Left Orbital Pain Research Articles

A Case of Malignant Transformation of an Orbital Epidermoid Cyst to Cystic Squamous Cell Carcinoma.

Squamous cell carcinoma of the orbit is uncommon as there is no squamous epithelium in the orbit. Thus, mechanistically squamous cell carcinoma of the orbit most commonly arises from a cutaneous lesion. Although orbital epidermoid cysts are thought to have very low malignant potential, these lesions possess squamous epithelium and theoretically can undergo malignant transformation. Here we present the case of a 63-year-old woman who presented with a 3-month history of diplopia and forehead tenderness with an orbital extraconal lesion on MRI consistent with a ruptured epidermoid cyst. Six months following resection, she suddenly experienced new-onset left upper eyelid ptosis, recurrent diplopia, and left orbital pain. MRI revealed a recurrence of the left orbital mass. Left anterior orbitotomy and biopsy revealed cystic squamous cell carcinoma. This case appears to demonstrate a very rare malignant transformation of an epidermoid cyst to cystic squamous cell carcinoma.

Orbital apex syndrome secondary to Noma Destruction: A Case Report

Purpose To present a case report of orbital apex syndrome secondary to Noma destructive processes. Method A case of 7-year-old child who presented with an ulcerative defect on the left cheek region and left orbital pain with reduced vision in the left eye has been presented. There was a history of cheek swelling, fever and, loss of appetite with a recent history of malaria treatment. Clinical examination revealed a cone shaped buccal ulcerative defect involving both the left outer and inner cheek walls with extension to the dentoalveolar segment, the maxilla and, the posterior palatal region with an observable sequestrum. Ophthalmological examination revealed loss of vision, complete ptosis and, ophthalmoplegia. There was loss of sensation in the frontal and preorbital region and, absolute pupillary defect in the same eye. A clinical diagnosis of orbital apex syndrome secondary to noma destruction was made. Result Management was instituted by a team of maxillofacial surgeons, ophthalmologists and, nutritionists. Antibiotics, serial debridement, and sequestrectomy were the predominant treatments given and there was resolution of the symptoms except persistent ptosis, loss of vision and, ophthalmoplegia. Conclusion Noma is a rapidly progressive disease that is capable of destroying oral and surrounding soft and, hard tissues with serious functional and cosmetic complications. Orbital apex syndrome was seen as a complication in this case report. This reinstates the need for early detection and treatment of noma.

Orbital apex syndrome secondary to apical periodontitis of a tooth: a case report

BackgroundOrbital apex syndrome (OAS) is a rare disease with a noticeable mortality rate. Although its etiology has been repeatedly assessed, few reports have concentrated on odontogenic infection. We presented a rare case of OAS secondary to apical periodontitis.Case presentationA 61-year-old male was admitted to our hospital for a 3-day history of left orbital and head pain, along with diplopia for 1-day. He also had toothache symptoms before his admission. Due to the atypical early symptoms of orbital apex and cranial nerve injury, no timely and effective diagnosis and treatment were initially provided. However, as the disease progressed and complications occurred, we timely adjusted the diagnosis and successfully controlled the infection. During the one-year follow-up, no recurrence of inflammation was observed; nevertheless, the ptosis and ophthalmoplegia persisted.ConclusionsOAS is a rare, while severe complication of odontogenic infection. This case had various symptoms and nerve injury in the orbital apical area. When disease is atypical in its early stages, treatment is easily overlooked. Early detection and suspicion of orbital apex-related complications should be heightened.

Diagnostic Value of PET/MR with DWI for Burkitt Lymphoma.

18F-FDG-PET/MR images, including DWI, of a 46-year-old male admitted to the Emergency Room of our tertiary center, who was suffering from diplopia, left orbital pain, and a headache for two weeks, demonstrated multiple hepatic nodules, a pancreatic mass, and skeletal metastases, in addition to thrombosis of the left cavernous sinus, thickening of the small intestine, and a large hepatic lesion identified at head and neck MR and whole-body CT, respectively. Hepatic and bone marrow biopsies revealed the diagnosis of Burkitt lymphoma. After four cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, methotrexate/ifosfamide, etoposide, and high dose cytarabine (R- CODOX-M/IVAC), a complete metabolic response occurred.

