PMC4541635_01
A, Coronal computed tomography scan shows the right anterior ethmoid sinus pushing the right medial rectus and displacing the optic nerve and globe. Right side Lamina papyracea is not visible. Thinning and erosion of the bone of the lateral wall of the anterior ethmoid air cell suggests that this is a pneumocele rather than pneumosinus dilatans. B and C, Axial computed tomography showing protrusion of the right anterior ethmoid pneumocele laterally, with erosion of the lamina papyracea and compression of the orbital contents.
arh0011501230001.jpg
PMC4541635_01_arh0011501230001.jpg
F1
The air cell was protruding into the medial right orbit, inferolaterally displacing the medial rectus muscle, optic nerve, and globe and laterally displacing the superior oblique muscle (Fig. 1).
Intraoperative images of the right ethmoid cavity before and after marsupialization of the right ethmoid pneumocele. Image A shows the anterior and inferior aspect of the pneumocele protruding from the ethmoid. Image B demonstrates a soft, dehiscent orbital wall, with a probe pushing on the periorbita. Image C shows the marsupialized pneumocele, again demonstrating the medial orbital wall.
arh0011501230002.jpg
PMC4541635_01_arh0011501230002.jpg
F2
Intraoperatively, a large right ethmoid air-filled space was entered, with immediate associated air-bubbling (Fig. 2).
One month postoperative endoscopic exam shows a more normal, medialized, position of the right orbital contents (arrow) and a patent ethmoid cavity.
arh0011501230003.jpg
PMC4541635_01_arh0011501230003.jpg
F3
At her two-week visit, the diplopia had resolved, and at the one month visit, her endoscopic examination showed her right globe to be in a normal anatomic position (Fig. 3).