Orbital Region Research Articles

Gender-based Morphometric Analysis of the Human Orbital Aperture Profile using 3D Reconstruction Computed Tomography: A Cross-sectional Retrospective Study

Introduction: Sex estimation is a crucial aspect of forensic medicine and requires primary consideration when examining skeletal remains. Among the various anatomical features, the orbital region holds significant importance due to its distinct morphological variations. These variations provide valuable insights for sex determination, making orbital anatomy an indispensable tool in forensic investigations and analysis. Aim: To measure and compare orbital apertures between males and females using 3D Computed Tomography (CT) in a sample from the Saudi population. Materials and Methods: A cross-sectional retrospective study was conducted from January to June 2024 in the Radiology Department of Tower Hospital, Arar, Kingdom of Saudi Arabia, following the acquisition of ethical approval from the Local Bioethics Committee at Northern Border University. A total of 100 CT scans were randomly selected from the available dataset. The study encompassed CT scans of subjects from both genders, aged 18 years and above. However, CT scans of patients who had sustained head trauma or orbital injuries were excluded from the study. The data retrieved were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. All continuous data were tested for normality and expressed as Mean±Standard deviation (SD). The significant differences in orbital measurements between males and females were assessed using the Independent t-test. A p-value of <0.05 was considered statistically significant. Results: A total of 100 participants were included in the study, with the majority being females (52%). The mean age of male and female subjects was 40.5±13.19 years and 39.13±13.10 years, respectively. A statistically significant difference was found in right orbital width (p-value=0.011), left orbital area (p-value=0.04), and Interzygomatic Distance (IZD), with these measurements being higher in males compared to females (p-value=0.009). Conclusion: The study revealed that males have greater orbital width, orbital area and IZD compared to females. These genderspecific variations in orbital and facial dimensions may play a crucial role in gender determination within forensic medicine.

Loss of Insight in Syndromes Associated with Frontotemporal Lobar Degeneration: Clinical and Imaging Features.

The present study aims to assess the prevalence, associated clinical symptoms, longitudinal changes, and imaging correlates of Loss of Insight (LOI), which is still unexplored in syndromes associated with Frontotemporal Lobar Degeneration (FTLD). Retrospective longitudinal cohort study, from Oct 2009 to Feb 2023. Tertiary Frontotemporal Dementia research clinic. A sample of 712 FTLD patients, 331 of whom had follow-up evaluation. LOI was assessed by interview with the primary caregiver. Univariate and multiple logistic regression and linear mixed models were used to estimate predictors and longitudinal changes over time associated with LOI. Voxel-based morphometry and structural covariance analyses of brain structural MRI images were implemented in Statistical Parametric Mapping. LOI was reported in 45% of patients (321/712, 95%CI = 41-49), with progressively increased prevalence from prodromal to severe dementia stages. LOI was more prevalent in the behavioural variant FTD, in the semantic variant of Primary Progressive Aphasia (svPPA) and FTD with Amyotrophic Lateral Sclerosis than in other phenotypes (all p-values<0.001). LOI severity increased over time only in patients with svPPA (β = +0.59, p <0.001) and clustered with other behavioral symptoms (all p-values <0.05). Finally, LOI was significantly associated with greater atrophy in the right medial orbital gyrus (p <0.001 uncorrected). Structural covariance analysis demonstrated loss of negative correlation between right medial orbital gyrus and regions belonging to the Default Mode Network (DMN), such as the left precuneus and the left angular gyrus (p ≤0.05 family-wise error-corrected) in FTLD patients with LOI. A better comprehension of LOI mechanisms could lead to more effective interventions and healthcare policies.

Surgical Correction of Unicoronal Synostosis: Fronto-orbital Distraction versus Calvarial Switch.

