underwent marsupialization using a combination of sublabial and endoscopic approaches, and the symptoms improved without recurrence.

Postoperative maxillary mucocele with orbital wall defect treated by transnasal endoscopic marsupialization with a penrose drain insertion: A case report

RATIONALE

A postoperative maxillary mucocele (POMM) is a delayed complication of maxillary sinus surgery. Although transoral enucleation is a conventional approach for its treatment, the intraoperative risk of injury to the inferior rectus muscle increases when there is an orbital floor defect. The transnasal endoscopic marsupialization has also been used widely for treatment. However, it has a potential risk of postoperative stenosis of the meatal antrostomy site, especially when the medial wall of the maxillary sinus is thick.

PATIENT CONCERNS

A 60-year-old man who underwent a right Caldwell-Luc operation about 30 years ago came to the emergency room with pain and swelling in the right periorbital region.

DIAGNOSIS

He was diagnosed with a POMM accompanied by an orbital floor defect and a thick medial wall of the maxillary sinus.

INTERVENTIONS

Transnasal endoscopic marsupialization was performed, and a cylindrical penrose drain was placed at the antrostomy site for one month.

OUTCOMES

The patient's periorbital pain disappeared after surgery. After 3 months, the postoperative computed tomography scan showed good opening at the meatal antrostomy site.

LESSONS

In a patient with POMM with an orbital floor defect and a thick medial wall of the maxillary sinus, transnasal endoscopic marsupialization with penrose drain insertion could prevent both injury of the inferior rectus muscle and postoperative stenosis.