Choroidal Effusions and Posterior Scleritis in Idiopathic Orbital Inflammation

A 67-year-old woman presented with 1 week of progressive left orbital pain and swelling. Her vision was normal. Her left eye had restriction of abduction and inferoduction, prominent periorbital edema, chemosis, and posterior choroidal folds and detachments (Fig A). Neuroimaging demonstrated a hyperintense enhancing lesion in the inferotemporal orbit (arrowhead) with surrounding fat stranding, scleral and choroidal thickening, enhancement, and circumferential effusions (Fig B). No sinusitis was noted.

Asymptomatic COVID 19 infection: An innocent bystander in Mucormycosis or maybe not?

We report a case of 48 year old male with past medical history of poorly controlled Diabetes mellitus, Chronic Liver Disease-child Pugh B who came with complaints of left frontal headache and left orbital pain. A clinical diagnosis of possible Rhinorbital Mucormycosis was made and further confirmed by potassium hydroxide (KOH) mount from tissue, which showed broad sparsely septate hyphae and fungal culture grew Rhizopus oryzae. Covid 19 infection was detected as an incidental finding on admission to the hospital. The patient was successfully treated with surgical debridement and liposomal Amphotericin B followed by oral Posaconazole.

A Primary Ethmoid Mucocele in a 9-Year-Old Child: A Case Report and Literature Review

A mucocele is a mucous-filled cavity in the paranasal sinuses due to obstruction or compression of neighboring structures by inflammatory processes, trauma, or prior surgery. It can be indolent, locally expanding, and destructive. Mucoceles are extremely rare in children. We report a nine-year-old boy with sudden-onset left orbital pain and proptosis. Computed tomography showed a well-defined soft tissue lesion originating in the left ethmoid sinuses, suggestive of a mucocele. The mass was marsupialized by endoscopic sinus surgery. Mucoceles should be a part of the differential diagnosis of a child presenting with proptosis. Imaging studies are helpful in establishing the diagnosis.

Infraorbital approach for retrobulbar orbital neurofibroma: a case report

<p class="abstract">Retrobulbar orbital tumours are rare and treatment is challenging. These tumors include cavernous hemangioma, neurofibroma, A-V malformations, glioma etc. A variety of approaches have been used in resection of these tumours. The various approaches in literature include endoscopic transethmoidal and sphenoidal, lateral orbitotomy, transmaxillary infraorbital, and cranial and sub cranial approaches. Such tumours located inferior to the optic nerve can be reached through infraorbital approach avoiding traction on optic nerve or pressure on globe. We are reporting a retrobulbar orbital neurofibroma in a middle aged lady who presented with unilateral loss of vision, episodic giddiness, severe left sided headache, left orbital pain and epiphora on exposure to sunlight. MRI showed well defined 1.8×1.8×1.7 cm enhancing lobulated solid left intraorbital mass extending along the substance of inferior aspect of left optic nerve with mass effect. With transmaxillary infraorbital endoscope assisted approach, the retrobulbar tumor was exposed and enucleated. Floor of orbit was reconstructed with tensor fascia lata and nasal septal cartilage graft. The patient had uneventful recovery and immediate post operative visual acuity was perception of light and likely to improve further. Histopathology revealed neurofibroma. This case report highlights the advantages of infraorbital approach as it is a simple approach along the suture lines through the orbital floor with the help of endoscopic guidance. It has the advantages of avoiding traction on optic nerve or optic chiasma, no retraction of brain, no communication with cranial cavity, no pressure on globe and easy reconstruction of orbital floor.</p>