There is a need for a new, less invasive surgical option for unicoronal synostosis (UCS). The aim of this study was to compare the resulting morphology and symmetry in patients with UCS following fronto-orbital distraction (FOD) or calvarial switch (CS). 79 patients with isolated UCS operated between 2005 and 2021 were analyzed. Follow-up was until 3 years of age. Angles describing orbital dystopia (ODA) and the anterior cranial fossa deviation and cant (ACFD and ACFC, respectively) were measured. Key linear dimensions, cranial cavities, and indices were calculated. 66 patients were included (14 in the FOD group and 52 in the CS group). The 3-year follow-up revealed significant improvement in all angles in both groups, with significant superiority in ODA correction following FOD (median improvement of 5.7 degrees as compared with 3.3 degrees after CS). Additionally, nasal and orbital volumes tended to be smaller, especially following CS; however, FOD resulted in a smaller absolute difference in orbital volume. Asymmetry in the orbital, nasal, and sphenoid regions also improved at the 3-year follow-up in both groups, although FOD resulted in complete normalization of the affected orbital shape and significantly improved overall asymmetry relative to that observed in the CS group. This study found that FOD achieves superior overall symmetry, as well as better shape correction of the cranium, as compared with CS, while also being less invasive. These findings suggest FOD as a safe and effective alternative to correct UCS and possibly the preferred surgical method.

Teamwork Approach in Management of Zygomaticomaxillary Complex (ZMC) Fracture with Globe Rupture: A Case Report

Introduction : Zygomaticomaxillary complex (ZMC) fractures are one of the most common fractures of the facial skeleton. Zygomatic fractures can cause ocular and mandibular functional impairment, along with cosmetic defects. The characteristic clinical signs of zygomatic bone fracture include diplopia, infraorbital nerve paraesthesia, flattening of the cheek, and trismus, whereas maxillary fracture may typically cause flattening of the midface and malocclusion. Therefore, surgical reconstruction is required to restore the function and appearance.Case Report : A 31-year-old man with ZMC fracture and globe rupture underwent open reduction and internal fixation using plate and orbital mesh. We collaborated with an ophthalmologist who performed enucleation and tarsorrhaphy.Discussion : The reconstruction improved functional and physical aspects and therefore psychological wellbeing. The main goal of the ZMC fracture treatment is to reconstruct the face in terms of functions and aesthetic. Furthermore, reconstruction of the left orbit (orbital rims and walls) as a secondary objective despite the blind eye, improved his appearance enabling formation of a pocket into which an eye implant was inserted. Satisfying functional and aesthetic outcome was achieved in this patient.Conclusion: A teamwork approach in surgical reconstruction for this case with ZMC fracture which always has an orbital component, was recommended to obtain an effective and optimal result. Both plastic surgeon and ophthalmologist can elaborate patient needs for facial reconstruction especially orbital region with good result.

Computer Aided Volume Measurement Using Osirix, A Free 3D-Rendering Software, In Preplanned Correction Of Enophthalmos With Diced Cartilage Graft

Autologous costal diced cartilage graft is an option for replenishment of the volume deficit in residual enophthalmos following orbito-zygomatic trauma. However, in published journals referring this treatment option, quantitative volume measurement of the graft needed has not been established. Two patients with orbito-zygomatic fractures resulted from motorcycle accidents, presented with dystopia, entrapment of the eyeball, diplopia, and depressed malar eminence on the affected side. CT scans demonstrated orbital-floor disruption and herniation of the intra-orbital content into the maxillary sinus. Using OsiriX®, a free and open source medical imaging software, we calculated the volume discrepancy of the affected orbit. On coronal slices, the segmentation of the bony orbital region of interest of each single slice was performed and grouped to compute the volume. At surgery, diced cartilage grafts were inserted to the orbital cavity according to the calculated volume, to promote forwards shift of the eye globe position after releasing the entrapment and replacing the orbital floor. In both patients, good position of the eye globe was achieved. The aesthetic appearance was perceived as quite acceptable to the patients and other viewers. Transient diplopia settled within 3 months. We considered OsiriX® as a reliable tool for accurate quantitative measurement of diced cartilage graft volume in enophthalmos correction.

Progress in 3D Printing Applications for the Management of Orbital Disorders: A Systematic Review.

Introduction: 3D printing technology has gained considerable interest in the domain of orbital illnesses owing to its capacity to transform diagnosis, surgery planning, and treatment. This systematic review seeks to deliver a thorough examination of the contemporary applications of 3D printing in the treatment of ocular problems, encompassing tumors, injuries, and congenital defects. This systematic review of recent studies has examined the application of patient-specific 3D-printed models for preoperative planning, personalized implants, and prosthetics. Methods: This systematic review was conducted according to the PRISMA guidelines. The PICOS is "What are the current advances and applications of 3D printing for the management of orbital pathology?" The databases analyzed for the research phase are MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, ScienceDirect, Scopus, CINAHL, and Web of Science. Results: Out of 314 studies found in the literature, only 12 met the inclusion and exclusion criteria. From the included studies, it is evident that 3D printing can be a useful technology for the management of trauma and oncological pathologies of the orbital region. Discussion: 3D printing proves to be very useful mainly for the purpose of improving the preoperative planning of a surgical procedure, allowing for better preparation by the surgical team and a reduction in operative time and complications. Conclusions: 3D printing has proven to be an outstanding tool in the management of orbit pathology. Comparing the advantages and disadvantages of such technology, the former far outweigh the latter.

