Suspected large gall bladder mucocele extending from right hypochondrium up to right iliac region turned out to be gall bladder perforation in a patient with schizophrenia: A rare case report and literature review.

Key Clinical Message: This is a challenging case where the surgeon has initially thought it is a gallbladder (GB) mucocele. The surprise finding of a mucocele during an emergency laparotomy highlights the deceptive nature of certain clinical manifestations within the hepatobiliary domain. The intraoperative discovery of a 1×1 cm GB hole on the right lateral wall of the GB fundus revealed an unexpected and significant deviation from the hypothesized pathogenesis. Abstract: This case report provides a complicated diagnosis scenario for a hepatobiliary illness aggravated by schizophrenia. Arriving with frequent nausea and vomiting, a 70-year-old female patient with schizophrenia missed typical symptoms of gallbladder (GB) disease, including fever and stomach discomfort. This odd look and corroborative imaging showing a cystic lesion in the right belly led to a diagnostic suspicion of a sizable GB mucocele. But a surprising result from an emergency laparotomy revealed a significant GB perforation, different from the previous diagnosis. This case highlights the difficulties in identifying atypical GB diseases, particularly in individuals with mental comorbidities that could conceal or alter the expression of physical symptoms. To confirm or rule out differential diagnosis and allow early and tailored treatments, it emphasizes the need for thorough diagnostic tests, including a complete clinical history, physical examinations, laboratory analysis, imaging modalities, and surgical procedures. This case emphasizes the importance of careful examination in complex medical contexts by stressing the requirement of thorough assessments and comprehensive diagnostic frameworks in navigating challenging clinical situations.

Macrocystic secretory carcinoma arising from the buccal minor salivary gland clinically mimicking a mucocele: A case report.

Secretory carcinoma (SC) is an uncommon salivary gland tumor that has been recently conceptualized. The present report describes a case of SC that was diagnosed as a mucocele on preoperative examination. A 46-year-old man presented to the Department of Oral and Maxillofacial Surgery at Saiseikai Senri Hospital (Suita-shi, Japan) with a main complaint of swelling of the right buccal mucosa. A mobile, elastic, hard mass was found beneath the right normal-appearing buccal mucosa. T2-weighted magnetic resonance imaging revealed a well-defined, internally homogeneous high-signal area with a maximum diameter of 18 mm. Based on the clinical diagnosis of mucocele, the buccal lesion was excised. Histopathological, immunohistochemical and fluorescence in situ hybridization analyses revealed the cystic lesion to be a macrocystic SC of a minor salivary gland. SC may have a mucocele-like appearance on magnetic resonance imaging. Even if a non-neoplastic lesion is suspected, the possibility of a malignant lesion such as SC must be considered for salivary gland disease.

Frontal Sinus Mucopyocele Presenting as a Painful Subcutaneous Forehead Mass in a Patient with Chronic Sinusitis.

Mucoceles of the paranasal sinuses are benign, expansile lesions that develop secondary to sinus ostia obstruction. Presenting signs and symptoms vary widely but frequently include frontal headache and swelling, as well as visual changes and globe displacement depending on orbital involvement in the case of frontal sinus mucoceles. Given the potential for orbital or intracranial involvement, urgent imaging with computed tomography (CT) is important for patients with symptoms concerning for a frontal sinus mucocele. Definitive treatment is surgical. In this article, we report a case of a 50-year-old male who presented to a primary care clinic with a painful forehead mass, found to have a frontal sinus mucocele with erosion through the frontal bone that was eventually treated surgically. We also summarize presenting signs and symptoms of frontal mucoceles reported in the literature as these are important for clinicians to be familiar with, considering the potential emergent complications.

Analytical interference in CA 19-9 immunoassay generates false-positive results in a young woman with a low-grade appendiceal tumor: An educational case report and brief literature review.

