Orbit Fossa Research Articles

A novel supraorbital surgical approach for enucleation in dromedary camels (Camelus dromedaries): cadaveric study

BackgroundEnucleation and exenteration are widely utilized ophthalmic procedures in veterinary practice, involving the complete removal of the eye and comprehensive extraction of orbital contents, respectively. These procedures are indicated for pain relief, excision, and management of neoplasia metastases, and addressing severe medically untreatable conditions.AimThis study aimed to develop an orbital enucleation surgical approach. The study evaluated the applicability of the new approach and investigated the impact of the surgical procedure.MethodsAnatomical dissection of three cadaveric heads and surgical orbital enucleation in four cadaveric heads were performed. Anatomical data was collected, and feasibility, safety and applicability of the procedure were assessed.ResultsAnatomical dissection showed a distinctive large orbital fossa, providing a suitable surgical window to access orbital structures. The procedure was found to be feasible, facilitating the complete removal of the orbital content. Notably, the preservation of intact eyelids was prioritized to enhance cosmetic appearance.ConclusionThe presented orbital enucleation technique proved to be feasible, safe, reproducible, and required basic surgical skills to perform.

Solitary Fibrous Tumor of Nasal Cavity: A Case Report.

Solitary fibrous tumors (SFTs) belonging to a distinct group of mesenchymal tumors, was originally described by Klemper and Rabin in the pleura in year 1931. However, it can also be extra-pleural in origin. With tongue being the most common site involved in this region, epiglottis, larynx, thyroid, external auditory canal, lacrimal sac, hypoglossal nerve, parotid gland, sublingual gland, Para pharyngeal space, nasopharynx, scalp, gingiva, orbit and infratemporal fossa as well as paranasal sinuses and nasal cavities can also get involved. But SFTs involving nasal cavities and nasopharynx are quite uncommon, accounting for < 0.1% of all Sino-nasal neoplasms. Until now there have only been 40 cases of nasal SFT reported in literature. We report the case of an extraserosa solitary fibrous tumor arising from the nasal cavity with extension to the sphenoid sinus, a much rarer presentation of its type. Our case report is one of its type, emphasizing the need conducting further studies on the nature and management of the disease.

Computed tomographic dimensions and densities of the normal eye in Jeju horses.

This study aimed to describe the computed tomographic (CT) dimensions and the contrast attenuation of the eye in Jeju horses and Thoroughbreds. We evaluated the CT images of 10 Jeju horses and 6 Thoroughbreds without ocular abnormalities to assess the ocular dimensions and contrast attenuation. The following measurements showed significant differences between Jeju horses and Thoroughbreds (P<0.05): the diameters of the lens, globe, posterior segment, orbital fossa, and lateromedial distance of the anterior chamber; and the Hounsfield units of the vitreous body. This study describes the CT anatomical characteristics of Jeju horses and Thoroughbreds and the differences between the two breeds and provides useful information for understanding and evaluating of the eyes of Jeju horses through a CT scan.

Midface microvascular reconstruction after maxillary complex tumor resection: A retrospective study

The study purpose is to review the surgical approach and evaluate the results in managing patients with advanced midface and maxillary complex tumors.The most common anatomical site of the primary tumor was the maxilla, sometimes with extension to the orbit and anterior fossa, parotid and middle ear or even the lip. Surgical resection included maxillectomy in the majority of cases, combined with orbital exenteration or orbitectomy and anterior fossa resection. Parotidectomy and mastoidectomy/core petrosectomy were also performed. Reconstruction was performed with radial forearm osteocutaneous free flap, latissimus dorsi myocutaneous flap with scapular bone flap, lengthening temporalis myoplasty, rectus abdominis free flap, anterolateral thigh flap, in combination with temporalis and vastus lateralis, as well as pectoralis major myocutaneous flap.A total of 36 midface tumor excisions were performed, followed by the appropriate reconstruction. The average follow-up period was 15 years. To date, 23 patients are disease free, while 6 patients presented disease recurrence and 7 patients died during the 15-year follow-up period.Surgical resection remains the gold standard for midface tumors management. When safely performed, combined with microvascular and dynamic face reconstruction, surgery can offer improvement in quality of life and prolong the overall survival.