Photon Shells, Black Hole Shadows, and Accretion Toroids

We analyze the properties of the Kerr black hole (BH) photon shell, focusing on the influence of aggregates of corotating and counterrotating toroids (ringed accretion disks, hereafter RAD), orbiting in the BH photon shell (photon shell “obscuration”). The particular case of a corotating accretion disk orbiting in the BH ergoregion is also investigated. We study influence on the BH shadow boundary, fixing the conditions under which it is possible to observe the ergoregion and RAD “imprint” on the shadows boundary. In general, remarkable differences appear between the counterrotating photon components of the boundary with respect to the corotating ones. Various regions of the shadow boundary generated from orbital regions linked to the aggregates of orbiting structures have been analyzed. In particular, we investigate the bound unstable spherical photon orbits in the ergoregion, or at the inversion point, where (toroidal) ϕ̇=0 , or with the impact parameter ℓ = 0 to characterize the effects of the frame dragging on the boundary. Five main classes of BHs have been identified by distinguishable features of their photon shells (and shadow boundaries) in the context of the orbiting RAD.

Endoscopic endonasal decompression for traumatic optic nerve injury: how I do it.

Endoscopic Endonasal Decompression for Traumatic Optic Nerve Injury has become an established endoscopic technique. However, Poor sphenoid sinus pneumatization often obscures landmarks, elevating the risk to vital neurovascular structures. By decompressing the orbital apex region and determining the contour of the optic nerve, sequential decompression of the medial wall, superomedial wall, and inferomedial wall of the optic canal. This surgical technique can gradually reveal the contour of the optic canal when the anatomical landmarks on the lateral wall of the sphenoid sinus are unclear, ensuring the surgery can be completed safely and effectively.

C1 root decompression as a therapeutic target in non-suboccipital non-Valsalva related headache associated with Chiari I malformation

Headache is the most common symptom impacting the quality of life of patients with Chiari I malformation. While headaches typically present in the occipital or suboccipital regions, and induced by Valsalva maneuver, complex migraine-like headaches referring to frontal or orbital regions also occur. Our study explores the therapeutic potential of C1 nerve root decompression in addition to increasing intracranial compliance in patients with Chiari I malformation. We retrospectively analyzed cases operated on for Chiari I malformation, focusing on patients with non-suboccipital, non-Valsalva induced headaches. Preoperative and postoperative visual analog scale (VAS) scores and headache frequency were recorded. Surgical technique involved suboccipital craniectomy, C1 laminectomy, cerebellar tonsil reduction, and C1 root decompression. Twelve patients (10 females, 2 males) aged 22-52 were included. Preoperative mean VAS score was 8, which improved to 2 or less in 11 patients postoperatively. The mean headache frequency decreased significantly. Our findings suggest that C1 root compression contributes to atypical headaches in Chiari I malformation and that C1 root decompression may improve surgical outcomes.

Single Stage Cranioplasty with Customized Polyetheretherketone Implant After Removal of Eosinophilic Granuloma skull bone: Case Report

Eosinophilic granuloma is a localized form of Langerhans cell histiocytosis, most commonly involving the skeletal system. Their origin from the dura is rare with only a handful of cases on record. We present one such rare case of an eosinophilic granuloma originating from the Extradural with secondary osseous invasion in a 20 year old male who presented with a swelling in the right fronto orbital region. A complete resection was scheduled with single stage reconstruction of the frontoorbital bone by a polyetheretherketone (PEEK) specific implant. This implant was computer-assisted designed and manufactured and verified by the surgeon before the intervention. Bang. J Neurosurgery 2024; 13(2): 152-156

Integrated machine learning and Mendelian randomization reveal PALMD as a prognostic biomarker for nonspecific orbital inflammation