CA 19-9 (carbohydrate antigen 19-9) is a tumor marker widely used for the follow-up of patients with pancreatic cancer and other digestive neoplasia. This case report describes a discrepancy between the results of serum CA 19-9 analyses using the Alinity analytical platform (Abbott™) and two other techniques, Kryptor Gold (ThermoFisher Scientific™) and Cobas E411 (Roche™), in the context of a young woman with appendiceal mucocele. In this context, when the serum concentration of CA 19-9 is high, it may raise concerns about potential malignancy or rupture of the mucocele that may lead to tumoral dissemination in the abdominal cavity. In the present case, we observed with Alinity a false elevation in CA 19-9 concentration at 190 kU/L (normal range < 37 kU/L) before appendix resection that continued to increase until reaching 619 kU/L six months after surgery. This situation led to unnecessary additional tests, increased hospitalization time and stress for the patient who also had to interrupt her medically assisted reproduction project. We solved this case using new measurements in CA 19-9 concentration with two other techniques, Kryptor Gold and Cobas E411, and we identified an analytical interference caused by the presence of heterophile antibodies. In all cases, abnormal result initially obtained with Alinity was found below normal range not only with the two other techniques but also with Alinity after a neutralisation step by using Heterophile Blocking Tubes (Scantibodies Laboratory™). Analytical interferences in medical tests can lead to inappropriate medical care. It is an important issue requiring a continuing training of biologists who must be aware of these problems, which are recurring concerns and are not always easy to identify in laboratories of medical biology, in particular when immunoassays are used. This case report also provides an opportunity to do a brief review of the literature and to remind some recommendations and actions to take into consideration in the presence of discrepancies between the clinic and the biology, in particular, one of them is to measure the biological analyte with a different technique. Moreover, the use of Heterophile Blocking Tubes neutralizing specifically the heterophile antibodies may be useful. In all cases, dialogue between clinicians and biologists remains essential.

Multicompartmental Paranasal Sinus Osteoma Complicated by Frontal Bone Hyperostosis, Intracranial Mucocele, and Inflammatory Pseudotumor.

Parasinusal osteoma complicated by intracranial and orbit extension, cranial vault hyperostosis, intracranial mucocele, and inflammatory pseudotumor is exceptional. A 68-year-old man presented with a long history of progressive proptosis and recurrent episodes of keratoconjunctivitis in the left eye, with restriction in upward gaze. Contrast-enhanced magnetic resonance imaging revealed a frontal sinus lesion extending to the left anterior fossa and orbit, featuring an intracranial cystic component and heterogeneous contrast enhancement. Head computed tomography confirmed the double calcific-cystic nature of the lesion. A left supraorbital-pterional approach allowed complete resection of mucocele and drilling of intracranial and orbital osteoma, including the intrasinusal component. The frontal sinus was cranialized, and a flap of pericranium, reinforced by Gelfoam sponge, was reflected on the anterior cranial base/orbital roof. The postoperative course was uneventful; magnetic resonance imaging depicted resolution of proptosis. Histological examination favored parasinusal osteoma associated with intracranial mucocele, frontal bone hyperostosis, and inflammatory pseudotumor.

Pediatric isolated intraorbital mucocele: Case report and review of literature.

A 9-year-old child presented with a palpable swelling under the right lower lid for 3 years. On examination, the swelling was nontender, well circumscribed, and cystic on palpation. A computed tomography scan showed a well circumscribed, hyperdense lesion in the inferior orbit with no anatomic connection with the paranasal sinuses. Transcutaneous orbitotomy was performed, and the lesion was excised in toto. Histopathological examination was suggestive of a mucocele.

Risk stratification of surveillance for low-grade appendiceal mucinous neoplasms.

BACKGROUND: Low-grade appendiceal mucinous neoplasms (LAMNs) can progress to pseudomyxoma peritonei (PMP). The incidence and risk factors for recurrence are unclear, and there is a lack of consensus on the need and duration of surveillance imaging. METHODS: Patients at the Mayo Clinic in Rochester, Minnesota, with a histologic diagnosis of LAMNs confined to the appendix and limited involvement of the right lower quadrant from 1992 to 2023 were included. Associations between recurrence and risk factors were assessed using Kaplan-Meier curves and Cox proportional hazards regression. RESULTS: A total of 125 patients with LAMNs underwent abdominal imaging surveillance for a median of 51.2 months (IQR, 26-92). Of note, 5 patients (4%) recurred, all of which were PMP. Overall, the 5- and 10-year cumulative recurrence incidence rates were 3% and 6%, respectively. The median time to recurrence was 24 months (IQR, 23-87). Only LAMNs limited to the right lower quadrant and LAMN tumor size of <2 cm were associated with recurrence (P < .05). The 5- and 10-year cumulative recurrence risks were 12% and 30%, respectively, for the 21 patients with either risk factor. Only 1% of patients without these 2 risk factors developed a recurrence at 10 years. CONCLUSION: The overall recurrence risk of LAMN after resection is low. Appendectomy is sufficient for LAMN. Select patients with acellular mucin confined to the right lower quadrant and a tumor size of <2 cm are at higher risk of recurrence. Thus, long-term surveillance is recommended for high-risk individuals. Conversely, LAMNs without risk factors can be safely observed expectantly.

