Iatrogenic ethmoidal mucocele with orbital extension in a patient with Widal's syndrome. A clinical case and review of the literature

Paranasal sinus mucoceles are benign, espansive processes filled with mucus and bordered by respiratory mucosa. Little is known about the etiopathogenesis of sinus mucocele, although the latest fìndings suggest that previous sinus surgery may play an important role in the development of disease causing obstruction of the sinus orifìce. Mucoceles predominantly occur in the frontoethmoidal region and present with compressing symptoms of the next structures according to their localization. Computed tomography (CT) is the primary modality in diagnosing and choosing of surgical approach. Marsupialization through an endonasal pathway is nowadays the most common surgical procedure far the treatment of this disease. In this paper is described a clinical case of ethmoidal mucocele with orbital extension occurring in 36-year old male with Widal's syndrome. The patient underwent surgical treatment through an endonasal endoscopic approach for nasal polyposis and presented with lid oedema, diplopia, exophtholmos and nasal obstruction two years after the surgery. CT and MRl showed a mass filling the ethmoidal sinus and invading in orbital site. Conservative treatment was performed through marsupialization under nasal endoscope confìrming the suspect of disease.