The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.

The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.



Ethmoidal mucocele

Photo by Professor Chua, Dr. Koay Chiang Ling, Dr. Ngo Chek Tung and Dr. Ting Siew Leng

A 63 year-old was referred because of a 3 year-history of a cystic swelling above the left medial canthus. A CT scan showed this to be a ethmoidal mucocele. An external approach was planned by removing the lining of the ethmoidal sinus, followed by removal of the ethmoidal bone and creation of a rhinostomy to prevent any future mucocele formation.


A cystic lesion above the right medial canthus for the past 3 years.


CT scan showing a well-circumscribed lesion arising from the ethmoidal sinus.


Another CT scan view of the lesion.



A straight line was marked over the lesion before the skin was infiltrated with lignocaine and adrenaline to aid haemostasis during the operation.


The skin and the periosteum were incised to expose the ethmoidal mucosa.


The cystic content was aspirated (15ml of mucous was removed) before proceeding with the operation to avoid

spilling the content into the orbital tissue which can cause inflammatory response.


The mucosa was opened and some mucous could be seen.


4/0 silk was used to exposed the ethmoidal mucosa and the mucous was removed via irrigation and suction.


The ethmoidal mucosa was then dissected from the surrounding tissue.


The ethmoidal bone was removed using a Kerrison ronguer.


The thin ethmoidal bone could be easily removed.



A rhinostomy was created by making a vertical cut using a scalpel. The picture showed that an instrument

was passed through the nose to ensure that the rhinostomy was patent.


Mattress sutures were used to closed the skin.


Appearance of the face at one week post-operative.

Atlas of Oculoplastic Surgery