A minimally invasive, combined approach to the recurrent/recalcitrant sino-orbital mucocele.

PURPOSE: To evaluate the results of a minimally invasive combined endoscopic and eyelid crease/medial suprabrow incision approach in collaboration with oculoplastic and sinus surgeons for the treatment of recurrent/recalcitrant sino-orbital mucoceles. METHODS: Eighteen cases of recurrent/recalcitrant sino-orbital mucoceles, treated in collaboration with oculoplastic and sinus surgeons at the University of Michigan, were retrospectively reviewed. The recurrence of mucocele, reduction in proptosis, and complications were evaluated. RESULTS: The mean age at the time of surgery was 49 years (range: 17-76 years). All cases had a history of previous sinus or orbital surgeries for mucoceles. Among 18 cases, eight were due to chronic sinus infections, six due to trauma, three due to Schneiderian papilloma, and one case was secondary to an inflammatory sinus disease. Thirteen cases (72%) presented with orbital or facial cellulitis, while five cases (38%) experienced periocular swelling and limited extraocular motility. Following a mean follow-up of 19 months (range: 1-76 months)), recurrence was observed in two cases (11%): one in a cystic fibrosis patient with chronic sinusitis, and the other in a case of Schneiderian papilloma. The mean pre-operative proptosis in the affected eye was 2.78 mm, with an average decrease of 2.33 mm after surgery. Complications occurred in two cases, including one case of hypoesthesia in the forehead and one case of post-operative strabismus. CONCLUSION: Our series of 18 cases of recurrent/recalcitrant mucoceles, with only two cases of recurrence, demonstrates that this minimally invasive approach can be successfully employed for advanced sino-orbital disease, with a low rate of adverse outcomes and aesthetically pleasing results.

Mucous extravasation phenomenon: A clinicopathologic evaluation of 68 cases.

Background: A mucocele is a benign, mucus-containing cystic lesion of the minor salivary gland also called a sialocele and ptyalocele. Two types are recognized as mucus extravasation cyst and the other is retention type. Objective: To evaluate the clinicopathologic features of oral mucocele cases. Materials and Methods: The archival blocks which were signed out as mucocele were taken for the study. The following parameters such as age, gender, history of trauma, site, histological features, and clinical presentations were taken into consideration. Results: 68 cases of mucous extravasation cysts were analysed, among which 58% were males and 42% were females. Age of the patients ranged from 4 to 70 years with an average of 20 years. The most common locations were the lower lip (87%), tongue (5%) and buccal mucosa (8%). Almost 53% of cases are seen on the left side of the oral cavity. Most of the cases presented a history of trauma. Histopathologically 23% of cases presented with muciphages in the lumen and connective tissue. Conclusion: The commonly encountered benign salivary lesion of the oral cavity is the mucus extravasation phenomenon of the mucocele. Various histopathological features were discussed in this study to avoid misdiagnosis of this common lesion in dental practice.

Temporal bone mucocele with extension to mastoid in a 60-year-old male: a case report and literature review.

Introduction: Mucoceles, characterized by cystic lesions with sterile mucus accumulation, mostly occur in the paranasal but rarely affect the temporal-mastoid bone. The pathogenesis involves obstruction of natural drainage or cyst enlargement. Here, the authors present a rare case of temporal-mastoid mucocele with temporal hypertrophy. Case presentation: A 60-year-old male presented with progressive painless right temporal region swelling associated with diminished hearing, headache, fever and ear symptoms. Audiometry indicated a profound hearing loss in the right ear. Computed tomography (CT) of the right temporal bone and MRI brain revealed a large, destructive lesion involving the right temporal mastoid suggesting temporal-mastoid mucocele. Surgical excision of the mucocele and mastoid exploration were performed. Postoperative recovery was uneventful, with significant improvement in symptoms. Clinical discussion: Temporal bone mucoceles are rare, with few cases reported in the literature. Their etiology remains unclear, although chronic otitis media may be associated in some cases. Clinical presentations may vary, ranging from asymptomatic to symptoms such as serous otitis media, retroauricular edema, or cholesteatoma. Expansion of the mucocele cavity can lead to bone erosion or remodeling, potentially causing hearing loss. Differentials should include cholesteatoma, histiocytosis, and cholesterol granuloma. Imaging such as temporal bone CT and MRI are crucial for diagnosing, with characteristic findings on T2W images helping in differentiation. Surgical treatment, such as mastoidectomy with marsupialization or complete lesion removal, is indicated to prevent complications and reduce the risk of recurrence. Conclusion: This study reports a unique case of concomitant temporal-mastoid mucocele with involvement of organs of hearing with temporal bone hypertrophy.