Non-surgical management of chronic granulomatous invasive fungal sinusitis with intracranial extension a case report and literature review

Chronic granulomatous invasive fungal sinusitis (CGIFS) is a rare manifestation of the heterogeneous disease process of fungal rhinosinusitis that is traditionally managed with some form of resective or debulking surgery. Historically, these were invasive transfacial resections. With the development of endoscopic surgery this treatment has become less invasive, but surgery still forms a major component of management. It is a rare disease that usually only occurs in dry subtropical areas. We describe the case of a female in her 30’s who presented with progressive headache and facial paresthesia. Workup demonstrated a large destructive lesion centred on the left sphenoid sinus invading the orbit and middle cranial fossa. The patient underwent urgent biopsies with a presumed diagnosis of an invasive malignancy. Upon identifying fungal organisms on culture the patient was commenced on anti-fungal treatment. We describe the first medically managed case of CGIFS with orbital and intracranial extension and perform a review of the contemporary literature to better understand this rare and challenging condition.

Optic canal: a CT-based morphometric study in north Indian population

BackgroundLesser wing of sphenoid joins the body of sphenoid by two roots which are separated by the optic canal. Optic canal is a communicating channel between orbit and middle cranial fossa, forming a passage for the ophthalmic artery and optic nerve. Considering the delicate neurovascular structure that traverses the narrow confines of the optic canal, knowledge of the morphometry, anatomical variations of this canal and their relations becomes an important part of diagnostic medicine and surgical management.ObjectiveThe aim of the study was to conduct morphometric analysis and document variations of optic canal in north Indian population and study its sexual dimorphism.Material and MethodType of Study Cross-sectional study. Sample size 200 Computerized tomography head axial section scans from picture archiving and communication system. The computer-assisted measurements of optic canal parameters were obtained on both right and left sides. Statistical analysis Unpaired t-test, paired t-test and ANOVA were applied.ResultOptic canal of 110 males, 90 females were examined. The overall cranial opening diameter, orbital opening diameter and length of optic canal in males were 4.34 ± 0.74, 3.17 ± 0.58 and 9.81 ± 1.62 and in females they were 3.99 ± 0.71, 2.97 ± 0.59 and 9.38 ± 2.02 respectively.ConclusionSignificant gender difference is seen in cranial and orbital opening diameter, and distance from midsagittal plane. No statistical significant difference is observed in right and left side parameters. A thorough knowledge of the normal dimensions of optic canal is important for evaluation and management of cases of optic nerve decompression.

SINONASAL ADAMANTINOMA-LIKE EWING SARCOMA: A CASE EXPANDING THE MORPHOLOGIC SPECTRUM

Adamantinoma-like Ewing sarcoma (ALES) is an exceedingly rare sinonasal malignancy defined by complex epithelial differentiation and EWSR1-FLI1 gene fusion. A 43-year-old female presented with painful facial swelling and proptosis. Computed tomography showed an exuberant heterogeneous tumor in the right sphenoid sinus that extended into the maxillary sinus, parapharyngeal space, orbit, and anterior cranial fossa. Microscopic analysis revealed sheets of monotonous basaloid cells with regular nuclear membranes and discernible nucleoli. Additionally, large foamy cells, ducts, whorls, and foci of abrupt keratinization were identified. Tumor cells were diffusely positive for AE1/3, p40, and CD99, and negative for NUT. The Ki-67 proliferation index was 40%. EWSR1 rearrangement was detected by FISH, confirming the final diagnosis of sinonasal ALES. Pathologists should consider ALES when evaluating aggressive sinonasal tumors composed of basaloid cells with focal keratinization. Immunopositivity for AE1/3, p40, and CD99, and molecular confirmation of EWSR1 rearrangement are essential for diagnosis. Adamantinoma-like Ewing sarcoma (ALES) is an exceedingly rare sinonasal malignancy defined by complex epithelial differentiation and EWSR1-FLI1 gene fusion. A 43-year-old female presented with painful facial swelling and proptosis. Computed tomography showed an exuberant heterogeneous tumor in the right sphenoid sinus that extended into the maxillary sinus, parapharyngeal space, orbit, and anterior cranial fossa. Microscopic analysis revealed sheets of monotonous basaloid cells with regular nuclear membranes and discernible nucleoli. Additionally, large foamy cells, ducts, whorls, and foci of abrupt keratinization were identified. Tumor cells were diffusely positive for AE1/3, p40, and CD99, and negative for NUT. The Ki-67 proliferation index was 40%. EWSR1 rearrangement was detected by FISH, confirming the final diagnosis of sinonasal ALES. Pathologists should consider ALES when evaluating aggressive sinonasal tumors composed of basaloid cells with focal keratinization. Immunopositivity for AE1/3, p40, and CD99, and molecular confirmation of EWSR1 rearrangement are essential for diagnosis.