Intracranial Leiomyosarcoma in an HIV-Infected Adult

This 33-year-old man presented with one-year history of intermittent left orbital pain and diplopia after was diagnosed as HIV infection for 6 months. He had limited movement of the left eye with impairment of nearly all gaze direction. RAPD was positive on the left. He had no weakness or sensory disturbance. MRI showed a well efined mass in the left cavernous sinus with post-gadolinium enhancement. Suprasellar extension with dural tail on the left side was noted with mild pressure effect to the left prechiasmatic optic nerve

De Novo Cluster Attacks after Intravenous Nitroglycerin Therapy (P03.215)

Objective: To describe a unique patient who experienced attacks of cluster headache (CH) after the administration of intravenous nitroglycerin (NTG) for Prinzmetal9s angina. Background NTG is widely utilized in the treatment of angina, and headache is a well-known side effect of this medication in both patients with and without a history of a primary headache disorder, including CH, which likely is from vasodilatory mechanisms. Patients with a prior history of primary headache disorders including CH may experience a delayed attack, characteristic of their typical headache, occurring up to 8 hours after stopping NTG infusion, likely secondary to direct neuronal and inflammatory mechanisms. To our knowledge, no patient has been described to have first onset CH attacks after NTG administration. Design/Methods: Case report from a tertiary medical center. Results: A 43 year old woman who previously only experienced infrequent episodic tension-type headache presented to our hospital with recurrent episodes of severe chest pain over 2 days, and was thought to have an ST-elevation myocardial infraction. Emergent cardiac catheterization revealed severe coronary vasospasm, consistent with Prinzmetal9s angina, and was treated successfully with an intravenous NTG infusion and subsequently verapamil. She subsequently experienced her first ever CH attacks, both within minutes after NTG initiation and 16 hours after its discontinuation. Both attacks were identical and characterized by 60 minutes of excruciating left orbital pain associated with moderate ptosis. Her interictal neurological examination, MRI and MRA of the brain were normal, and she experienced no subsequent attacks. Conclusions: This patient experienced de novo CH attacks from intravenous NTG. The delayed onset of CH attacks strongly suggests a direct neuronal or inflammatory mechanism rather than attacks occurring from intracranial vasodilation. Perhaps a brief cluster period itself was brought on by NTG, which was rapidly suppressed by both withdrawal of the agent and institution of verapamil. Disclosure: Dr. Agopian has nothing to disclose. Dr. Robbins has nothing to disclose.

Acute orbital myositis before Herpes zoster ophthalmicus

Acute orbital myositis before Herpes zoster ophthalmicus

Laryngeal carcinoma metastasis to the orbit: case report

We present the first report in the all English literature of a case of laryngeal squamous cell carcinoma metastasis to the orbit. Case report of orbital metastasis from laryngeal carcinoma; clinical, radiological and pathological findings are discussed. A 75-year-old man presented to the ENT department with a five-week history of left orbital pain, swelling and reduced vision. Past medical history included laryngectomy, bilateral neck dissection and post-operative radiotherapy for T4 N2c M0 squamous cell carcinoma of the supraglottis, 10 months earlier. Imaging showed an orbital mass extending along the roof and lateral aspect of the orbit into the optic canal and superior orbital fissure, and further posteriorly into the left cavernous sinus with meningeal enhancement in the left anterior cranial fossa. Histopathological analysis after biopsy showed the mass to be consistent with metastatic poorly differentiated squamous cell carcinoma. After searching the all English literature, we report what is, to our best knowledge, the first case of laryngeal carcinoma metastasis to the orbit. Despite its rarity and poor prognosis, such a metastasis should be considered as part of the differential diagnosis of an orbital mass, as timely recognition can improve the patient's quality of life.

