Analysis of Roentgen Findings in the Frontal Mucocele

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Thirty five cases (thirty seven sides) of mucoceles in the fronto-ethmoidal region were studied using conventional X-ray films in Caldwell and Waters views. Polytome films in frontal and lateral sections were also included in the analysis. Cases were classified by the two methods. First classification comprises; postop. extranasal frontal sinusectomy, 11 sides, post. either endonasal or Caldwell-Luc operation, 15 sides, and no surgery (chronic sinusitis) 11 sides. Second classification is done according to the types of X-ray findings by the coventional views and comprises; type 1 (simple expanding type), 14 sides, type 2 (chronic sinusitis type), 19 sides, and type 3 (obliterated and cystic type), 4 sides. In the postop. extranasal cases, the distribution of types is as follows; type 1, 45%, type 2, 36%, and type 3, 18%. In the post op. either endonasal or Caldwell-Luc, type 1, 27%, type 2, 67%, and type 3, 7%. In no surgery, type 1, 45%, type 2, 45%, and type 3, 9%. The type 2, which shows no typical radiological signs for the frontal mucocele, occupies about 50% of the cases.X ray-findings were analysed according to the sites in the frontal sinus, i. e., marginal portion, intrasinus portion and basal portion. In the marginal portion of the frontal mucocele, marginal sclerosis, either loss or incomplete absorption of the marginal scalloping were included in the analysis. The marginal sclerosis was also divided into three subdividions, i. e., linear, bandage-like and fading sclerosis. The distribution of the three subdivisions is as follows; linear, 51%, bandage-like, 5%, and fading, 43%.The change in the marginal scalloping is as follows; complete loss, 46%, and incomplete absorption, 54%. In the intrasinus portion, increased radiolucency was seen in 43%, radiopacity in 46%, and irregular soft tissue in 16%. In the basal portion of the frontal mucocele, distortion of the superior orbital wall was seen in 16%, absence in 49%. Distortion of the medial orbital wall was seen in 35%, absence in 30%. Bulla frontalis was seen in 11% and lateral recess in 76%. Supraorbital extension of the mucocele was classified into, anterior one third, anterior two thirds, and the whole of the superior orbital wall. The distribution is, 51%, 38%, and 4% in that order. As the last roentgen sign for the basal portion, the anterior group of the ethmoid air cells was classified according to the radiolucency. Normal radiolucency was seen in 30% and increased radiopacity in 70%.The most important clues for the correct diagnosis of the frontal mucocele are history and the conventional rhinological methods of examination. X-ray findings only assist in the diagnosis. Among the many X-ray signs, important ones are the changes in the marginal portion and in the basal portion. The presence of marginal sclerosis, changes in the marginal scalloping, either loss or distortion of the superior and the medial orbital walls, and the presence of bulla frontalis and lateral recess deserve special emphasis.

Analysis of Roentgen Findings in the Frontal Mucocele

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