Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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A Case of Nasal Endoscopic Treatment for Paranasal Mucocele

안와첨 증후군을 동반한 부비강 점액낭종의 비내시경적 치료 1예

Cho, Eun-Young;Choi, Yeon-Kyoung;Choi, Woong-Chul
조은영;최연경;최웅철

  • Published : 20040800
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Abstract

Purpose: We report a case of sphenoid and ethmoid mucocele causing orbital apex syndrome, which was successfully treated with drainage under nasal endoscopy. Methods: A 82-year-old female visited the hospital complaining of decreased visual acuity in her left eye for 15days. Visual acuity of the left eye was hand motion . She also complained of left ocular pain and headache. In ophthalmologic examination, exophthalmos, mild ptosis, extraocular muscle movement limitation and RAPD (relative afferent pupillary defect) of the left eye were found. Orbital CT showed a 3.3${\times}$2.9${\times}$4.1cm sized well-demarcated cystic lesion involving the left sphenoid sinus, left ethmoid sinus, and posterior portion of the right ethmoid sinus. The ethmoid air cell was remodeled by this cystic mass. The medial wall of the left orbit was protruded outward. So, the medial rectus muscle and optic nerve in the left orbit were compressed. We found a bulging yellowish cystic mass supero-posterior to the middle turbinate under nasal endoscopy. We performed incision and drainage under nasal endoscopy. Results: At post-operative 2days, orbit CT showed the removed large mucocele in the sphenoid and ethmoid sinuses. At post-operative 2weeks, corrected visual acuity of the left eye was 0.6. There was no exophthalmos, ptosis, or extraocular muscle movement limitation. Conclusions: Endoscopic surgery in the treatment of paranasal mucocele can be performed during a short time under local anesthesia and anatomical change of the paranasal sinus can be minimized. We therefore suggest that drainage through nasal endoscopy is effective method in the treatment of paranasal sinus mucocele.

목적 : 안와첨증후군을 유발한 접형동 및 사골동 점액낭종의 치료에 비내시경을 통한 배액법으로 합병증 없이 신속하고 성공적으로 치료한 1예를 보고하고자 한다. 대상과 방법 : 82세 여자 환자가 15일 전부터 발생된 좌안의 시력저하를 주소로 내원하였다. 환자의 좌안 시력은 안전수동, 좌안의 안통, 안구돌출, 안검하수, 내외전 및 상하전시 안운동장애, 상대구심성동공운동장애 소견 보였다. 안와 전산화단층촬영상 좌측 접형동 및 사골동과 우측 사골동 뒤쪽일부를 침범한 3.3${\times}$2.9${\times}$4.1 cm 크기의 경계가 분명한 낭종이 있었고, 이로 인해 사골동 공기세포(air-cell)들은 모두 변형되었고, 좌측안와의 내벽이 돌출되어 내직근 및 시신경이 압박받고 있는 소견을 보였다. 비내시경상 중간비갑개 후상측에 황색 낭종이 발견되었고, 비내시경을 통해 절개 및 배액을 시행하였다. 결과 : 술후 2병일 시행한 안와 전산화단층촬영상, 점액낭종은 보이지 않았고, 술후 2주째 좌안 교정시력 0.6으로 회복되었으며, 안운동제한 및 안구돌출, 안검하수도 소실되었다. 결론 : 비내시경을 통한 점액낭종의 치료는, 국소마취하에서 짧은 시간동안 수술이 가능하며, 술 후 외모의 변형을 일으키지 않고 부비동내 점막과 구조물 손상을 최소화 할 수 있어, 효과적인 치료법으로 생각된다.

Keywords

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