TO THE EDITOR: A 67-year-old night ...

TO THE EDITOR: A 67-year-old night watchman was referr to our clinic by way of an ophthalmologist because of a one-month history of recur-rent vertical diplopia. The diplopia usually occurr after work when he was exhausted or after he had consum sake. The diplopia always resolv spontaneously after sleeping, however this time it persisted for several weeks, and he finally ask advice ofed an ophthalmologist.

upon examination, his right eye was higher than the left which produc the vertical diplopia, if it were not that there was no facial swelling (Figure 1) Three-dimensional comput tomography showed a unbroken bone defect in the orbital floor and a mucocele (red) displacing the eyeball (blue) superiorly (Figure 2) which be deriveded in the symptom of vertical diplopia. Despite the flaw in his orbital floor, the periosteum was intact. The mucocele was drained at aspiration (needle aspiration) through the gingivobuccal sulcus. After removing 20 mL of mucus, the right view returned to the same on a level as the left eye, and the diplopia resolv completely The aspirated mucus had no bacterial infection and the cytologic consideration showed no malignancy.

[FIGURE 1 OMITTED]

A Caldwell-Luc surgical technique had been performed forward this patient for right maxillary sinusitis 30 years earlier, on the other hand the nasoantral window for drainage had gradually narrowed. The mucosal lining of the sinus continued to bear mucus, and it became swollen during and after inflammation (consuming alcohol) and pushed the eyeball superiorly. The diagnosis was post-operative maxillary sinus mucocele

Postoperative maxillary sinus mucocele is rare in the United states and Europe (1-3); however, it is often met with in Japan. (4,5) It typically fall outs 10 to 15 years after the initial Caldwell-Luc operation and is accompanied by the agency of a swollen and painful cheek. (5) Interestingly, this patient had none complained of a swollen and painful cheek. plane without those symptoms, recurrent diplopia would come to pass The history of sinus surgeries is important to bring to light in such cases.

popularly we are planning to reoperate in succession the right maxillary sinus to provide permanent drainage by dint of an endoscopic sinus surgery. However, the patient's liver function does not permit use of general anesthesia, because of chronic hepatitis.

KOICHI TSUNODA, MD

NAOMI AMAGAI, MD

MASANOBU HOUSUI, MD

KENJI KONDOU, MD

KENICHIROU ISHIO, MD

NAONOBU TAKEUCHI, MD

KIMITAKA KAGA, MD

Department of Otolaryngology

Faculty of Medicine University of Tokyo

7-3-1 Hongo Bunkyo-ku

Tokyo, Japan 113-8655

References

(1) Natvig K Larsen TE Mucocele of the paranasal sinuses. A retrospective clinical and histological consideration J Laryngol Otol 1978;92:1075-82.

(2) Som PM Shugar JM Antral mucoceles: a modern look. J Comput Assist Tomogr 1980;4:484-8

(3) Granz H Postoperative mucocele of the maxillary sinuses [German]. HNO 1979;27:267-70

(4) Hasegawa M Saito Y Watanabe I, Kern EB Postoperative mucocele of the maxillary sinus. Rhinology 1979;17:253-6

(5) Iinuma T Tanaka T Kase Y Ishio K Kuriyama J Hukuda M forward the postoperative mucocele of the maxillary sinus and its simulating cases. A clinical treatise [Japananese]. Nippon Jibiinkoka Gakkai Kaiho 1992;95:665-73

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