Multidisciplinary Approach in Managing Orbital Tumors in Ibadan, Nigeria

Abstract

Patient A. O., an 8-year-old school pupil presented to the Eye Clinic of the University College Hospital, Ibadan with a 3 year history of gradual painless protrusion of the left eye. She lost vision in the eye 4 months before presentation. The general examination was normal. No features of neurofi bromatosis were found. The visual acuity were 6/5 and NLP in the right and left eyes respectively. There was a non-axial proptosis of about 18 mm in the left eye. The deviation was down and out. No palpable mass was felt, and the orbital rim was smooth. The proptosis was not tender, non-retropulsive, non-pulsatile and no bruit was heard over the eyeball. The extra ocular muscle movements were full in all directions of gaze (Fig. 1A). An afferent pupillary defect was present in the left eye. Dilated fundoscopy showed left optic atrophy. The right eye was normal. A cranial CT scan showed a fusiform enlargement of the left optic nerve compressing the eyeball. No intracranial extension was seen. (Fig. 1B) An assessment of left optic nerve glioma was made. Differential diagnosis of unilateral proptosis in the young includes orbital cellulitis, orbital tumors such as Burkitt’s lymphoma, myeloid leukemia and secondaries. Further evaluation and investigations supported an optic glioma. Case 2 Patient A.B, 47 year old woman with 10 year history of gradual painless proptosis of the right eye. Examination showed right visual acuity of 6/12, non axial proptosis, superotemporal fi rm, non tender orbital mass, mild ophthalmoplegia, and choroidal folds on fundoscopy. The right optic disc was normal. Regional lymph nodes were not palpably enlarged. The left eye was normal at presentation. Cranial computerized tomography scan showed a circumscribed superolateral orbital mass, with no intracranial extension. An assessment of a lacrimal gland tumour was made. The two patients had lateral orbitotomy in conjunction with the maxillofacial surgeons. At surgery, a C shaped skin incision was made just lateral to the lateral orbital rim, Hemostasis was secured. Subcutaneous tissue and temporalis muscle were dissected to gain access to the lateral orbital rim. Periosteal elevator was used to expose the fronto zygomatic suture, and with the aid of a drill, two bore holes were drilled on either sides of the suture to facilitate the removal of a bone window by a rotating electric saw (Fig. 1D).