216 Indications and Outcome of Endoscopic Transorbital Surgery for Trigeminal Schwannoma Based on the Classification: A multicenter Study With 50 cases (Korean Society of Endoscopic Neurosurgery - 009)

INTRODUCTION: Trigeminal schwannoma is a rare central nervous system tumor and involves multi-compartmental skull base. Recently, endoscopic transorbital approach (ETOA) has been emerging technique as a minimally invasive surgery. METHODS: Between Sep. 2016 and Feb. 2022, we performed ETOA in 50 patients with trigeminal schwannoma at four tertiary hospitals. There were 15 men and 35 women with the mean age of 46.9 years. All tumors were classified type A (mainly involving the middle cranial fossa), type B (mainly posterior cranial fossa), type C (dumbbell-shaped tumor involving middle and posterior fossa), type D (Extracranial type). Type D tumors were also classified the ophthalmic division (D1), maxillary division (D2), mandibular division (D3). RESULTS: In this study, overall gross or near total resection was performed in 45 of 50 patients (90.0%). Median follow-up period was 21.9 months ranging from 1 to 61.7 months. There was no regrowing or recurrence during the follow-up period. Based on the classification, there were 17 tumors with type A, 1 type B, 19 type C and 13 type D. In particular, seven tumors were belong to D1, one D2, and five D3. For type A tumors, GTR/NTR was achieved with ETOA in 16 of 17 patients (94.1%). 18 of 20 patients with type C received GTR/NTR. For type D tumors, GTR was achieved in 5 of 7 patients who underwent ETOA. CONCLUSIONS: This study showed that trigeminal schwannomas can be effectively treated with a minimally invasive ETOA in all types of tumor except tumors mainly involving posterior fossa (type B). Especially, trigeminal schwannoma involving orbit (D1) or infratemporal fossa (D3) can be successfully removed with ETOA alone or combined ETOA with the endoscopic endonasal approach.

Functional Arterial Anatomy of the Cranial Base

Two main vascular routes supply the brain, internal carotid arteries (ICAs) and vertebral arteries. The external carotid artery (ECA) mainly supplies the skin, muscle, and skull; thus, neurointerventionalists should be aware of ECA‐ICA, ECA‐vertebral artery, and extracranial–intracranial anastomoses. These anastomoses are not newly formed but are arteries that are remnants of developmental processes. During development, the ICA has anastomoses with the original ECA at the first and second pharyngeal arches, and carotid‐basilar anastomoses exist between the ICA and vertebral artery/basilar artery. Advances in neurointerventional technology are increasingly expanding the indications for transarterial embolization in the ECA territory. To avoid embolic complications to the brain and cranial nerve palsy, knowledge and understanding of such extracranial–intracranial anastomosis are crucial for neurointerventionalists interested in neurovascular diseases. The arterial contributions to these anastomoses are mainly the branches of the maxillary artery, ascending pharyngeal artery (extracranial), ophthalmic artery, and branches of the ICA (intracranial). Knowledge of the embryological processes is essential for understanding the routes and patterns of these anastomoses. This review discusses ECA development, the ICA segmental concept and functional anatomy of the extracranial‐intracranial anastomoses in the orbit, cavernous sinus, petrosal bone, and posterior fossa from an embryological point of view.