Reversal of Sudden Blindness as a Consequence of Isolated Sphenoid Sinus Mucocele: A Case Report and Literature Review.

Mucoceles are locally invasive but benign expansive cystic lesions that can arise within paranasal sinuses. Isolated sphenoid sinus Mucoceles (SSM) are quite rare, comprising less than 1% of all paranasal sinus mucoceles. Due to the critical position and proximity of the sphenoid sinus to vital structures, SSMs can cause a multitude of symptoms and complications. We report a case of a 53-year-old man who presented with sudden vision loss and was found to have an isolated SSM. Following surgical drainage and management of the SSM, the patient had full recovery of visual acuity upon discharge.

A 28 years surgical experience of 398 sinusal mucoceles: how technologies, techniques and experiences have changed their treatment throughout the years.

PURPOSE: Sinonasal mucoceles (SM) are benign, expansive neoformations which require surgical marsupialization to prevent severe complications. The present study reports the larger case history ever published: a 28-years expertise in the surgical management of SM. METHODS: A retrospective study was conducted on patients surgically treated for SM at the Departments of Otorhinolaryngology of Varese and Pavia, between 1994 and 2022. RESULTS: 398 patients were reported. An endoscopic endonasal marsupialization of SM was performed in 92,5% of cases. 7% of patients underwent a combined approach while 0,5% required an exclusive open surgery. The average follow-up after surgery was 10-60 months. SM overall recurrence was observed in 11,4% of cases. CONCLUSION: Endonasal endoscopic SM marsupialization is a feasible technique which allows the preservation of the anatomy and physiology avoiding the surgical invasiveness of the external approaches. The well-established surgical expertise in the endonasal endoscopy together with technological improvements widened the indication range of the exclusive endoscopic technique over the traditional open surgery.

Pseudomyxoma Peritonei: An Incidental Diagnosis With Atypical Intraoperative Findings Discovered During a Laparoscopic Cholecystectomy.

Although pseudomyxoma peritonei (PMP) classically presents with profuse mucinous ascites within the peritoneal cavity, the physical manifestations of this disease exist on a spectrum, with the possibility of milder forms that lack typical findings. The authors report an indolent case of PMP diagnosed incidentally during workup and treatment for chronic cholecystitis in a 43-year-old male. This presentation of PMP was atypical due to a lack of discernible symptoms as well as uncharacteristic intraoperative findings consisting of numerous omental and pelvic adhesions with only sparse mucinous deposits. This case contributes to the growing understanding of PMP by exploring an uncharacteristic presentation of the disease with the hope that it may assist clinicians in diagnosing those cases of PMP that are more indolent and insidious in nature.

Pediatric Oral Mucocele Management: A Case Series Investigating Different Treatment Approaches.

A mucocele is a benign cystic lesion containing clear fluid within a thin capsule, typically resulting from the disruption of minor salivary glands and leakage into surrounding tissues, most commonly on the lower lip. These lesions often arise due to traumatic injuries such as lip-sucking, biting, or trauma from orthodontic appliances. This study compares different surgical methods for mucocele removal in pediatric patients through three distinct cases. This study includes three pediatric cases of mucocele removal using different surgical methods. Case 1 involved a nine-year-old girl with a traumatic bite on the lower lip, treated with a traditional approach using a scalpel. The surgical excision resulted in adequate healing with no recurrence after six months. Case 2 described a 12-year-old boy with a lip-biting habit, who presented with a swelling on the lower left lip. He underwent diode laser treatment, which facilitated faster healing, minimal discomfort, and no scarring after 30 days. Case 3 involved a 14-year-old boy, also with a lip-biting habit, who had swelling on the lower left lip. Electrocautery was used for his treatment, resulting in minimal bleeding, effective healing after 21 days, and no recurrence at the six-month follow-up. These cases demonstrate the efficacy of different treatment modalities for mucocele removal in pediatric patients. Evaluations of pain, bleeding, and swelling indicated that minimally invasive methods like the diode laser offer significant benefits in patient comfort and recovery. These findings highlight the potential of minimally invasive techniques to enhance the management of mucoceles in pediatric patients, underscoring the need for further research to determine the long-term efficacy of various treatment modalities.

