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He Z, Han H, Shang W, Song K. Orbital Apex Syndrome secondary to residual tooth root infection: a case report. Braz J Otorhinolaryngol 2024; 90:101455. [PMID: 38968749 PMCID: PMC11283021 DOI: 10.1016/j.bjorl.2024.101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 07/07/2024] Open
Affiliation(s)
- Zongxuan He
- The Affiliated Hospital of Qingdao University, Department of Oral & Maxillofacial Surgery, Shandong Province, China; Qingdao University, School of Stomatology, Shandong Province, China
| | - Hongyu Han
- Qingdao University, Qingdao Municipal Hospital, Shandong Province, China
| | - Wei Shang
- The Affiliated Hospital of Qingdao University, Department of Oral & Maxillofacial Surgery, Shandong Province, China; Qingdao University, School of Stomatology, Shandong Province, China.
| | - Kai Song
- The Affiliated Hospital of Qingdao University, Department of Oral & Maxillofacial Surgery, Shandong Province, China; Qingdao University, School of Stomatology, Shandong Province, China.
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2
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Kim DH, Jeong JU, Kim S, Kim ST, Han GC. Bilateral Orbital Apex Syndrome Related to Sphenoid Fungal Sinusitis. EAR, NOSE & THROAT JOURNAL 2023; 102:NP618-NP620. [PMID: 34281412 DOI: 10.1177/01455613211024768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Orbital apex syndrome (OAS) is a rare condition that usually occurs due to damage to surrounding inner and surrounding bone tissue. Orbital apex syndrome may result from a variety of conditions that cause damage to the superior orbital fissure and to the optic canal leading to optic nerve (II) dysfunction. We recently experienced a rare case of sphenoidal Aspergillosis, which damaged the adjacent cavernous sinus structures and led to the definite symptom of bilateral OAS in a 77-year-old male. We present this rare case with a brief review of these disease's entities.
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Affiliation(s)
- Dong Hyun Kim
- Department of Otolaryngology-Head & Neck Surgery, Gachon University, College of Medicine, Gil Medical Center, Incheon, Korea
- 21st Marine Battalion, 2nd Marine Brigade, 1st Marine Division, Republic of Korea Marine Corps, Pohang, Korea
| | - Jin Uk Jeong
- Department of Otolaryngology-Head & Neck Surgery, Gachon University, College of Medicine, Gil Medical Center, Incheon, Korea
| | - Seul Kim
- Department of Otolaryngology-Head & Neck Surgery, Gachon University, College of Medicine, Gil Medical Center, Incheon, Korea
| | - Seon Tae Kim
- Department of Otolaryngology-Head & Neck Surgery, Gachon University, College of Medicine, Gil Medical Center, Incheon, Korea
| | - Gyu Cheol Han
- Department of Otolaryngology-Head & Neck Surgery, Gachon University, College of Medicine, Gil Medical Center, Incheon, Korea
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Xiang W, Wei H, Xu L, Liang Z. Orbital apex syndrome secondary to apical periodontitis of a tooth: a case report. BMC Neurol 2022; 22:354. [PMID: 36123630 PMCID: PMC9484228 DOI: 10.1186/s12883-022-02890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orbital 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 PRESENTATION A 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. CONCLUSIONS OAS 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.
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Affiliation(s)
- Wei Xiang
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Hongchun Wei
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Luyao Xu
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Zhigang Liang
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.