Modified Lateral Orbitotomy Approach to Lesions of the Orbital Apex, Superior Orbital Fissure, Cavernous Sinus, and Middle Cranial Fossa.

The lateral orbitotomy approach (LOA) provides minimally invasive access to the orbit, cavernous sinus region, and middle cranial fossa. Orbital retraction with this approach can nonetheless injure orbital structures, causing unnecessary morbidity. To describe our clinical experience with the modified LOA (mLOA), wherein the medial aspect of the lateral orbital wall posterior to the orbital rim is preserved. This is a retrospective, single-institution case series of patients undergoing a mLOA for lesions of the orbital apex, superior orbital fissure, cavernous sinus, and middle cranial fossa. The dimensions and variance of selected anatomic parameters relevant to this approach (orbital rim-superior orbital fossa depth, lateral orbital wall angle) were also analyzed using computed tomography scans from 30 adult patients. Eight patients underwent a mLOA (mean age 54.0 ± 19.6 years; 3 males). Surgical targets included the superior orbital fissure (2; cavernoma and meningioma), sphenoid wing with or without the orbital apex (2; meningioma), cavernous sinus (2; rule out carcinoma and smooth muscle tumor), and anterior/mesial temporal lobe (2; cavernoma). Visual acuity/fields and diplopia was stable or improved in all patients postoperatively. One patient experienced a cerebrospinal fluid leak. On computed tomography analysis, the relevant bony anatomy displayed limited variability, with a mean orbital fossa depth of 42.7 ± 2.8 mm and a lateral orbital wall angle of 44.4° ± 2.7°. The mLOA can provide safe, minimally invasive access to select lesions of the orbital apex, superior orbital fissure, cavernous sinus, and middle cranial fossa. The operative corridor has relatively consistent bony anatomy.

Finger Compression Technique with an OK Gesture on the Bilateral Emerging Points of the Ophthalmic Artery: A Simple Three-Step Method with Dual Real-Time Imaging to Reduce the Risk of Filler-Associated Blindness.

