Mirror, Mirror on the Roof!

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A 37-year-old male presented with gradually progressive nonaxial proptosis of 3-years duration (Fig. 1A). CT scan of the orbit revealed a frontal sinus mucocele with a single, deep anterior recess extending 1.5 cm above the supraorbital rim (Fig. 1B). The patient underwent anterior orbitotomy via eyelid crease approach, and the mucocele was exposed. A controlled drainage of the mucocele enabled removal of its thick secretions, and collapse of the mucosal wall lining the expanded sinus cavity. Ensuring complete removal of the mucosal wall was a challenge due to limited visualization and illumination into the roof of the sinus.
A simple technique using a dental mirror was utilized to remove the entire mucosa under direct visualization (Fig. 1C) with a metal suction tip. The mirror allowed adequate amount of illumination in the area of interest, and also served as a safe retractor for the globe and soft tissues. The postoperative healing was uneventful, and he continued to remain free of recurrence 22 months following the surgery (Fig. 1D).
The authors are aware that the use of dental mirror cannot possibly reach deep recesses of large and multiloculated mucocele, and that endoscopic-guided removal or open sinusotomy may be required in cases where visualization is difficult.
To the best of our knowledge, this is the first documented report highlighting intraoperative use of a dental mirror during orbital surgery. This technique could also be useful during excision of deep orbital dermoid cysts to ensure complete removal of the wall. Although an endoscope can provide good access, a dental mirror is a simple, inexpensive tool that can be readily sterilized and kept handy for such surgeries.
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