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4
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Lee PH, Shao SC, Lee WJA. Orbital Apex Syndrome: A Case Series in a Tertiary Medical Center in Southern Taiwan. Front Med (Lausanne) 2022; 9:845411. [PMID: 35345765 PMCID: PMC8957219 DOI: 10.3389/fmed.2022.845411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/04/2022] [Indexed: 12/17/2022] Open
Abstract
Background Orbital apex syndrome (OAS) is a rare ocular complication following by infection, inflammation, trauma, neoplasms, and vascularity. The epidemiological features of OAS remained limited, so this study aimed to present ophthalmic clinical features, determine the causes to evaluate the visual prognosis of orbital apex syndrome (OAS) patients in Taiwan. Methods This was a retrospective study by reviewing the electronic medical records from National Cheng Kung University Hospital in Taiwan during 2017–2019. We included patients diagnosed with OAS to review their ocular symptoms and signs, visual acuity, ocular images, etiologies, treatment and visual prognosis. Results Twenty cases (mean age: 65.55 ± 13.06; male: 75%) with the diagnosis of OAS were included in this study. All patients presented as unilateral involvement, but the initial ocular presentations and etiologies varied. For example, blurred vision was reported in 80% of these patients, and tumor-related compression (55%) and infection (15%) were the most frequent causes for the OAS. After the follow-up, we found 35% of patients' visions declined or worsened to the blindness, 15% of patients' visions remained stable, 20% of patients' visions had mild improvement, and 35% of patients' visions were not measured because of debilitating clinical condition. We identified three OAS patients with mortality (15%), and all of them were attributed to the underlying malignancies. Conclusion The clinical magnifications and etiologies of OAS are heterogeneous in Taiwan. Our findings indicated the tumor-related compression is the most frequent causes of OAS in Taiwan, and it is also related to poor clinical outcomes.
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Affiliation(s)
- Peng-Hsuan Lee
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wan-Ju Annabelle Lee
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan
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5
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Dreizin D, Sakai O, Champ K, Gandhi D, Aarabi B, Nam AJ, Morales RE, Eisenman DJ. CT of Skull Base Fractures: Classification Systems, Complications, and Management. Radiographics 2021; 41:762-782. [PMID: 33797996 DOI: 10.1148/rg.2021200189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As advances in prehospital and early hospital care improve survival of the head-injured patient, radiologists are increasingly charged with understanding the myriad skull base fracture management implications conferred by CT. Successfully parlaying knowledge of skull base anatomy and fracture patterns into precise actionable clinical recommendations is a challenging task. The authors aim to provide a pragmatic overview of CT for skull base fractures within the broader context of diagnostic and treatment planning algorithms. Laterobasal, frontobasal, and posterior basal fracture patterns are emphasized. CT often plays a complementary, supportive, or confirmatory role in management of skull base fractures in conjunction with results of physical examination, laboratory testing, and neurosensory evaluation. CT provides prognostic information about short- and long-term risk of cerebrospinal fluid (CSF) leak, encephalocele, meningitis, facial nerve paralysis, hearing and vision loss, cholesteatoma, vascular injuries, and various cranial nerve palsies and syndromes. The radiologist should leverage understanding of specific strengths and limitations of CT to anticipate next steps in the skull base fracture management plan. Additional imaging is warranted to clarify ambiguity (particularly for potential sources of CSF leak); in other cases, clinical and CT criteria alone are sufficient to determine the need for intervention and the choice of surgical approach. The radiologist should be able to envision stepping into a multidisciplinary planning discussion and engaging neurotologists, neuro-ophthalmologists, neurosurgeons, neurointerventionalists, and facial reconstructive surgeons to help synthesize an optimal management plan after reviewing the skull base CT findings at hand. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- David Dreizin
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Osamu Sakai
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Kathryn Champ
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Dheeraj Gandhi
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Bizhan Aarabi
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Arthur J Nam
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - Robert E Morales
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
| | - David J Eisenman
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.)