Filler injections to the glabella, nose, or forehead have increased probabilities of catastrophic, irreversible vascular complications, including skin necrosis, blindness, and cerebrovascular accidents.1 Filler-associated blindness is mainly attributed to intravascular injection of filler material through the branches of the ophthalmic artery (OA), such as the supratrochlear artery, supraorbital artery, and dorsal nasal artery.1 The ophthalmic artery runs through the emerging points of the OA (EMP/OA), giving branches through the superior part of the medial orbital rim (SMOR) and supraorbital foramen or notch [SOF(N)] to nose, glabella, and forehead.1 Because intravascular occlusions are rare, recommendations for prevention have been based on expert consensus.2 Finger compression is one of the measures used to reduce the risk of filler-associated blindness in facial danger zones,2 but no demonstrations of precise positioning and hand gestures are available. In addition, patterns of the OA main branches emanating from the orbital fossa and the precise location of EMP/OA of the SMOR are variable within individuals.3 We propose a practical finger compression method under dual real-time imaging guidance that has been used in our daily practice of filler injection to the danger zones of the face. First, the SOF(N) can be palpated easily and is marked. Second, a transillumination device (Vein Viewer; Christie Medical Holdings, Inc., Memphis, TN) is used on the SMOR to determine the precise location of EMP/OA (Fig. 1), which are subsequently marked. Then, Doppler ultrasound examination (LeSono LU700L; Leltek, Inc., New Taipei City, Taiwan) is performed to confirm the locations of the EMP/OA of the SMOR and the SOF(N). [See Figure, Supplemental Digital Content 1, which shows the EMP/OA of the SMOR demonstrated in Doppler ultrasound examination. High Doppler signals indicate the EMP/OA with a 10-MHz ultrasound transducer (LeSono LU700L; Leltek, Inc.), https://links.lww.com/PRS/F601. See Figure, Supplemental Digital Content 2, which shows the EMP/OA of the SOF(N) demonstrated in Doppler ultrasound examination. High Doppler signals indicate the EMP/OA with a 10-MHz ultrasound transducer (LeSono LU700L; Leltek, Inc.), https://links.lww.com/PRS/F602.] Third, the bilateral EMP/OA of the SMOR and SOF(N) are compressed with the fingers of the nondominant hand in an “OK” gesture (Fig. 2) as fillers are injected with the dominant hand simultaneously. Additional compression force of the fingertips and finger pulps is targeted at the EMP/OA of the SMOR and SOF(N), respectively. Finger compression with an OK gesture is a basic and one-person technique to reduce the risk of filler-associated blindness during nose and forehead augmentation with a blunt cannula or for filling deep wrinkles of the glabella with a sharp needle.Fig. 1.: The emerging points of the ophthalmic artery (EMP/OA) shown by a transillumination device. The superior part of the medial orbital rim (SMOR) and supraorbital foramen or notch [SOF(N)] can be palpated and marked. Next, the precise emerging point of the ophthalmic artery of the superior part of the medial orbital rim is demonstrated by a transillumination device (Vein Viewer).Fig. 2.: OK gesture finger compression method. After the anatomic landmarks have been confirmed, bilateral emerging points of the ophthalmic artery of the superior part of the medial orbital rim and supraorbital foramen or notch are compressed with the nondominant hand in an OK gesture at the same time; fillers can be injected by the dominant hand simultaneously.Other finger compression techniques are modified based on the same concept and can be used to temporarily occlude unilateral or bilateral main branches of the OA [See Figure, Supplemental Digital Content 3, which shows the application of various finger compression techniques for injections in different danger zones. Various finger compression techniques can be used to temporarily occlude unilateral or bilateral main branches of the OA https://links.lww.com/PRS/F603.] This three-step method with dual real-time imaging is not aimed to eliminate vascular complications attributable to other coexistent pathways associated with filler-associated blindness, such as arteriovenous shunting and true anastomoses with the external carotid artery. Other strategies for reducing the risk of filler-associated blindness are encouraged to be performed simultaneously or sequentially to enhance the safety of facial volumetric rejuvenation.2 Investigation of the effectiveness of this method in large-scale studies is worthwhile. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

The first discovery of in situ Pelophylax pueyoi (Amphibia: Anura) from the Late Miocene of Libros Konservat-Lagerstätte (Teruel, Spain)

ABSTRACT For the first time, a specimen of Pelophylax pueyoi Navás, 1922a has been recovered in situ, about 600 meters from the main entrance inside the Libros II mine (Teruel, Spain). The fossil comes from the Libros Gypsum Unit (Late Miocene), and represents a nearly complete articulated adult frog exposed in ventral view, with partial preservation of soft tissues. The only apomorphic character diagnosing the family Ranidae is the presence of cylindrical sacral diapophyses. Other characteristics congruent with that of the family Ranidae can be observed: sphenethmoid fused medially, large and oval orbital fossa, well-developed pterygoids without alar expansion and the inner ramus clearly shorter than the posterolateral ramus, transverse processes of presacral vertebrae and sacral diapophyses of subequal length, sacrum unfused with the urostyle, probable bicondylar sacro-urostylar articulation, transverse processes of the urostyle lacking, absence of ribs, and elongated hind limb. An apomorphic combination of features of the genus Pelophylax can also be recognized, such as the more open sacral diapophysis, and less elongated and more robust femora than usually observed in the genus Rana. Finally, some discrete characteristics permit establishing a close relationship with P. pueyoi, such as the large size of the fossil, the wide proportion of the skull, and the somewhat trapezoidal distal contour of the V4 transverse processes. The carpus of P. pueyoi is described here for the first time, suggesting a similar condition of the adult carpal morphology found in most Neobatrachian species. Presence or absence of a praepollex in P. pueyoi still cannot be resolved.

