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Comments, Opinions, and Brief Case Reports
November 25, 2002

Frontal Sinus Mucopyocele

Arch Intern Med. 2002;162(21):2487-2488. doi:10.1001/archinte.162.21.2487

A 78-year-old woman presented with an acute onset of urinary incontinence and paraparesis. She also had hypertension and a 1-year history of memory impairment and personality changes, before which she had been able to live alone and take care of herself. Physical examination revealed a 4 × 7-cm soft pulsatile mass bulging centrally on her forehead. The neurologic examination demonstrated a lack of orientation to time and place and paraparesis, with the right leg being weaker than the left. Magnetic resonance imaging revealed the presence of a bilateral extra-axial mass in the frontal region that measured up to 7 cm in anteroposterior diameter and 9 cm in transverse diameter (Figure 1). The mass appeared to extend through the anterior floor of the skull into the superior nasal septum. The patient underwent a bifrontal craniotomy and was found to have a 4 × 4-cm defect in the frontal bone. Immediately under the bone, there was a collection of foul-smelling green pus representing an infected mucocele. A sample of the pus was sent for aerobic, anaerobic, and fungal cultures, which yielded β-lactamase–negative Haemophilus influenzae. Vancomycin hydrochloride (1 g) was intravenously administered after surgery. The patient was treated with a 6-week course of ceftriaxone sodium and metronidazole, with significant improvement of her behavioral disturbances and paraparesis, but unfortunately she continues to be incontinent.

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