Frontal sinus mucocele in a 79-year-old with ptosis
Abstract
A mucocele is a benign, mucus-filled cystic lesion that can occur when paranasal sinus drainage is obstructed. As mucoceles grow, they may cause erosion of the bony sinus walls and symptoms of mass effect, such as nasal congestion, headaches, and proptosis. Uncommonly, they can expand into the orbit and present with ptosis due to compression of Cranial Nerve III (oculomotor nerve). This case report describes a 79-year-old male who first presented to the ophthalmology clinic with a 6-12 month history of unilateral ptosis. On exam, right-sided eyelid ptosis with mild restriction on right upward gaze was noted. Past ophthalmic history is significant for cataracts, posterior vitreous detachment, nonexudative age-related macular degeneration, and presbyopia. There was no history of ocular injury or surgery. Imaging with MRI and CT revealed a right frontal sinus mucocele with sinus expansion encroaching on the right superior orbit with extension into the orbit. Multifocal sites of bone thinning surrounding the frontal sinus, and inferiorly displaced right globe proptosis due to mucocele extension were present. CT sinus imaging from 6 years prior was significant for pansinusitis and new mild polypoid mucosal thickening in the right frontal sinus. The patient was referred to ENT for surgical intervention. This case report chronicles the progression of mucocele development, including physical exam and imaging findings, following the unusual presentation of unilateral ptosis due to compression of Cranial Nerve III from mucocele expansion.
Start Time
16-4-2025 9:00 AM
End Time
16-4-2025 11:30 AM
Presentation Type
Poster
Presentation Category
Health
Student Type
Clinical Doctoral Student (e.g., medical student, pharmacy student)
Faculty Mentor
Brent Aebi
Faculty Department
Surgery
Frontal sinus mucocele in a 79-year-old with ptosis
A mucocele is a benign, mucus-filled cystic lesion that can occur when paranasal sinus drainage is obstructed. As mucoceles grow, they may cause erosion of the bony sinus walls and symptoms of mass effect, such as nasal congestion, headaches, and proptosis. Uncommonly, they can expand into the orbit and present with ptosis due to compression of Cranial Nerve III (oculomotor nerve). This case report describes a 79-year-old male who first presented to the ophthalmology clinic with a 6-12 month history of unilateral ptosis. On exam, right-sided eyelid ptosis with mild restriction on right upward gaze was noted. Past ophthalmic history is significant for cataracts, posterior vitreous detachment, nonexudative age-related macular degeneration, and presbyopia. There was no history of ocular injury or surgery. Imaging with MRI and CT revealed a right frontal sinus mucocele with sinus expansion encroaching on the right superior orbit with extension into the orbit. Multifocal sites of bone thinning surrounding the frontal sinus, and inferiorly displaced right globe proptosis due to mucocele extension were present. CT sinus imaging from 6 years prior was significant for pansinusitis and new mild polypoid mucosal thickening in the right frontal sinus. The patient was referred to ENT for surgical intervention. This case report chronicles the progression of mucocele development, including physical exam and imaging findings, following the unusual presentation of unilateral ptosis due to compression of Cranial Nerve III from mucocele expansion.