Septic shock induced by latent odontogenic orbital infection: a case report

A 65-year-old patient was admitted to the hospital due to proptosis of the left eye accompanied with ophthalmodynia and toothache for two months. Ophthalmic examination revealed a palpable mass around the lateral orbit and temporal fossa, and maxillofacial CT suggested a malignant tumor invading the left orbital floor wall. One week later, the patient was diagnosed with left orbital cellulitis and septic shock due to peri-orbit redness, eyelid edema, chest tightness, nausea, vomiting, hypotension, and a marked increase in peripheral blood neutrophil count. The infection was well controlled after remission of shock, anti-infective therapy and surgical drainage. At 2 months after surgery, the surgical incision of the upper eyelid skin recovered well and the best corrected visual acuity of the left eye was 1.0.

Is pre-operative imaging of external angular dermoid cysts in children necessary?

To investigate the frequency and modality of pre-operative imaging in children with an external angular dermoid cyst and whether this influenced subsequent management. A retrospective study was undertaken to assess the presentation, investigation, treatment and outcomes in children aged less than 16 years with an external angular dermoid cyst. All children who underwent external angular dermoid cyst excision between January 2008 and April 2021 at a regional children's hospital were analysed. Sixty-one patients (32 boys) were identified. Fifty-four were managed by paediatric surgeons and seven by ophthalmic surgeons. Pre-operative imaging was performed in 19 (31%) patients, including plain radiographs (3), ultrasound scan (14), computerised tomography scan (1), and magnetic resonance imaging scan (2). None of these investigations showed evidence of an intracranial or orbital extension of the cyst or changed management. All cysts were excised under day-case general anaesthesia. There was one minor postoperative complication and two recurrences. External angular dermoid cysts rarely communicate through the bone with the orbit or anterior cranial fossa. Routine pre-operative imaging is unnecessary unless there are clinical features such as an atypical location (e.g. temporal), eye signs (e.g. strabismus, proptosis and globe displacement) or a draining sinus.

A CASE REPORT OF CYTOMEGALOVIRUS ASSOCIATED ANOPHTHALMIA IN A PRETERM INFANT

PURPOSE: Cytomegalovirus belongs to the family of Herpesviridae, also known as HHV-5. The ocular manifestations of congenital cytomegalovirus infection include chorioretinitis, microphthalmos/anophthalmos, keratitis, cataract and optic atrophy. Anophthalmia is a condition in which there is a complete absence of any visible globe structure, though a microphthalmic remnant or cyst maybe present. MATERIALS AND METHODS: A 20 day old preterm baby born at 35 weeks with a birth weight of 2kg presented to the Ophthalmology OPD with microcephaly. No jaundice or hepatosplenomegaly was seen. An ocular examination showed left sided anophthalmia and coloboma iris of RE. USG orbit of left side revealed an ill- defined cystic lesion within the orbital fossa. Real time-PCR done on the sample of the infant was positive for CMV virus. A CT scan was done which showed no periventricular calcification. RESULTS: Congenital cytomegalovirus is associated with a high incidence of eye abnormalities and this infant showed findings consistent with CMV in infants.

MUCORMYCOSIS EFFECTS ON TURBINO SEPTAL COMPONENTS-OUR EXPERIENCE.

