Abstract
Dear Mr. Editor-in-Chief,
We have read with interest the article by Gozgec and Ogul published in your esteemed journal and would like to congratulate them for a good and concise presentation of the case. 1 Based on our own experience and data from the literature, we would like to make some additions that we believe would enrich the publication and its conclusions. The clinical picture of mucocele of the sphenoid sinus (MSC) is quite varied and non-specific. The duration from the onset of the disease to its diagnosis varies from 3 days to 38 years, with an average of 4 years. 2 Headache is the most common non-specific clinical symptom in MSC, occurring in 70–80% of the cases. 3 It is due to both mechanical pressure on the dura mater overlying the planum sphenoidale or the base of the anterior cranial fossa, as well of the cytokines present in the MSC (TNF alpha, IL-6, IL-1, and PGE2), which modulate the trigeminal pain threshold. 3 It is most likely that the patient’s migraine headache diagnosis is a manifestation of MSC. Although this is not an omission of the respected Gozgec and Ogul, but in our opinion, in such cases, it is necessary to perform a computed tomography (CT) scan, which is able to visualize or reject the diagnosis of mucocele.
Being aware of the limitation in the number of words and figures when publishing a case report, we consider it necessary to report the type and volume of the operative intervention performed, as well as to show the post-operative control neurological examination. We fully agree that endoscopic transnasal marsupialization is the preferred treatment approach, but we would like to add that it is also necessary to allow an adequate drainage by opening the anterior and inferior walls of the sphenoid sinus and/or balloon dilatation of the foramen, which avoids the possibility of recurrence of the disease. 4
