Meta-analysis performed at Mayo Clinic, Arizona. Case series performed at Loyola University Medical Center. Presented as a poster at the American Rhinologic Society section of the Combined Otolaryngological Spring Meeting, San Diego, CA, U.S.A., April 18–22, 2012.
Contemporary management of frontal sinus mucoceles: A meta-analysis
Article first published online: 6 AUG 2013
Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.
Volume 124, Issue 2, pages 378–386, February 2014
How to Cite
Courson, A. M., Stankiewicz, J. A. and Lal, D. (2014), Contemporary management of frontal sinus mucoceles: A meta-analysis. The Laryngoscope, 124: 378–386. doi: 10.1002/lary.24309
Approval obtained from Loyola University Chicago Institutional Review Board. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 21 JAN 2014
- Article first published online: 6 AUG 2013
- Accepted manuscript online: 12 JUL 2013 09:08AM EST
- Manuscript Revised: 26 JUN 2013
- Manuscript Accepted: 26 JUN 2013
- frontal sinus;
- endoscopic sinus surgery;
- open approach;
To analyze trends in the surgical management of frontal and fronto-ethmoid mucoceles through meta-analysis.
Meta-analysis and case series.
A systematic literature review on surgical management of frontal and fronto-ethmoid mucoceles was conducted. Studies were divided into historical (1975–2001) and contemporary (2002–2012) groups. A meta-analysis of these studies was performed. The historical and contemporary cohorts were compared (surgical approach, recurrence, and complications). To study evolution in surgical management, a senior surgeon's experience over 28 years was analyzed separately.
Thirty-one studies were included for meta-analysis. The historical cohort included 425 mucoceles from 11 studies. The contemporary cohort included 542 mucoceles from 20 studies. More endoscopic techniques were used in the contemporary versus historical cohort (53.9% vs. 24.7%; P = <0.001). In the authors' series, a higher percentage was treated endoscopically (82.8% of 122 mucoceles). Recurrence (P = 0.20) and major complication (P = 0.23) rates were similar between cohorts. Minor complication rates were superior for endoscopic techniques in both cohorts (P = 0.02 historical; P = <0.001 contemporary). In the historical cohort, higher recurrence was noted in the external group (P = 0.03).
Results from endoscopic and open approaches are comparable. Although endoscopic techniques are being increasingly adopted, comparison with our series shows that more cases could potentially be treated endoscopically. Frequent use of open approaches may reflect efficacy, or perhaps lack of expertise and equipment required for endoscopic management. Most contemporary authors favor endoscopic management, limiting open approaches for specific indications (unfavorable anatomy, lateral disease, and scarring).
Level of Evidence
N/A. Laryngoscope, 124:378–386, 2014