Introduction: Mucormycosis is a aggressive and most dangerous type of oppurtunistic Fungal infection. This disease starts commonly from Nose and Para nasal Sinuses. Many a times Middle Turbinate alone and some time both Middle and Inferior Turbinate are affected. This Fungi invades the Arteries more than the Veins and produce Thrombus and further reduces blood supply to concerned region and later on resulting in Necrosis of soft and Hard tissues , which was seen clinically as Black coloured “ Eschar”, the characteristic Endoscopic nding of Mucormycosis. Objectives: To Study about the effects Mucormycosis in the Turbinate, Septum and Floor of Nasal Cavity and to know the Effect of Septal Deviation in development of Sinusitis and further development of Mucormycosis. Study Design: Analytical Study, Retrospective Study. Materials And Method: This study was conducted in Govt Thanjavur Medical College, in Department of E.N.T and Head and Neck Surgery, from May 2021 to July 2021. Total Number of cases taken for study was 81 cases. Cases with Orbital and Pterygo Palatine Fossae and Infra Temporal Fossae involvement and Intra cranial involvement are excluded from the study. All cases are subjected to DNE and classied according to ndings. All cases under went Endoscopic Sinus Surgery and tissues sent for HPE and Fungal culture, followed by Systemic Amphotericin and Regular Post Operative Follow up for 4-6 weeks. Results: Males are involved more in numbers (48) than Females. Commonest age group involved are 21 to 40years. Strong Positive association present between Post Covid-19 status and Diabetes. Middle Turbinate involved in more number (34cases), followed by Inferior Turbinate (21 cases) and Septum (18 cases). Most common Anatomical factor present are High Septal Deviation (60 cases) and Osteo Meatal Complex (OMC) crowding (56 cases). Discussion: Mucormycosis is a Fulminant Fungal infection, which is common in Immunodecient individuals. Patients with Uncontrolled Diabetes Mellitus, on Prolonged Steroid therapy and Post COVID_19 status are very much prone for this infections. Angio invasion to Arteries and the resultant formation of Thrombi and Gangrene of involved areas is characteristic of Mucor. Black coloured dead tissue is called as ESCHAR. Depending upon the Arterial involvement Anterior half of Middle Turbinate or Posterior half of Middle Turbinate is involved, Posterior half of septum or entire septum is also involved. High septal deviation gives indirect disturbances to Osteo Meatal Complex functions resulting in development of Sinusitis and further chances of developing Mucormycosis. Early Surgical debridement of dead tissues followed by Inj.Amphotericin is very important in restriction of Disease spread. Proper management of predisposing factors and Postoperative Regular Weekly follow up and Endo Cleaning reduces the Recurrences. Conclusion:In our Study Males are affected more in numbers. 21-40 years are affected more. High Septal Deviation and OMC crowding are present in more number of patients which was responsible for the development of Acute Sinusitis. Post Covid status and Uncontrolled Diabetes was the commonest Predisposing factor the development of Mucormycosis. Middle Turbinate was involved more in numbers followed by Inferior Turbinate and Septum. Routine Examination followed by Nasal Septal Correction plays a major preventive role in development of sinusitis and further dreaded complications like Mucormycosis. Adequate Glycemic Control and Inj Amphotericin plays important role in the management of Mycormycosis. Regular Follow up with Endo Cleaning is reduces the chances of Recurrence.

Metastatic Pancreatic Neuroendocrine Tumor With Primary Presentation as Orbital Cellulitis

ABSTRACT Neuroendocrine tumors (NET) are rare malignancies of the gastrointestinal tract or lung with the most common metastases being the liver. Surgery remains the mainstay of treatment. We describe a 53-year-old woman with pancreatic NET metastatic to the liver, spleen, and orbital fossae. She presented with orbital cellulitis and was managed as a case of ocular tuberculosis after a preliminary ultrasound of the eye which showed soft-tissue edema of the orbit, and aspiration cytology showed ill-formed lymphocyte clusters. Eight weeks later, she developed antitubercular therapy-induced hepatitis. Further investigations revealed the real diagnosis of metastatic NET with orbital deposits. She received somatostatin analogue therapy, everolimus, and peptide receptor radionuclide therapy with significant reduction in size of lesions and resolution of symptoms.

Recurrent Painful Ophthalmoplegic Neuropathy: Migraine, Neuralgia, or Something Else?

