Risk factors for recurrence of paranasal sinus mucoceles after ESS

Risk factors for recurrence of paranasal sinus mucoceles after ESS. Objective: Paranasal sinus mucoceles are benign, expansive processes filled with mucus and bordered by respiratory mucosa. The purpose of our study was to determine risk factors for recurrence of mucoceles after endoscopic sinus surgery (ESS) based on clinical and radiological characteristics. Methods: We performed a retrospective review of 57 patients consecutively treated endoscopically for mucoceles between 1992 and 2002 at the UZ Leuven, a tertiary referral university hospital. Results: Paranasal sinus mucoceles predominantly occurred in the maxillary sinus and the fronto-ethmoidal region (both 35%). In 69% of patients there was a history of sinus surgery (51%) or facial trauma (18%). Recurrence occurred in 5 of 49 patients who were treated by ESS in elective circumstances, while four of eight patients who underwent ESS at the moment of acute infection had recurrence (p = 0.004). Although all recurrences following elective ESS occurred in mucoceles related to previous facial trauma or sinus surgery, this relationship was not statistically significant (p = 0.2). In three patients, significant extension outside the sinus wall was present; three other patients had multiple mucoceles. Presence of multiple mucoceles and significant extension outside the sinus walls were also risk factors for recurrence (p = 0.002 and p = 0.001, respectively). In one patient with recurrence, the frontal recess was damaged during previous ESS. Conclusions: Three conditions can be considered risk factors for mucocele recurrence after ESS: surgery at a moment of acute infection, presence of multiple mucoceles, and significant extension outside the sinus wall.