Background: Nonspecific Orbital Inflammation (NSOI) remains a perplexing enigma among proliferative inflammatory disorders. Its etiology is idiopathic, characterized by distinctive and polymorphous lymphoid infiltration within the orbital region. Preliminary investigations suggest that PALMD localizes within the cytosol, potentially playing a crucial role in cellular processes, including plasma membrane dynamics and myogenic differentiation. The potential of PALMD as a biomarker for NSOI warrants meticulous exploration. Methods: PALMD was identified through the intersection analysis of common DEGs from datasets GSE58331 and GSE105149 from the GEO database, alongside immune-related gene lists from the ImmPort database, using Lasso regression and SVM-RFE analysis. GSEA and GSVA were conducted with gene sets co-expressed with PALMD. To further investigate the correlation between PALMD and immune-related biological processes, the CIBERSORT algorithm and ESTIMATE method were employed to evaluate immune microenvironment characteristics of each sample. The expression levels of PALMD were subsequently validated using GSE105149. Results: Among the 314 DEGs identified, several showed significant differences. Lasso and SVM-RFE algorithms pinpointed 15 hub genes. Functional analysis of PALMD emphasized its involvement in cell-cell adhesion, leukocyte migration, and leukocyte-mediated immunity. Enrichment analysis revealed that gene sets positively correlated with PALMD were enriched in immune-related pathways. Immune infiltration analysis indicated that resting dendritic cells, resting mast cells, activated NK cells, and plasma cells positively associate with PALMD expression. Conversely, naive B cells, activated dendritic cells, M0 and M1 macrophages, activated mast cells, activated CD4 memory T cells, and naive CD4 T cells showed a negative correlation with PALMD expression. PALMD demonstrated significant diagnostic potential in differentiating NSOI. Conclusions: This study identifies PALMD as a potential biomarker linked to NSOI, providing insights into its pathogenesis and offering new avenues for tracking disease progression.

Disentangling gray matter atrophy and its neurotransmitter architecture in drug-naïve Parkinson's disease: an atlas-based correlation analysis.

Parkinson's disease is characterized by multiple neurotransmitter systems beyond the traditional dopaminergic pathway, yet their influence on volumetric alterations is not well comprehended. We included 72 de novo, drug-naïve Parkinson's disease patients and 61 healthy controls. Voxel-wise gray matter volume was evaluated between Parkinson's disease and healthy controls, as well as among Parkinson's disease subgroups categorized by clinical manifestations. The Juspace toolbox was utilized to explore the spatial relationship between gray matter atrophy and neurotransmitter distribution. Parkinson's disease patients exhibited widespread GM atrophy in the cerebral and cerebellar regions, with spatial correlations with various neurotransmitter receptors (FDR-P < 0.05). Cognitively impaired Parkinson's disease patients showed gray matter atrophy in the left middle temporal atrophy, which is associated with serotoninergic, dopaminergic, cholinergic, and glutamatergic receptors (FDR-P < 0.05). Postural and gait disorder patients showed atrophy in the right precuneus, which is correlated with serotoninergic, dopaminergic, gamma-aminobutyric acid, and opioid receptors (FDR-P < 0.05). Patients with anxiety showed atrophy in the right superior orbital frontal region; those with depression showed atrophy in the left lingual and right inferior occipital regions. Both conditions were linked to serotoninergic and dopaminergic receptors (FDR-P < 0.05). Parkinson's disease patients exhibited regional gray matter atrophy with a significant distribution of specific neurotransmitters, which might provide insights into the underlying pathophysiology of clinical manifestations and develop targeted intervention strategies.

Evaluation of the Effect of Topical Prostaglandin Analog Treatment on Orbital Structures in Open-Angle Glaucoma with Computed Tomography