Waiting for self-healing as a primary management strategy for lower lip mucoceles.

OBJECTIVES: Oral mucoceles are most frequently encountered on the lower lip. A variety of treatment options are currently employed, including surgical excision, pharmacological injections, and laser therapy. However, each of these approaches may introduce risks and potential complications. Clinical practice has demonstrated a potential for self-healing in lower lip mucoceles, making a conservative observational approach more appealing. This research is a prospective study aimed at evaluating the self-healing capacity of lower lip mucoceles. METHODS: In this prospective study, patients with mucoceles were encouraged to intentionally delay medical intervention and to wait for self-healing. Disappearance of the mucocele for at least 3 months was defined as self-healing. RESULTS: Thirty patients with lower lip mucoceles were included. With no intervention, 24 patients (80%) reported self-healing of lower lip mucoceles. The mean natural duration of the mucoceles was 3.63 (± 4.7; 1-24) months. After self-healing of the mucocele, the patients were followed up for 17.21 (± 9.45; 2-30) months and there were no reported recurrences. CONCLUSIONS: Lower lip mucoceles have a high potential for self-healing and patients may be routinely encouraged to wait for self-healing. CLINICAL RELEVANCE: The high self-healing rate observed in this study suggests that a conservative, non-interventional approach might be considered as the first-line management for lower lip mucoceles.

An unusual clinical presentation of a plunging ranula-The plunging ranula with extension to the vallecula.

Key Clinical Message: A plunging ranula may present initially as an extensive vallecular cyst and correct diagnosis may be reached with the use of ultrasound, fluid aspiration for amylase detection, and MRI imaging. Abstract: The ranula is a pseudocyst of the sublingual salivary gland and can be divided into two known subtypes. The simple ranula and plunging ranula. While the simple type can be found in the floor of the mouth, the plunging ranula usually pervades the mylohoid muscle and presents as a cervical swelling. The presented case should outline the difficulties in diagnostic and treatment of an uncommon expression of a mucocele above the mylohoid muscle without presenting either a cervical or an intraoral swelling, only extending towards the vallecula. We present a previously unreported clinical manifestation of a ranula of an 18-year old male, which extends posteriorly, remaining confined in the supramylohyoid muscle space. The cystic lesion protrudes in the oropharynx, and clinically appears as an extensive vallecular cyst. On magnetic resonance imaging the initial suspected diagnosis of a vallecular cyst was changed to the final diagnosis of a plunging ranula. The marsupialization of the cyst sac was performed. Outpatient follow-up revealed a persisting ostium, indicating a continuous extravasation of the sublingual gland. The present case report describes an unusual clinical presentation of a plunging ranula, remaining above the mylohyoid muscle and protruding into the oropharynx, misdirecting to the first suspected diagnosis of a vallecular cyst. The case highlights the useful contribution of the MRI imaging for differential diagnoses and the need for criteria to indicate further investigations.

The Relationship Between Destruction Sites and Clinical Findings in Diffuse Paranasal Sinus Mucoceles.