Recurrent painful ophthalmoplegic neuropathy (RPON) is a very rare disease characterized by recurrent attacks (at least two) of unilateral headache associated with ipsilateral ophthalmoplegia due to paresis of one or more cranial motor nerves, not due to any orbital, parasellar, or posterior fossa lesions. The differential diagnoses for this condition are broad. In addition to disability during an acute attack, this disease could also cause a permanent neurologic deficit. The understanding of RPON pathogenesis has changed over time, leading to a change in the classification of this disorder between editions of the International Classification of Headache Disorders, in which the condition was moved from the chapter on migraine to the chapter on cranial neuralgias and central causes of facial pain. There is no consensus on the pathogenesis of RPON. It is possible that multiple pathogenic mechanisms underlie various clinical forms of the disease. A depiction of pathologic analyses of patients with radiologically confirmed changes in the affected nerves during and outside of attacks would significantly contribute to knowledge of its pathogenesis. Brain imaging should be performed in each patient during an acute RPON attack and at a regular schedule between attacks. Further case reports and case series are required before further conclusions can be made regarding RPON pathogenesis and proposals for treatment options.

A Clinicopathological Study of Olfactory Neuroblastoma

Background: Olfactory neuroblastoma, also known as Esthesioneuroblastoma, is a malignant neoplasm of neuroectodermal origin. In view of its rarity, a clinicopathological study of esthesioneuroblastoma is presented.Aim: Study Olfactory neuroblastoma cases diagnosed in the past ten years in patients attending Otorhinolaryngology outpatient.Patients and Methods: A retrospective study was conducted at Kasturba Medical College, Mangalore from 2009-18. Patients who attended Otorhinolaryngology outpatient and proven histopathologically to have Olfactory neuroblastoma are included in the study with the exclusion criteria being metastasis of Neuroblastoma to Head and Neck. It is a time-bound study and cases during the study period fulfilling the inclusion criteria are included.Results: A total of six cases are taken up for the study. These include one female and five male patients. Epistaxis was the most common presenting complaint. All the patients had nasal mass and local spread was seen most commonly to paranasal sinuses, orbit and anterior cranial fossa. Level two lymph nodes were most commonly involved. Overall they were staged as Kadish C in three, A in two and D in one. Treatments included surgical resection and radiation therapy. Two patients presented with recurrence during follow-up out of which one was local and another nodal recurrence.Conclusion: Although rare, any patient in the sixth decade presenting with epistaxis must be evaluated for Olfactory neuroblastoma. Better results are obtained with the combined modality of treatment. Also, the patients must be followed-up for an extended period for the timely detection of recurrences.

An internally validated diagnostic tool for acute invasive fungal sinusitis.

Acute invasive fungal sinusitis (AIFS) is a potentially life-threatening diagnosis in immunocompromised patients. Identifying patients who could benefit from evaluation and intervention can be challenging for referring providers and otolaryngologists alike. We aimed to develop and validate an accessible diagnostic tool to estimate the probability of AIFS. Retrospective chart review from 1999 to 2017 identified all patients evaluated for possible AIFS at a tertiary care center. AIFS was diagnosed by pathologic confirmation of fungal tissue angioinvasion. Stepwise selection and univariate logistic regression were used to screen risk factors for a multivariable predictive model. Model performance was assessed using Tukey's goodness-of-fit test and the area under the receiver operator characteristic curve (AUC). Model coefficients were internally validated using bootstrapping with 1000 iterations. A total of 283 patients (244 negative controls, 39 with AIFS) were included. Risk factors in our final diagnostic model included: fever ≥38°C (log-odds ratio [LOR] 1.72; 95% CI, 0.53 to 2.90), unilateral facial swelling, pain, or erythema (LOR 2.84; 95% CI, 1.46 to 4.23), involvement of the orbit or pterygopalatine fossa on imaging (LOR 3.02; 95% CI, 1.78 to 4.26), and mucosal necrosis seen on endoscopy (LOR 5.52; 95% CI, 3.81 to 7.24), with p < 0.01 for all factors. The model had adequate goodness of fit (p > 0.05) and discrimination (AUC = 0.96). We present an internally validated diagnostic tool to stratify the risk for AIFS. The estimated risk may help determine which patients can be observed with serial nasal endoscopy, which ones could be biopsied, and which ones would benefit from immediate surgical intervention.