Background/Objectives: This study aims to evaluate the computed tomography (CT) scans of glaucoma patients using prostaglandin analogs (PGA) in one eye, investigate findings associated with prostaglandin-associated periorbitopathy (PAP), and compare these findings with those of the contralateral eyes. Methods: Patients with open-angle glaucoma who had CT images of the orbital region taken for another reason at least one month after starting PGA treatment in one eye were included in the study. Enophthalmos measurements from thin-slice CT images, along with 3D volume measurements of orbital fat tissue, periorbital muscles, and the optic nerve, were performed. Ophthalmological examination findings and treatment information were collected. The values were compared with those of the contralateral eyes of the same patients not using PGA. Intraclass correlation coefficients (ICCs) were computed to evaluate measurement repeatability. Results: Forty patients were included in the study. Among them, 29 (72.5%) used latanoprost, 9 (22.5%) used bimatoprost, and 2 (5%) used travoprost. The mean enophthalmos values on the treated side (15.5 ± 2.0 mm) were lower than on the untreated side (16.1 ± 1.4 mm), but this difference was not statistically significant (p = 0.07). In 29 patients (72.5%), enophthalmos measurements were smaller on the treated side, with 7 patients (17.5%) showing a difference of 2 mm or more. No significant correlation was found between the duration of PGA use and enophthalmos measurements (p = 0.768 r = −0.048). Additionally, no significant differences were found in orbital fat volume, total extraocular muscle volume, and optic nerve volume (p &gt; 0.05). ICC values demonstrated excellent reliability (ICC &gt; 0.75) for all measurements. Conclusions: We did not find significant differences in enophthalmos measurements, orbital fat volume, total muscle volume, and optic nerve volume between the PGA-treated and untreated eyes.

Optimizing 20 Gbps of ground-to-satellite free-space optical communication in low earth orbit with hybrid wavelength-mode division multiplexing

High-speed free-space optical (FSO) communication has emerged as a promising technology for low earth orbit (LEO) region in the last decade. In this paper, we simulate 20 Gbps simplex ground-to-satellite with various wavelengths and transmitter beam pointing error of 0.1 to 2.5 urad. The C-band wavelength is chosen, and a non-return-zero (NRZ) pulse generator with 16 channels hybrid wavelength-mode division multiplexing (WDM-MDM) technique employing Hermite-Gaussian (HG) modes is used to vary the pointing error. The effect of beam pointing error and receiver aperture diameter was discussed in this paper. A transmitter beam pointing error of 2.5 urad can work appropriately at distances of 1000 km and 1500 km, with a BER value of 1.41 × 10−6 and 3.56 × 10−5, respectively. Based on the receiver aperture diameter of 100 cm, it successfully achieves a BER value of 2.4 × 10−8 at the LEO region and a clear eye diagram.

The impact of breastfeeding on facial appearance in adolescent children.

Evidence that breastfeeding impacts the facial features of children is conflicting. Most studies to date have focused on dental and skeletal malocclusion. It currently remains unclear whether such effects are of sufficient magnitude to be detectable on outward facial appearance. Here, we evaluate the extent to which maternally reported breastfeeding is associated with 3D facial shape in a large adolescent cohort. After extracting 3D facial surfaces from MR scans in 2275 9- and 10-year-old children and aligning the surfaces in dense correspondence, we analyzed the effect of breastfeeding on shape as a dichotomous (no/yes) and semi-quantitative (to assess duration in months) variable using partial least squares regression. Our results showed no effect (p = 0.532) when breastfeeding was dichotomized. However, when treated as a semi-quantitative variable, breastfeeding duration was associated with statistically significant changes in shape (p = 3.61x 10-4). The most prominent facial changes included relative retrusion of the central midface, zygomatic arches, and orbital regions along with relative protrusion of forehead, cheek, and mandible. The net effect was that as breastfeeding duration increased, the facial profile in children became flatter (less convex). The observed effects on the face, however, were subtle and likely not conspicuous enough to be noticed by most observers. This was true even when comparing the faces of children breastfed for 19-24 months to children with no reported breastfeeding. Thus, breastfeeding does appear to have detectable effect on outward facial appearance in adolescent children, but its practical impact appears to be minimal.

Clinical and Surgical Results of Treatment Modalities in Orbital Roof Fractures: Single-Center Experience.

Orbital roof fractures are uncommon craniofacial fractures. Due to the location of the fracture and the mechanism of trauma, it is often associated with neuroophthalmological injuries. The authors aimed to evaluate the results of conservative and surgical treatments of patients with orbital roof fractures and present our clinical experiences regarding optimal treatment planning, especially in cases of moderate or severe head trauma. The authors retrospectively identified 145 patients who were treated for orbital roof fractures. Three colored silicone-injected cadaver samples and a dry skull were used to show the panoramic view of the anatomy of the orbital region. In this study, orbital roof fractures were classified under 4 types. The most common fracture type was type 1 (42%). Intracranial hemorrhage was observed in 60% of all cases and was most common in type 3 fractures (68%). Neuro-ophthalmological deficits were detected in 16% of all patients and were most common in Type 4 fractures (47%). Third cranial nerve deficit was the most common deficit (39%). Neuroophthalmological deficits were detected in 9.5 % of patients with mild head trauma and 32.5% in patients with moderate or severe head trauma. Moderate or severe head trauma was detected in 28% of the cases. Moderate or severe head trauma makes it difficult to detect neuro-ophthalmological complications, which are critical in determining the need for acute surgery. In patients with moderate or severe brain injury, treatment should be individualized according to the nature of the displacement and the relationship between concomitant fractures and intracranial hemorrhage.

