Drainage of posterior ethmoidal mucocele under electromagnetic navigation guidance using combined anesthesia: a case report

Abstract

Mucocele is a benign, cyst-like lesion of the paranasal sinuses that develops as a result of persistent obstruction of drainage through the sinus ostium. The frontal sinus and ethmoid cells are most commonly affected. Isolated involvement of the ethmoid cells, particularly its posterior part, is relatively rare and often asymptomatic. Prolonged blockage of the ostium leads to secretion stasis and increased pressure on the bony walls. This results in thinning and expansion of the bone, with cavity formation. Currently, the main treatment approach is endoscopic sinusotomy with opening and drainage of the mucocele, followed by ostium enlargement. Surgical access to this area is technically difficult. Opening the posterior ethmoidal cells often requires dissection of the anterior group. However, in cases of isolated lesions, the necessity and advisability of disrupting intact surrounding structures, which common in the traditional transethmoidal approach, remain debatable. In such cases, computer-assisted navigation is used as an auxiliary technology to facilitate the surgeon’s orientation within the surgical field. This article presents a clinical case of surgical treatment of an isolated mucocele of a posterior ethmoidal cell, performed under local anesthesia with the use of navigation equipment. The lesion was drained through a direct approach, positioned medial to the middle turbinate, analogous to the access route used for the sphenoidal recess.

Keywords

mucocele / ethmoid cells / isolated ethmoiditis / ESS / ethmoidotomy / image-guided surgery

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