Sinus mucocele refers to a dilated sinus, usually as a result of mucus accumulation in the sinuses. The condition is rarely severe and can be treated surgically. However, the best remedy for a mucocele is prevention.
What is a sinus mucocele?
A sinus mucocele is a chronic accumulation of mucus in one of the sinuses. It occurs when the excretory duct of the sinus is blocked and secretions can no longer drain. As a result, the bone structure may deform and fracture due to the growing pressure, causing mucus to leak into the orbit. Surgical removal of the mucus plug is the only treatment option, and analgesic and expectorant medications are prescribed concomitantly.
Causes
The trigger of paranasal sinus mucocele is an obstruction of the entrance of the respective paranasal sinus. The cause may be, for example, a tumor or an adhesion, as well as inflammation, trauma, or scar tissue, as often remains after surgery. The most common cause is a protracted inflammation of the paranasal sinuses. Since mucus cannot drain through the narrowed ducts, secretions quickly build up in the sinuses, which can lead to enlargement of the ducts and thinning of the nasal septums. The actual cause is the buildup of excessive mucus in the sinuses. Combined with damage or dysfunction of the sinuses, which prevents the secretions from draining, this leads to enlargement of the sinuses.
Symptoms, complaints, and signs
A sinus mucocele is manifested by an initial mild pressure in the sinuses. The feeling of pressure increases as the accumulation of mucus increases and spreads to the orbits, often accompanied by flu-like symptoms as pathogens are unable to drain through the blocked ducts. Later, the disease becomes clearly visible by the altered eyeball: due to the pressure on the sinuses, the secretion breaks through into the eye socket and pushes the eyeball forward. An initial sign of this progression may be a severe pressure pain between the eyeball and the nasal bone.
Diagnosis and course of the disease
A sinus mucocele can be diagnosed quickly based on symptoms and specific complaints. Before doing so, however, the physician will have a discussion with the patient and gather insights for the clinical picture. It is possible that the sinuses have been inflamed more than once or that there are other clues that facilitate the diagnosis. An ultrasound examination provides a view of the cavities of the paranasal sinuses and reveals any accumulations of mucus: the mucus appears whitish in the X-ray image and is demarcated from the free sinuses. Finally, a computed tomography (CT) scan provides information about the overall extent of the disease. If it is suspected that the accumulation of mucus has already led to damage in the nasal and sinus area, the doctor performs a nasal endoscopy (rhinoscopy) and examines the sinuses with the aid of a nasal endoscope. The inside of the nose can be sufficiently assessed in this way to make a final diagnosis. A sinus mucocele develops over a period of several days. If channels in the nose are initially still permeable, the sinuses become more and more blocked as the disease progresses until they are finally completely closed off. The mucus can no longer drain away and forms a kind of plug that, once it reaches a certain size, presses on the surrounding bones. In extreme cases, the bones become deformed and break through. Depending on the position of the mucus plug, the secretion then flows either into the eye level or into the pharynx. The course is rarely fatal, but the escape of the pathogens brings further complications; sepsis and the development of further mucoceles or polyps may occur.
Complications
Usually, the clinical picture of paranasal sinus mucocele occurs as a result of infection, so various complications are also possible in the process. In general, if a sinus mucocele remains without any treatment by a doctor or medication, significant complications or a significantly more unpleasant course of the disease can be expected.In many cases, the affected person gets significantly worse air. Especially during the night hours this symptom increases significantly. Headaches, nausea, vomiting and also an increased temperature are also possible complications that can occur in connection with a sinus mucocele. A visit to the doctor is strongly recommended at this point, otherwise the individual symptoms may intensify considerably. However, if the affected person seeks medical treatment from the beginning, then the above-mentioned complications can be avoided at an early stage. However, those who forgo appropriate treatment must reckon with a considerable aggravation of the complications that arise.
When should one go to the doctor?
A persistent accumulation of mucus in the nose should be presented to a physician. If the affected person is unable to adequately clear his or her nose independently, the help and assistance of a physician should be sought. A doctor is needed in case of nasal speaking, disturbances in breathing as well as a feeling of tightness in the nose. If there is a cold, headache or disturbance of concentration, a visit to the doctor should be made. An unpleasant taste in the throat, a loss of appetite as well as a general feeling of malaise should be clarified by a doctor. Fatigue, sleep disturbances as well as increased tiredness are indications of a disease. If daily activities can no longer be performed or if the usual leisure activities are impaired, a visit to the doctor is advisable. A change in the eyeball is considered worrisome and must be examined and treated by a doctor as soon as possible. Secretions in the eye, changes in vision, or a feeling of illness are signs of a health disorder requiring treatment. If the symptoms increase in intensity or if new symptoms appear, a visit to the doctor is necessary. The pathogens spread and trigger an increasing deterioration of the general well-being. Without medical care, the affected person feels lacking in energy, ill, and unable to fulfill his or her obligations.
