CASE REPORT   

Otorinolaringologia 2018 December;68(4):161-5

DOI: 10.23736/S0392-6621.18.02163-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Giant sphenoid mucocele in a teenager

Robbert J. ENSINK ¹ ✉, Abebe MELAKU ², Glenn ISAACSON ^{3, 4}

¹ Department of Otolaryngology, Gelre Hospitals, Zutphen, The Netherlands; ² Department of Otolaryngology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia, 3 Department of Otolaryngology, Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA; ⁴ Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA

Sphenoid mucoceles occur rarely in the pediatric age group. We describe a 19-year-old who presented with progressive visual impairment and headache of a month’s duration. Magnetic resonance imaging (MRI) showed a huge skull base lesion, arising in the sphenoid and extending through its lateral wall to the pterygopalatine fossa, infratemporal fossa, lateral orbit, and middle cranial fossa. The lesion proved to be a giant mucocele on endoscopic endonasal surgery. Marsupialization resulted in prompt resolution of blurred vision, limitation of lateral gaze, headache and restricted jaw closure. At 4-month follow-up she remained well. Her follow-up MRI showed aeration of the mucocele cavity with no change in its extent. Differential diagnosis of large erosive sphenoid lesions includes mucocele, cystic degeneration of fibrous dysplasia, aneurysmal bone cysts, and benign and malignant tumors. Imaging aids in diagnosis, but biopsy is often needed for confirmation. Endonasal marsupialization of mucoceles provides long-term control of symptoms. Recurrences are rare.

KEY WORDS: Endoscopy - Paranasal sinuses - Middle cranial fossa - Mucocele - Vision disorders