Frontal Sinus Swelling After Puppy Trauma? Surgical Outcomes From 8-Dog Case Series

Clinical Findings and Outcomes of Eight Dogs With Surgically Treated Frontal Sinus Mucoceles

Karen M. Tobias, Talisha Moore, Jessica Ogden, Grayson Cole, Brett Darrow, Christine DePompeo

Background

Frontal sinus mucoceles arise when nasofrontal openings obstruct, trapping secretions and leading to expansile, erosive lesions that can distort the face and compress adjacent structures. They are rare in dogs, with only nine cases reported since 1971. Most have been linked to skull trauma in young animals. This study describes the clinical features, imaging, surgical management, and outcomes in eight dogs with surgically treated frontal sinus mucoceles.

Methods

Eight dogs presented to five referral hospitals (2016–2023) with swelling over the frontal bone, often painful. Seven had evidence of early-life skull trauma; one had nasal disease after intraoperative regurgitation. CT was used in all dogs, showing fluid-attenuating, expansile lesions with bone erosion. All dogs underwent frontal sinusotomy, debridement, and lavage. Some had sinus lining removed with fat graft ablation; others had re-establishment of nasofrontal drainage with or without stenting. Postoperative care included analgesics, NSAIDs or prednisone, and antibiotics (though cultures were consistently negative). Follow-up ranged 7 months–7 years.

Results

Four dogs achieved long-term resolution after the first surgery, though three had temporary swelling or discharge. Four dogs developed recurrence within 1–9 months; three underwent repeat sinusotomy with nasofrontal stenting, after which two remained normal (6–20 months) and one had intermittent swelling manageable with guaifenesin ± anti-inflammatories. The eighth dog’s recurrence was untreated due to financial constraints. Overall, six of eight dogs achieved resolution after one or two surgeries. Recurrence occurred in both stented and ablation-only cases; success was most consistent when sinus drainage was re-established with stenting or thorough lining removal.

Limitations

The study was retrospective with varied surgical techniques and incomplete operative records. Small case number limited assessment of prognostic factors. The extensiveness of lining removal could not always be confirmed, and follow-up varied.

Conclusions

Frontal sinus mucoceles in dogs, often trauma-associated, present with expansile aseptic lesions detectable on CT. Definitive management requires restoring sinus drainage or complete lining removal, sometimes necessitating multiple surgeries. Antibiotics alone are not curative. With appropriate surgery, long-term resolution is achievable in most cases.

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