Recurrent Post-traumatic Frontal Mucocele Following Previous Endoscopic Management: Alternative Surgical Reconstruction With Partial Capsule Resection

Frontal sinus mucoceles are benign but locally aggressive expansile lesions that may occur years after trauma or previous sinus surgery. Their progressive enlargement can lead to bone remodeling, facial deformity, orbital involvement, and intracranial complications. Endoscopic marsupialization is currently considered the standard treatment in most cases; however, recurrence remains possible, particularly in patients with altered anatomy secondary to trauma or previous surgical manipulation. This report describes the case of a 55-year-old man with a history of severe frontal trauma after a motor vehicle accident resulting in loss of the anterior table of the frontal sinus. The patient subsequently developed a frontal mucocele that had previously been treated elsewhere with endoscopic frontal sinus drainage and osteoma shaving. Despite initial management, recurrence occurred slightly more than one year later, with progressive frontal deformity and patient dissatisfaction. An alternative surgical strategy was therefore proposed consisting of complete frontal sinus drainage, partial capsule resection, excision of redundant frontal skin after decompression, and reduction with closure of the residual capsule. Histopathological analysis of the capsule and drained material demonstrated no evidence of neoplasia. The patient evolved with satisfactory aesthetic contour, good scar healing, and no recurrence after one year of follow-up. This case highlights an alternative surgical option for selected patients with recurrent post-traumatic frontal mucoceles and anatomically distorted frontal sinuses following previous endoscopic management.