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Sphenoid Mucocele Mimicking an Orbital Apex Syndrome

Author: Mohd Zul Izzi Bin Fauzi

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Abstract

Mohd Zul Izzi¹, Sakinah Mohamad¹, Amran Mohamad², Ramiza R. Ramli¹, Adil Hussein³

 

Mucoceles are expansile cystic lesions found within the paranasal sinuses lined by pseudostratified epithelium and usually developed due to the obstruction of the sinus ostium. The frontal sinus is most commonly affected followed by ethmoidal sinuses. Meanwhile, the isolated mucocele of the sphenoid sinus alone is rarely reported. Here, we report a case of sudden onset of blurry vision with ophthalmoplegia presented to an ophthalmology clinic which led to suspicion of orbital apex syndrome. This case was then referred to the Otorhinolaryngology team for surveillance assessment, routine ORL examinations were insignificant and the rigid nasal endoscopic evaluation showed normal findings. However, the diagnosis of sphenoid mucocele was revealed by the computed tomography of the paranasal sinuses. The mucocele in the sphenoid was drained via endoscopic sphenoidotomy and posterior septectomy gave us an adequate view and room for our procedures. Her visual acuity was immediately improved postoperatively.

CT paranasal sinus is important to investigate the cause of orbital apex syndrome. Normal nasal endoscopic findings never rule out the sphenoid mucocele.

Isolated sphenoid sinus mucocele is an infrequent entity however such diagnosis should be kept in mind by ophthalmologist as well as otorhinolaryngologist in a case of headache, visual disturbance, and external ophthalmoplegia. Early intervention will reverse the pathological manifestation and prevent permanent blindness or neurological deficit.

 

Keywords: Sphenoid mucocele; Cystic lesion; Orbital apex syndrome

 

  1. Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti of Sains Malaysia, Kota Bharu, Kelantan;
  2. Department of Otorhinolaryngology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia;
  3. Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti of Sains Malaysia, Kota Bharu, Kelantan

 

Correspondence to: Mohd Zul Izzi, Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia, [email protected].

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