Malignant neoplasia of the paranasal sinuses associated with mucocele

Anteromedial approach to the orbit

This study evaluated the surgical results of the anteromedial approach for treatment of orbital lesions in 16 patients. Pre- and postoperatively, all patients underwent a complete physical examination focusing on the head and neck area including a thorough ophthalmologic evaluation, computerized tomography, and magnetic resonance imaging. The surgical approach was limited to a medial orbitotomy in five patients; the remaining 11 patients underwent a medial orbitotomy combined with an external sphenoethmoidectomy. The tumor was removed completely without damaging the intraorbital neurovascular structures in all but one patient whose recurrent clival chordoma extended beyond the limits of an extracranial approach. Fibro-osseous lesions, cavernous hemangiomas, and dermoid cysts were the most common pathologies. The follow-up ranged from 18 to 48 months, and no patient has shown evidence of a recurrence. One patient with a clival chordoma received radiation therapy. The lateral nasal skin incision healed with acceptable cosmetic results. The anteromedial approach to the orbit provides a wider working space and direct exposure while protecting neurovascular structures.

Cystic lesions of the orbit

BACKGROUND/AIMS

Cystic lesions of the orbit constitute a group of lesions with diverse clinical findings, histopathologic features and pathogenesis.

METHODS

We reviewed the histopathologic and clinical records on 128 orbital cystic lesions diagnosed during a 32-year period from 1963 to 1995.

RESULTS

Of the 128 orbital cystic lesions, dermoid cysts were the most frequent (38 cases, 29.7%). The other lesions, in decreasing order of frequency, were hydatid cysts (33 cases, 25.8%), mucoceles (31 cases, 24.2%), pyoceles (10 cases, 7.8%), meningoencephaloceles (9 cases, 7.0%), epidermal inclusion cysts (4 cases, 3.1%), hematoceles (2 cases, 1.6%) and teratoma (one case, 0.8%).

CONCLUSIONS

Our review showed that 64.1% of patients with cystic lesions were aged 18 years or less. With the exception of mucopyoceles, all the other cystic lesions were more frequent in pediatric patients. Cystic lesions behaved clinically as benign lesions. At a mean follow-up of 6.7 years we did not observe development of malignancy in any of the cystic tumor cases though variable degrees of vision loss developed due to factors such as optic nerve compression, ocular damage and amblyopia.