Frontoethmoidal mucocele following pediatric craniofacial surgery.
BACKGROUND
Mucoceles occur as a result of accumulation and retention of mucous secretions in a paranasal sinus and are uncommon in the pediatric age group. Persistent or intermittent closure of its ostium through a variety of causes, including previous surgery, is implicated in etiology. The authors report 2 cases of frontoethmoidal mucocele that followed box osteotomies for the treatment of orbital dystopia, with medical literature review and discussion of possible causal factors and events.


METHODS
Case histories and radiological imaging are presented on 2 patients presenting with frontoethmoidal mucoceles following craniofacial surgery. Both had transcranial craniofacial techniques where all orbital walls and globe are moved en bloc as a "box."


RESULTS
Patient 1, a 12-year-old male patient with Crouzon syndrome, developed mucoceles within 18 months of monobloc distraction surgery and box osteotomies. This was successfully marsupialized with a combined external and endoscopic surgical approach. The second patient, a 15-year-old boy with previously corrected right-sided facial cleft, developed mucocele 9 years following box osteotomies; this was successfully managed by endoscopic drainage. Of 3 other patients having similar box osteotomies in our unit, no other mucoceles were noted as complications.


CONCLUSIONS
Mucoceles are a rare complication of craniofacial surgery, and literature review confirms a paucity of reports. Only 1 case has previously been alluded to of mucocele complicating box osteotomy for orbital dystopia. Our 2 cases illustrate and highlight a successful management approach in a multidisciplinary craniofacial unit.
From the *Royal National Throat Nose and Ear Hospital; and †The Craniofacial Unit, Great Ormond Street Hospital for Children; and ‡Department of ENT-Head & Neck Surgery, North West London Hospitals NHS Trust, London, United Kingdom; §Craniofacial Unit, Westmead Children's Hospital, Sydney, New South Wales, Australia; and ∥Department of Radiology, Imperial Healthcare NHS Trust; and #Department of ENT-Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
Taran
T
Tatla
Charles
C
East
Damian D
DD
Marucci
Hiba
H
Al-Reefy
Gitta
G
Madani
Richard
R
Oakley
David J
DJ
Dunaway
D000293:Adolescent; D002648:Child; D019465:Craniofacial Abnormalities / Q000601:surgery*; D005005:Ethmoid Sinus; D005147:Facial Bones / Q000601:surgery; D005626:Frontal Sinus; D006801:Humans; D008297:Male; D009078:Mucocele / Q000209:etiology*; D019857:Osteogenesis, Distraction / Q000009:adverse effects*; D010027:Osteotomy / Q000009:adverse effects*; D010254:Paranasal Sinus Diseases / Q000209:etiology*; D012189:Retrospective Studies