We report the clinical features of paranasal sinus mucoceles with orbital extension and compare the results of external and transnasal approaches based on the rates of complications and recurrence.

Thirty-three cases of paranasal sinus mucoceles with orbital extension diagnosed at our hospital from 2003 to 2007 were retrospectively reviewed.

The mean age of patients was 48.6 years. The common sites of origin were the frontal, ethmoidal, frontoethmoidal sinuses, and proptosis was the most common presenting feature. Among the mucoceles of frontal and frontoethmoid sinuses, there was no difference in the rates of recurrence or complications between the two different methods.

Mucoceles with orbital involvement generally present with a noninfiltrating mass resulting in many ophthalmic signs and symptoms. Obliteration of the involved sinus is not recommended if there is erosion of the sinus bony wall with extension of the mucocele into the orbit. The mucosa lining the mucocele become adhered to the orbital periosteum and cannot be removed during surgery without significant risk of injury to the adjacent structures. Endoscopic sinus surgery is considered effective for paranasal sinus mucoceles with orbital involvement.