Mukotsele (piotsel) of a frontal bosom — the kistoobrazny expansion of a frontal bosom which resulted from its stretching the accumulated serous liquid (mukotsela) or pus (piotsela). Mukotsele of a frontal bosom is followed by gradually amplifying pains in a forehead, over an eye-socket and around an eye; emergence of protrusion in an internal corner of an eye; ekzoftalmy and eyeball shift from top to bottom; violation of visual acuity and color perception; dacryagogue and diplopiya. For diagnostics to a mukotsela of a frontal bosom apply a rinoskopiya, a X-ray analysis, ultrasonography, KT, MPT and a diafanoskopiya, a diagnostic puncture and sounding of a frontal bosom. All patients with the mukotsel of a frontal bosom are subject to surgical treatment.
Mukotsele of a frontal bosom
The frontal bosom settles down in a medial part of a frontal bone behind nadbrovny arches. Its lower wall at the same time is the top wall of an eye-socket, the back wall separates a frontal bosom from a brain. The right and left frontal bosoms are located a row and separated from each other by a thin partition. By means of the frontal and nasal channel the frontal bosom is connected to the average nasal course of a cavity of a nose. Inside the frontal bosom is covered by a mucous membrane which cells produce special liquid. Outflow of this liquid is carried out via the frontal and nasal channel. Violation of outflow leads to a liquid congestion in a cavity of a bosom and to education to a mukotsela of a frontal bosom. At suppuration of the accumulated secret speak about the piotsel.
Mukotsele of a frontal bosom is most often observed at school age. Because formation of frontal bosoms begins after the birth of the child and comes to an end at the age of 6-7 years, at children of preschool age to a mukotsela of a frontal bosom does not arise. Slow growth to a mukotsela of a frontal bosom leads to the fact that the first clinical symptoms of a disease can appear several years later from the beginning of pathological changes in a frontal bosom. In otolaryngology the case when to a mukotsela of a frontal bosom it was diagnosed for the adult patient 15 years later after the nose injury which provoked his development is known.
Reasons for a mukotsela of a frontal bosom
Development to a mukotsela of a frontal bosom is connected with a full obturation or partial violation of passability of the frontal and nasal channel. Curvatures of a nasal partition, foreign matters of a nose, an ekzostoza and a tumor, nose injury as a result of which develops can lead to emergence to a mukotsela of a frontal bosom periostit. The solderings and hems which are formed in owing to sinusitis of a frontal bosom can block the frontal and nasal channel.
Liquid infection to a mukotsela of a frontal bosom with emergence to a piotsela can come at spread of an infection from a nose cavity, and also a hematogenic or limfogenny way. At the same time an infection source first of all are infectious and inflammatory diseases of a nasopharynx: rhinitis, antritis, pharyngitis, quinsy, chronic tonsillitis, laryngitis.
Symptoms to a mukotsela of a frontal bosom
Mukotsele of a frontal bosom is characterized by a long asymptomatic current. Before emergence of the first clinical signs to a mukotsela can exist within 1-2 years and longer. Mukotsele of a frontal bosom begins to prove with gradually amplifying headache in frontal area. Then pain over an eye-socket and around an eyeball joins, in an internal corner of an eye protrusion of rounded shape appears. Pressing on this protrusion usually is painless and leads to emergence of the characteristic sound reminding a crash or a crunch. Strong pressing can become the reason of formation of fistula through which begins to leave viscous mucous (at the mukotsel) or purulent (at the piotsel) liquid.
Eventually at the mukotsel of a frontal bosom there is a lowering of the lower wall of a frontal bosom in this connection eyeball shift is noted down and outside. Often there is a doubling in eyes (diplopiya), violation of perception of flowers, decrease in visual acuity. At a sdavleniye of slezovyvodyashchy ways at patients with the mukotsel of a frontal bosom dacryagogue is observed.
The congestion in the mukotsel of a frontal bosom of a large amount of liquid can cause its break with formation of a fistula in one of walls of a frontal bosom. Izlitiye of pus through a fistula in the structures adjoining to a frontal bosom leads to development of purulent complications.
Complications to a mukotsela of a frontal bosom
The complications arising at the mukotsel of a frontal bosom are connected with suppuration of its contents and distribution of purulent process on the anatomic educations, next to a bosom. Most often the break of pus happens through the lower wall of a frontal bosom. The drift of a purulent infection in a cavity of an eye-socket can lead to development of a panoftalmit, endoftalmit and phlegmon of an eye-socket. In rare instances to a mukotsela of a frontal bosom formation of a fistula in a back wall of a bosom with developing of meningitis is observed.
Diagnostics to a mukotsela of a frontal bosom
Mukotsele of a frontal bosom is diagnosed by the otolaryngologist. At existence of complications from an eye consultation of the ophthalmologist is necessary, at suspicion of meningitis — the neurologist. Diagnostics to a mukotsela of a frontal bosom is based on complaints of the patient, his survey, a rinoskopiya and a research of okolonosovy bosoms. Rinoskopiya at patients with the mukotsel of a frontal bosom can not reveal any pathological changes. Sometimes during a rinoskopiya in the field of the average nasal course small smooth protrusion is visualized.
The radiological research at the mukotsel of a frontal bosom defines increase in the sizes of a bosom, stretching of its bottom, transparency reduction. Protrusion of a partition between frontal bosoms in the healthy party is possible. Intermittence of contours of a frontal bosom can indicate existence of a fistula. More exact and informative research is KT of a frontal bosom. Ultrasonography and MRT of okolonosovy bosoms can be applied. In certain cases for definition of lightness of a frontal bosom it is carried out a diafanoskopiya. At difficulties in diagnostics the diagnostic puncture is shown to a mukotsela of a frontal bosom. Make sounding of a frontal bosom for definition of passability of the frontal and nasal channel Lansberg's probe.
According to indications conduct a research of an organ of vision: visual acuity check, color testing, oftalmoskopiya and biomicroscopy of an eye. The differential diagnosis to a mukotsela of a frontal bosom is carried out with frontity, a tumor and a dermoidny cyst.
Treatment to a mukotsela of a frontal bosom
Piotsel and the mukotsel of a frontal bosom are subject to obligatory surgical treatment. It is carried out operation with removal of the lower wall of a frontal bosom and expansion of the frontal and nasal channel is radical. Opening of a frontal bosom (frontotomiya) is made after a skin section on eyebrow length. Then the cavity of a bosom is cleared of slime and pus, establish a drainage. At adults and children of advanced age operation can be performed under local anesthesia. Postoperative drainage of a bosom is carried out it is long (within 2-3 weeks) before formation of hems. It is necessary for creation of the resistant message between a frontal bosom and a cavity of a nose.
Along with surgical carry out drug treatment to a mukotsela of a frontal bosom. To the patient appoint antibiotics, anti-inflammatory and antiedematous means.
Forecast and prevention to a mukotsela of a frontal bosom
At in due time carried out surgical treatment to a mukotsela of a frontal bosom has the favorable forecast. Development of complications worsens the forecast. Prevention to a mukotsela of a frontal bosom consists in effective treatment of infectious and inflammatory diseases of a nasopharynx, the prevention of traumatizing a nose and overcoolings, correction of a nasal partition at its curvature, removal of tumors and foreign matters of a nose.