The efficacy of radiation monotherapy for Tolosa-Hunt syndrome

Sirs, Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia due to an idiopathic chronic granulomatous inflammation of the cavernous sinus [9]. THS usually improves with corticosteroids, however, in cases showing an insufficient effect of corticosteroid therapy or side effects, alternative therapies such as immunosuppressive agents [3] or focal radiation therapy have been reported [2, 5–7]. We describe a patient with THS who was successfully treated with radiation monotherapy. A 36-year-old man with chronic hepatitis B and impaired glucose tolerance since age 30 developed acute left orbital pain and double vision at the end of July 2006. Neurologic examination on 3 August 2006 demonstrated only mild restriction of abduction of the left eye. Magnetic resonance imaging (MRI) of the brain showed no abnormality including the cavernous sinus region at that time. His illness progressed rapidly and he was admitted to our hospital on 14 August 2006. On admission, body temperature and blood pressure were normal. Neurologic examination demonstrated almost complete ophthalmoplegia in all directions and blepharoptosis without pupil abnormality on the left. Spontaneous left ophthalmic pain was also reported. There were no ophthalmic symptoms on the right and there were no symptoms of lower cranial nerves on both sides. Urinalysis and routine hematological examination were normal. Blood chemistry examination demonstrated mild elevation of aspartate aminotransferase (60 IU/L; normal range 11–34 IU/L), alanine aminotransferase (151 IU/L; normal range 6–39 IU/L) and glycohemoglobin A1c (6.1%; normal range 4.3–5.8%). Surface antigen and core antibody of hepatitis B virus were positive. The following immunological and inflammatory investigations were normal or negative; antinuclear antibody, cytoplasmic and perinuclear antineutrophil cytoplasmic antibody, angiotensin converting enzyme level and b-D-glucan. Chest radiography and Gallium scintigraphy of the whole body showed no abnormality suggestive of systemic inflammatory disease. Cerebrospinal fluid examinations were normal including cytology and culture for bacteria and mycobacteria. Brain MRI showed abnormal soft tissue enhanced with gadolinium within the left cavernous sinus (Fig. 1). Based on a diagnosis of THS, we first considered corticosteroid therapy for THS with simultaneous antiviral therapy for hepatitis; however, the patient refused corticosteroid therapy because of the possible exacerbation of hepatitis. One week after admission, the left pupil was dilated and light response was diminished, indicating progression of THS. Thereafter, the patient received a total of 30 Gy in 15 fractions focused on the left cavernous sinus by three-dimensional conformal radiotherapy (3D-CRT). Left blepharoptosis and ophthalmoplegia gradually improved within 2 weeks after the initiation of radiation therapy; blepharoptosis had almost completely disappeared by the middle of October 2006. Ophthalmoplegia also Y. Furukawa W. Yamaguchi K. Ito T. Hamada H. Miyaji Department of Neurology, Fukui Prefectural Hospital, Fukui, Japan

篩骨洞原発神経内分泌小細胞癌例

A 51-year-old man had a chief complaint of left epistaxis and orbital pain. Anterior rhinoscopy showed a tumor in the left nasal cavity. CT showed a mass in the left ethmoid sinus, and the nasal septum and skull base showed thinning. Ga cintigraphy showed accumulation only in the left nasal cavity. Thereafter, MRI showed a mass with acute intracranial invasion occurring two-week with a period. We biopsied the nasal tumor, and the diagnosis was SNEC. Because the tumor acutely extended to the intracranial space, the patient developed convulsion. We performed treatment for convulsion with glyceol, rinderon and phenytoin. After radiotherapy with cyberknife effectively reduced the size both of the primary lesion and intracranial lesion, abdominal CT detected liver metastasis. The patient is currently receiving chemotherapy with irinotecan and cisplatin.

Malignant orbital schwannoma with massive intracranial recurrence

A 62 year old male presented with progressive diplopia, left orbital pain and impairment of visual acuity. Neuroradiological investigation disclosed an orbital tumour. The lesion was totally excised. Histopathology examination revealed a malignant peripheral nerve sheath tumour (MPNST). The tumour recurred with intracranial extension. The patient died 13 months after the initial diagnosis. To our knowledge, this is the first reported example of a massive intracranial recurrence of an orbital MPNST. The epidemiological features, clinical course and treatment of these lesions are discussed.

