Clin Exp Otorhinolaryngol.  2013 Jun;6(2):103-106.

Ethmoidal Mucocele Presenting as Oculomotor Nerve Paralysis

• Kim DW
• Sohn HY
• Jeon SY
• Kim JP
• Ahn SK
• Park JJ
• Woo SH
• Hur DG

Abstract

A 56-year-old male was admitted with an acute headache and sudden ptosis on the right side. No ophthalmological or neurological etiologies were apparent. A mucocele of the right posterior ethmoid sinus was observed with radiology. After the marsupialization of the mucocele via a transnasal endoscopic approach, the patient's symptoms (oculomotor nerve paralysis and headache) resolved in 4 weeks. Oculomotor paralysis is a rare symptom of an ethmoidal mucocele. In this article, we report this rare case along with a literature review.

Keyword

Blepharoptosis; Mucocele; Oculomotor nerve

MeSH Terms

Blepharoptosis
Ethmoid Sinus
Headache
Humans
Male
Mucocele
Oculomotor Nerve
Oculomotor Nerve Diseases
Ophthalmoplegia
Paralysis

Figure

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  Fig. 1 Preoperative photodocumentation. The arrow indicates ptosis of the right eyelid.

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  Fig. 2 Preoperative images. (A) Two coronal images of computed tomography without enhancement. A small mucocele was found in the right posterior ethmoid sinus (left). The arrow indicates the erosion of lamina papyracea (right). (B) T2 weighted magnetic resonance image. The arrow indicates the mucocele in the posterior ethmoidal sinus. (C) A simple illustration of the magnetic resonance imaging image. The arrow indicates the suggestive oculomotor nerve pathway from the brainstem. The mucocele resides where the oculomotor nerve spreads its branches superiorly and inferiorly to the external ocular muscles.

Reference

1. Kim DY, Kwon BW, Park DE. Clinical evaluation of paranasal sinus mucocele. J Clin Otolaryngol. 2004; 2. 15(1):93–97.

2. Lee KC, Kwon KH, Kang HG, Jin SM, Lee YB. Endoscopic sinus surgery in paranasal sinus mucoceles. Korean J Otolaryngol-Head Neck Surg. 1997; 6. 40(6):855–860.

3. Beasley NJ, Jones NS. Paranasal sinus mucoceles: modern management. Am J Rhinol. 1995; Sep-Oct. 9(5):251–256.

4. Kennedy DW, Josephson JS, Zinreich SJ, Mattox DE, Goldsmith MM. Endoscopic sinus surgery for mucoceles: a viable alternative. Laryngoscope. 1989; 9. 99(9):885–895. PMID: 2770380.

5. Canalis RF, Zajtchuk JT, Jenkins HA. Ethmoidal mucoceles. Arch Otolaryngol. 1978; 5. 104(5):286–291. PMID: 646725.

6. Kim SS, Kang SS, Kim KS, Yoon JH, Lee JG, Park IY. Clinical characteristics of primary paranasal sinus mucoceles and their surgical treatment outcome. Korean J Otolaryngol-Head Neck Surg. 1998; 11. 41(11):1436–1439.

7. Friedmann G, Harrison S. Mucocoele of the sphenoidal sinus as a cause of recurrent oculomotor nerve palsy. J Neurol Neurosurg Psychiatry. 1970; 4. 33(2):172–179. PMID: 5443476.

8. Ehrenpreis SJ, Biedlingmaier JF. Isolated third-nerve palsy associated with frontal sinus mucocele. J Neuroophthalmol. 1995; 6. 15(2):105–108. PMID: 7550927.

9. Sethi DS, Lau DP, Chan C. Sphenoid sinus mucocoele presenting with isolated oculomotor nerve palsy. J Laryngol Otol. 1997; 5. 111(5):471–473. PMID: 9205613.

10. Lin CJ, Kao CH, Kang BH, Wang HW. Frontal sinus mucocele presenting as oculomotor nerve palsy. Otolaryngol Head Neck Surg. 2002; 5. 126(5):588–590. PMID: 12075238.

11. Akan H, Cihan B, Celenk C. Sphenoid sinus mucocele causing third nerve paralysis: CT and MR findings. Dentomaxillofac Radiol. 2004; 9. 33(5):342–344. PMID: 15585814.

12. Prepageran N, Subramaniam KN, Krishnan GG, Raman R. Ocular presentation of sphenoid mucocele. Orbit. 2004; 3. 23(1):45–47. PMID: 15513020.

13. Vaphiades MS, Roberson GH. Sphenoid sinus mucocele presenting as a third cranial nerve palsy. J Neuroophthalmol. 2005; 12. 25(4):293–294. PMID: 16340496.

14. Soon SR, Lim CM, Singh H, Sethi DS. Sphenoid sinus mucocele: 10 cases and literature review. J Laryngol Otol. 2010; 1. 124(1):44–47. PMID: 19825255.

15. Kumagai M, Hashimoto S, Suzuki H, Matsuura K, Takahashi E. Orbital apex syndrome caused by sphenoethmoid mucocele. Auris Nasus Larynx. 2003; 8. 30(3):295–297. PMID: 12927296.

16. Ayberk G, Ozveren MF, Yildirim T, Ercan K, Cay EK, Koçak A. Review of a series with abducens nerve palsy. Turk Neurosurg. 2008; 10. 18(4):366–373. PMID: 19107682.

17. Lin JY, Lin SL, Chang YL, Lo SH, Chuang FS, Lin SY. Sphenoid sinus mucocoele presenting with optic neuropathy and abducens palsy: a late complication of radiotherapy to the head and neck. Eye (Lond). 2005; 6. 19(6):697–699. PMID: 15332102.

18. Kimakura M, Oishi A, Miyamoto K, Yoshimura N. Sphenoethmoidal mucocele masquerading as trochlear palsy. J AAPOS. 2009; 12. 13(6):598–599. PMID: 19879786.

19. Johnson LN, Hepler RS, Yee RD, Batzdorf U. Sphenoid sinus mucocele (anterior clinoid variant) mimicking diabetic ophthalmoplegia and retrobulbar neuritis. Am J Ophthalmol. 1986; 7. 102(1):111–115. PMID: 3728609.