Initial Frontal Sinus and Orbit Tumor Signaling Late Distant Metastasis in Kidney Cancer.

Although metastases to the paranasal sinuses are exceedingly rare, when they do occur, renal clear cell carcinoma is the most frequent primary tumor involved. The aim of this work was to present a case of metastatic clear cell renal carcinoma in the frontal sinus and orbit region, 7 years after the initial diagnosis and treatment. The patient was referred to our clinic due to drooping of the left eyelid and displacement of the left eyeball. Computed tomography revealed an expansive lesion in the left frontal sinus and orbit, causing destruction of its anterior, lateral, and roof walls. Profuse bleeding from the tumor and left orbit hindered a comprehensive assessment of tumor extension into the orbit and residual tumor size. Therefore, complete tumor removal was not possible; instead, reduction was achieved. Subsequent histopathologic and immunohistochemical analysis confirmed the lesion as a metastasis of renal cell carcinoma in the sinonasal tract. Unfortunately, 10 weeks later, the patient passed away. Treatment of metastatic clear cell renal carcinoma depends on the localization of the disease as well as the overall condition of the patient. If there is a solitary metastatic lesion, as in the case of the sinonasal region, surgical treatment is recommended. Metastasis of clear cell renal carcinoma to the sinonasal region is a rare occurrence; however, it is essential to consider it in cases of rapidly growing tumor masses, typically presenting with symptoms such as epistaxis and nasal obstruction.

A Fractional Model to Study Soliton in Presence of Charged Space Debris at Low-Earth Orbital Plasma Region

A Fractional Model to Study Soliton in Presence of Charged Space Debris at Low-Earth Orbital Plasma Region

Transcriptional patterns of amygdala functional connectivity in first-episode, drug-naïve major depressive disorder

Previous research has established associations between amygdala functional connectivity abnormalities and major depressive disorder (MDD). However, inconsistencies persist due to limited sample sizes and poorly elucidated transcriptional patterns. In this study, we aimed to address these gaps by analyzing a multicenter magnetic resonance imaging (MRI) dataset consisting of 210 first-episode, drug-naïve MDD patients and 363 age- and sex-matched healthy controls (HC). Using Pearson correlation analysis, we established individualized amygdala functional connectivity patterns based on the Automated Anatomical Labeling (AAL) atlas. Subsequently, machine learning techniques were employed to evaluate the diagnostic utility of amygdala functional connectivity for identifying MDD at the individual level. Additionally, we investigated the spatial correlation between MDD-related amygdala functional connectivity alterations and gene expression through Pearson correlation analysis. Our findings revealed reduced functional connectivity between the amygdala and specific brain regions, such as frontal, orbital, and temporal regions, in MDD patients compared to HC. Importantly, amygdala functional connectivity exhibited robust discriminatory capability for characterizing MDD at the individual level. Furthermore, we observed spatial correlations between MDD-related amygdala functional connectivity alterations and genes enriched for metal ion transport and modulation of chemical synaptic transmission. These results underscore the significance of amygdala functional connectivity alterations in MDD and suggest potential neurobiological mechanisms and markers for these alterations.

Nasal Histoplasmosis in an Immunocompetent Patient - A Case Report

The clinical case described below deals with the diagnosis and treatment of a fungal infection in the nasal region, rare in immunocompetent patients and with few reports in the literature. A 49-year-old woman from the south of Brazil, with no previous comorbidities, began to suffer from swelling in the right nasal and orbital region for around 4 weeks, accompanied by intense pain, fever and drainage of purulent secretion from the nostril. The first biopsy was inconclusive, but subsequent biopsies led to the identification of a fungal infection and finally the diagnosis of histoplasmosis. Treatment with antifungal drugs was then started, which consequently allowed the condition to improve after several hospitalizations.