Acute Morphological Change in an Extracranial Carotid Artery Dissection on Transoral Carotid Ultrasonography

A 69-year-old man suddenly developed left visual field blurring, left orbital pain, and hyperesthesia of the right side of the body and was emergently admitted to our stroke center. Diffusion-weighted magnetic resonance imaging demonstrated a fresh infarct in the left post central gyrus. On emergent carotid ultrasonography, no end-diastolic flow was seen in the left internal carotid artery (ICA), which indicated occlusion of the distal part of the ICA. However, on conventional angiography performed 3 hours later, the left ICA was recanalized but was severely stenotic in the cervical portion (C2 vertebral level). …

Cluster-like headache secondary to trigeminal meningioma

A 30-year-old man presented with episodic severe left orbital pain associated with ipsilateral lacrimation, rhinorrhea, and conjunctival injection. Attacks lasted 15–60 minutes, occurred two to four times per month, and partially resolved with …

Character changes from idiopathic cranial pachymeningoencephalitis

A 66-year-old man with idiopathic cranial pachymeningoencephalitis was described. He suffered from left orbital pain, and character changes. He became short tempered, and was very attached to trifles. Two years prior to these symptoms, he had developed transient left abducent nerve palsy. Head MRI showed a thickening and enhancement of the dura mater on gadolinium-enhanced T1-weighted images, and high signal intensity lesions at bilateral frontal lobes predominantly in the white matter on T2-weighted images. Biopsies revealed microglial proliferation in the cerebral parenchyma, and mild lymphocytic perivascular infiltration. No evidence of intracranial infection was detected. We therefore treated him with methylprednisolone pulse therapy followed by oral prednisolone. His character became gradually normalized, and bilateral frontal lobe lesions seen on MRI disappeared. This is the first case to describe recurrent pachymeningoencephalitis with character changes, and symptoms were probably due to frontal lobe dysfunction.

Radiation therapy for recurrent orbital hemangioma

Surgical resection and corticosteroid therapy have traditionally been the preferred methods of treatment for orbital hemangioma. Radiation therapy is not usually indicated because of the potential for ocular complications. With modern radiation techniques, however, patients may experience substantial clinical improvement without significant radiation-induced morbidity. A case of unresectable, recurrent orbital hemangioma is described. The clinical presentation, management protocol using radiation therapy, and 5-year follow-up are reviewed. The patient was initially seen with left orbital pain, diplopia, proptosis, and conjunctival edema caused by a recurrent left orbital hemangioma after failed previous surgery. CT scan and angiogram revealed a large, irregular, multilocular mass in the left orbit consistent with hemangioma. The patient was treated with a total of 2000 cGy in 10 treatments. Five-year follow-up revealed a stable, regressed hemangioma with no radiation complications. Radiation therapy may be used if appropriately indicated for function-threatening orbital hemangioma.

Orbital apex leiomyoma with intracranial extension

BACKGROUND Leiomyoma is a rare, benign smooth muscle tumor of the orbit. It occasionally shows some histologic resemblance to other common tumors of the orbit like neurofibroma and schwannoma. Its location at the orbital apex is uncommon and only one case with intracranial extension has been reported so far. CASE DESCRIPTION A nine-year-old boy presented to us with left orbital pain. Four years earlier he had undergone partial excision, elsewhere, of a tumor at the orbital apex, which was reported as a schwannoma. The computed tomography (CT) scan showed regrowth of the tumor with intracranial extension. The tumor was totally resected by an intracranial route. One year postoperatively there was no recurrence of the tumor. CONCLUSIONS Leiomyoma of the orbit, though a benign tumor, does show regrowth after partial excision. Total excision, including any intracranial component, is advised. The cases reported so far are reviewed and the histopathology and possible etiopathogenesis of this tumor are discussed.