Management of frontal sinus mucoceles with posterior table erosion in the pretransplant cystic fibrosis population.
BACKGROUND
Chronic rhinosinusitis has been described as a universal finding in cystic fibrosis (CF). Much of the literature has focused on pediatric population with a relative paucity of data on adult CF patients. In this report, we review our experience with management of frontal sinus mucoceles with posterior table (PT) erosion diagnosed by imaging in asymptomatic adult CF patients presenting for pretransplant evaluation.


METHODS
Retrospective chart analysis.


METHODS
Adult CF patients presenting with frontal sinus mucoceles from January 2003 to December 2005 comprised the focus of the study. Charts were reviewed for age, sex, clinical presentation, culture results, complications, and outcome.


RESULTS
Fifty-nine CF patients undergoing lung transplant evaluation were seen in the outpatient rhinology clinic. Among these, 3 patients presented with asymptomatic frontal sinus mucoceles with PT erosion. The average age was 28.7 years (range, 23-38 years) and male-female ratio was 1:2. Two patients were managed with computer-aided endoscopic frontal sinusotomy during the pretransplant period. In the third patient, surgery was performed post transplantation when the patient was clinically stable. Intraoperative cultures grew Pseudomonas aeruginosa in all cases. No intraoperative surgical complications were encountered. One patient required overnight ventilatory support and was extubated successfully after 24 hours. Endoscopic patency of the frontal sinusotomy was confirmed at mean follow-up of 12.7 months (range, 4-22 months).


CONCLUSIONS
This preliminary report describes asymptomatic frontal sinus mucoceles with PT erosion in CF patients presenting for transplant evaluation. A high index suspicion must be maintained to avoid an inordinate delay in diagnosis given the potential risk of intracranial complications with this clinical entity.
Solares
C Arturo
CA
Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Citardi
Martin J
MJ
Budev
Marie
M
Batra
Pete S
PS
D000328:Adult; D002908:Chronic Disease; D015897:Comorbidity; D003550:Cystic Fibrosis / Q000601:surgery; D004724:Endoscopy; D005260:Female; D005626:Frontal Sinus; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009078:Mucocele / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012220:Rhinitis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012852:Sinusitis / Q000453:epidemiology