Objective: This study aimed to investigate that complicated mucoceles of paranasal sinuses and their clinical presentation, complications of relations with size, destructions areas, extension limits in affected patients. Materials and methods: A retrospective review was performed on patients who were diagnosed and treated as paranasal sinus mucoceles at ENT department from 2002 to 2013 years. Patients' demographic data, mucoceles location, symptoms, surgical approach and complications were evaluated. Results: The study group included 9 male and 10 female patients with a mean age of 45,0 years (range, 12-76 years). This case series include fronto-ethmoidal complex (52,6%), followed by frontal (26,3%), maxillary (15,7%) and sphenoid sinus mucoceles (5,2%). Endoscopic sinus surgery (ESS) was performed on 11 patients (57.8%); endoscopic procedures included marsupialization through an infundibulotomy, associated with an anterior ethmoidectomy and maxillary sinus antrostomy. Four patients (21%) underwent an external surgical procedure. 8 patients (42%) were treated by a combination of both endoscopic and external approaches such as trephination of the anterior wall of the frontal sinus, osteoplastic flap approach, Caldwell-Luc operation, anterior craniotomy and Lynch procedure. Complications occurred only in 2 cases (10.5%). Conclusion: The majority of patients with extensive paranasal sinus mucoceles exhibited ophthalmologic and intracranial symptoms. A satisfactory outcome can be achieved after surgical treatment of both endoscopic and external approaches.

Mucocele of the appendix: case report of a rare disease with changing diagnostic-therapeutic behavior.

Mucinous appendicular neoplasms are a rare and heterogeneous group of tumors, whose treatment may vary based on histologic features and extent. We present a case of low-grade appendiceal mucinous neoplasm mimicking an acute appendicitis scenario. The patient underwent appendectomy along with resection of the caecal fundus. Choosing the correct treatment according to the case by following current guidelines is crucial to avoid under- or overtreatment.

Frontal sinus reconstruction with overlapping sinus mucosa and vascularized pericranial flap Coverage after modified transbasal bifrontal craniotomy: Novel technique and clinical outcomes.

Background: The modified transbasal bifrontal craniotomy is a variant of the bifrontal craniotomy with a wider surgical corridor than the standard approach. There are several methods for frontal sinus repair in bifrontal craniotomy. This study reports a novel method for frontal sinus repair in the modified transbasal interhemispheric approach by precisely overlapping the frontal sinus mucosa margin (without frontal sinus mucosa exenteration) with packing the frontal sinus with povidone-soaked gel foam and covering it with a vascularized pericranial flap. Methods: In this case series, we retrospectively collected the clinical outcomes regarding cerebrospinal fluid (CSF) leakage, meningitis, and mucocele formation of patients who underwent modified transbasal bifrontal craniotomy at Vara Hospital. Results: From January 2016 to December 2021, 65 patients with anterior skull-base lesions were treated with a modified transbasal interhemispheric approach with frontal sinus repair by overlapping frontal sinus mucosa with gel foam packing and vascularized pericranium flap covering. There was no case of postoperative CSF leakage, meningitis, or mucocele formation during the follow-up period of 19.2 months (min 1, max 73). Conclusions: We demonstrated that the modified transbasal interhemispheric approach with frontal sinus repair using gel foam packing and pericranial flap is effective in preventing postoperative CSF leakage and meningitis.

Long-Term Follow-Up of Post Radiation Complete Sinus Opacification in Sinonasal Cancer Patients.

OBJECTIVE: Treatment of sinonasal malignancies most often requires primary or postoperative radiation treatment. Post radiation sinonasal morbidity has been previously described; however, none addressed post-radiation sinus obstruction. Our objective was to investigate the long-term outcomes of post radiation complete isolated sinus opacification (CISO). METHODS: A retrospective analysis of sinonasal cancer patients treated with radiation therapy during the years 2002 to 2022. Clinical, imaging and treatment data were collected from patients' medical records. Only patients with at least 12 months of follow-up and available imaging for review were included. RESULTS: Out of 109 patients, 37 patients were identified to meet the inclusion criteria. Mean follow-up was 58 months. 35% of patients were diagnosed with persistent post radiation CISO with a mean onset of 4 months. All these patients remained asymptomatic, and their imaging remained stable during follow-up with none developing an expanding mucocele. Ethmoid sinus tumor involvement was found to be more prevalent in the CISO group (62% vs. 25%, p-value = 0.048) as well as chemotherapy/immunotherapy (54% vs. 38%, p-value = 0.046). Multivariant analysis revealed that ethmoid sinus involvement (OR = 9.516, p-value = 0.047) and adjuvant therapy, either chemotherapy/immunotherapy (OR = 10.75, p-value = 0.036) were found to be a predictive factor for complete opacification. CONCLUSION: Our study revealed that a substantial number of post-radiation patients develop a stable and persistent CISO, often in the frontal and sphenoid sinuses. These patients remained asymptomatic, and none required surgical intervention during nearly 5 years of follow-up. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.