Perineural spread of epidermoid Carcinoma in the infraorbital nerve: Case report

Abstract

Perineural spread is a phenomenon that has been described relatively frequently in head and neck tumors. It involves the dissemination of tumor cells throughout the perineural and endoneural spaces of the nerves fibers, usually of the 5th and 7th cranial nerves. 1,2 Cruveilhier was the first investigator to describe the presence of perineural metastasis, 3 although it was Ballantine who did the first study in an 80 case series. 1 We report a case of perineural spread through the infraorbital nerve of a lower eyelid epidermoid carcinoma, and its cranial extension through foramen rotundum. Using magnetic resonance imaging (MRI), an early diagnosis of the disease can be established before the appearance of the clinical symptoms, which normally appear too late. MRIs obtained from this case clearly showed the behavior and nature of this type of neoplastic spread. The objective of this report is to emphasize the importance of MRI studies on those patients who are at the risk of suffering perineural metastasis, so as to obtain an early diagnosis of this type of dissemination and thus to provide appropriate therapy.