Treatment and therapy
A paranasal sinus mucocele is primarily treated surgically. In a procedure called functional endoscopic sinus surgery (FESS), the altered sinuses are surgically treated and any accumulations of mucus are removed. If only the so-called hook process is affected, an infundibulotomy is performed, an opening of the anterior ethmoid bone. Depending on how severely the canals have already been damaged by the mucocele, the sinuses must be closed again in the course of several operations. Several access routes are possible for this, depending on the findings: an endonasal operation is performed with the aid of an endoscope and is considered for the removal of mucous growths or polyps. Surgery through the oral vestibule is necessary if the mucocele has penetrated into the maxillary sinus. Subsequent therapy is limited to sinus recovery. Patients should initially speak very little and cool the area around the nose. Also necessary are care measures for the mucous membranes, such as the use of ointments. Medications are prescribed depending on the findings and severity of the sinus mucocele.
Outlook and prognosis
In general, a good outlook can be formulated for sinus mucocele. Complications rarely occur. Basically, healing accelerates insofar as the diagnosis is made at an early stage and treatment is started immediately. The peculiarity of the disease entails the necessity of surgery. For this, the general risks arise, which are also known from other surgical interventions. The inflammation disappears after surgery. However, further disease may occur. This makes it necessary to remove the accumulation of mucus again. If the patient omits treatment or delays it, the mucocele may spread. Not infrequently, the brain is then affected. The eyeball may also be displaced to a different position, causing the affected person to suffer vision loss. Generally, treatment does not affect lifespan. Surgical scars remain, but are not noticeable due to new procedures. The patient can continue his regular life after healing. Disadvantages and discomfort are not expected.Sometimes medications need to be taken for a longer period of time and care measures need to be taken on the mucous membranes.
Prevention
To prevent a sinus mucocele, it is advisable to take regular care of the sinuses. Through this and general measures to strengthen the immune system, the development of mucus accumulation in a sinus can be prevented. Regular oral care prevents inflammation of the oral mucosa, while care of the nose prevents irritation and possible obstruction of the sinuses. Furthermore, a balanced diet helps to strengthen the intestinal flora and thus improve the immune system. People who are prone to colds and flus can prevent a mucocele by using nasal spray and nourishing oil. Inhaling loosens mucus in the nasal passages, thereby preventing blockage of the delicate ducts and the development of a sinus mucocele.
Aftercare
Generally, sinus mucocele does not require long-term follow-up care. Patients can return to their daily lives after surgery. The symptoms subside after a short time. However, the condition may recur. Therefore, adherence to preventive measures is advisable. A healthy diet and regular oral care ensure that the sinus mucocele stays away permanently. The treating physician informs his patient about suitable behavioral measures. The implementation of preventive aftercare is the responsibility of the patient. In the case of an unfavorable course of the disease, a temporary permanent treatment may become necessary. Affected persons must then accept further therapy measures. Above all, complications must be prevented. For example, the sinus mucocele can spread to the brain. Loss of vision cannot be ruled out. Depending on the severity, the doctor and patient agree on an appointment schedule. Computed tomography has been established as a reliable means of determining progression. Medication is the standard treatment. If necessary, follow-up also includes further surgery. After a sinus mucocele, patients should not take symptoms suggestive of influenza lightly. Another focus of inflammation may have developed. To avoid complications, a trip to the doctor is inevitable.
What you can do yourself
As a rule, sinus mucocele is treated surgically. Depending on the size of this operation, it is important that the affected patients speak little after the procedure and cool the area around the nose. So-called cool pads, which are available in medical supply stores or pharmacies, are suitable for cooling. It is important to wrap the cooling pad with a hand towel or tea towel beforehand so that the pad does not come into direct contact with the skin. Otherwise, cold burns could occur. The freshly operated nose benefits from regular care. Ointments prescribed or recommended to patients by their doctor are used for this purpose. Another way to care for the nasal mucous membranes is nasal irrigation with salt. Both the nasal douche and the accompanying rinsing salt are available in pharmacies and drugstores. Oral hygiene is also very important for patients with a sinus mucocele, as the nose and mouth are connected and inflammation could otherwise spill over into each other. To prevent infections, colds and runny nose, the patient’s immune system must be strengthened. This is done through a diet rich in vitamins and minerals, sufficient sleep and plenty of exercise in the fresh air.
