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Mucocelos dos seios perinasais : o papel da cirurgia endoscópica nasossinusal
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Os mucocelos dos seios perinasais são estruturas quísticas revestidas por epitélio respiratório, formados secundariamente à obstrução do trato de drenagem dos respetivos seios. Apesar de benignos, têm um carácter expansivo, com possibilidade de invasão e destruição de estruturas anatómicas vizinhas. São igualmente prevalentes em ambos os sexos, sendo mais frequentes entre a 3ª e 5ª décadas de vida. Por ordem decrescente de frequência, localizam-se no seio frontal, etmoidal, maxilar e esfenoidal. A clínica é bastante variável, dependendo da localização e tamanho do mucocelo. Contudo, são comuns os sintomas nasais, oftalmológicos e, por vezes, neurológicos. O diagnóstico é sugerido pela clínica e complementado pela TC dos seios perinasais, o exame goldstandard na avaliação desta patologia. A RM é apenas realizada no caso de invasão da órbita ou base do crânio ou na necessidade de esclarecer dúvidas diagnósticas. O diagnóstico definitivo é histológico. Atualmente, o tratamento do mucocelo é cirúrgico na maioria dos doentes, sendo a cirurgia endoscópica endonasal a abordagem preferencial. A marsupialização endoscópica é uma cirurgia minimamente invasiva, com baixa morbilidade e que atinge taxas de recorrência perto de zero, sendo uma cirurgia segura que deve ser usada como primeira linha. O seio frontal é aquele onde a abordagem endoscópica se revela mais complicada, podendo ser necessária a utilização de uma abordagem combinada.
Paranasal sinus mucoceles are cystic structures lined by respiratory epithelium, with benign characteristics. They occur secondary to an obstruction of the sinus drainage pathway. Although they are benign, they have the ability to expand and they can reach close anatomic structures. They are equally prevalent in men and women and they occur more often in the 3rd and 5th decade of life. By decreased order of frequency, they locate in the frontal, ethmoidal, maxillary and sphenoidal sinus. Clinical presentation varies, depending on the location and size of the mucocele. However, nasal, ophtalmologic and sometimes neurologic symptoms can appear. Diagnosis is suggested by clinical presentation and complemented by CT scan of the sinus, the goldstandard exam to assess this pathology. MRI is only used in cases of orbital or cranial invasion or when there is diagnostic doubt. Definitive diagnosis is histological. Nowadays, mucocele’s treatment is surgical and the endonasal endoscopic surgery is the best approach. Endoscopic marsupialization is a minimal invasive surgery with low morbidity and with recurrence close to zero and should be used as first line treatment of mucoceles. The frontal sinus is where endoscopic approach is more challenging and the use of a combined approach may be necessary.
Paranasal sinus mucoceles are cystic structures lined by respiratory epithelium, with benign characteristics. They occur secondary to an obstruction of the sinus drainage pathway. Although they are benign, they have the ability to expand and they can reach close anatomic structures. They are equally prevalent in men and women and they occur more often in the 3rd and 5th decade of life. By decreased order of frequency, they locate in the frontal, ethmoidal, maxillary and sphenoidal sinus. Clinical presentation varies, depending on the location and size of the mucocele. However, nasal, ophtalmologic and sometimes neurologic symptoms can appear. Diagnosis is suggested by clinical presentation and complemented by CT scan of the sinus, the goldstandard exam to assess this pathology. MRI is only used in cases of orbital or cranial invasion or when there is diagnostic doubt. Definitive diagnosis is histological. Nowadays, mucocele’s treatment is surgical and the endonasal endoscopic surgery is the best approach. Endoscopic marsupialization is a minimal invasive surgery with low morbidity and with recurrence close to zero and should be used as first line treatment of mucoceles. The frontal sinus is where endoscopic approach is more challenging and the use of a combined approach may be necessary.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Mucocelo Seios perinasais Cirurgia endoscópica Marsupialização Otorrinolaringologia