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One case of orbital apex syndrome caused by small cell lung cancer metastasis. Rev Neurol (Paris) 2021; 177:1032-1035. [PMID: 33810838 DOI: 10.1016/j.neurol.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/21/2022]
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7
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Robert J, Gomes FE, Porter I, Sumner JP. Orbital apex syndrome secondary to an orbital sarcoma in a dog. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2021; 62:27-31. [PMID: 33390595 PMCID: PMC7739388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 12-year-old castrated male cocker spaniel dog was presented with a 4-week history of left episcleral injection and pawing at the face. Clinical examination findings included left internal and external ophthalmoplegia, left dorsal strabismus, pain opening the mouth, and intermittent amaurosis. Imaging studies revealed a left orbital apex mass with adjacent sphenoid bone lysis and extension into the cranial cavity. A left exenteration was performed and histopathology confirmed an orbital soft tissue sarcoma. Key clinical message: This report describes an orbital tumor causing orbital apex syndrome. This condition should be differentiated from cavernous sinus syndrome as the latter does not course with optic neuropathy.
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Affiliation(s)
- Jayden Robert
- Cornell University - College of Veterinary Medicine, Ithaca, New York, USA
| | | | - Ian Porter
- Cornell University - College of Veterinary Medicine, Ithaca, New York, USA
| | - Julia P Sumner
- Cornell University - College of Veterinary Medicine, Ithaca, New York, USA
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8
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Dhiman S, Anand K, Rastogi A, Dutta P, Jain P, Mishra M, Nagpal V. Orbital apex syndrome secondary to myocysticercosis: a rare case report. Int J Ophthalmol 2020; 13:1013-1014. [PMID: 32566517 DOI: 10.18240/ijo.2020.06.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/17/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- Shweta Dhiman
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Kamlesh Anand
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Anju Rastogi
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Paromita Dutta
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Parul Jain
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Manisha Mishra
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Vaibhav Nagpal
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
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9
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Endoscopic Transethmosphenoid Optic Canal and Orbital Apex Decompression for Patients With Traumatic Orbital Apex Syndrome. J Craniofac Surg 2020; 31:214-218. [DOI: 10.1097/scs.0000000000005904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Yoon JH, Cho SH, Lee SH, Ma SK, Kim SW, Bae EH. Central Diabetes Insipidus Associated with Orbital Apex Syndrome. J NIPPON MED SCH 2019; 86:254-257. [PMID: 31484882 DOI: 10.1272/jnms.jnms.2019_86-409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Orbital apex syndrome (OAS) manifests as multiple cranial nerve palsies caused by an abnormal nerve response to inflammation or other processes. Central diabetes insipidus (CDI) is characterized by deficient synthesis or secretion of antidiuretic hormone. A 62-year-old woman underwent myringotomy for otitis media with effusion. Two months after the procedure, symptoms of hearing loss had not improved, and she underwent left tympanoplasty and mastoidectomy. After surgery, she presented with left ocular pain and visual loss. Neurologic examination revealed ptosis, total ophthalmoplegia, and a relative afferent pupillary defect on the left eye. Magnetic resonance imaging showed an asymmetric contrast-enhancing lesion in the left orbital apex and left cavernous sinus, with adjacent dural thickening and enhancement. OAS was diagnosed, and steroid treatment was started. During the regular follow-up period, she reported polyuria, and CDI was diagnosed. Treatment with intranasal desmopressin 10 μg twice daily was started, and symptoms greatly improved. The mechanism underlying the association of CDI with OAS is unclear, and further research is needed. The present case suggests that polyuria in OAS should alert neurologists and ophthalmologists to possible CDI.
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Affiliation(s)
- Jung Hwan Yoon
- Department of Internal Medicine, Chonnam National University Medical School
| | - Su Hyeon Cho
- Department of Internal Medicine, Chonnam National University Medical School
| | - Seung-Han Lee
- Department of Neurology, Chonnam National University Medical School
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School
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Shokri T, Zacharia BE, Lighthall JG. Traumatic Orbital Apex Syndrome: An Uncommon Sequela of Facial Trauma. EAR, NOSE & THROAT JOURNAL 2019; 98:609-612. [PMID: 31266402 DOI: 10.1177/0145561319860526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Orbital apex syndrome (OAS) is a rare ocular complication following craniomaxillofacial trauma. This traumatic syndrome is a combination of features seen in both superior orbital fissure syndrome and traumatic orbital neuropathy due to nerve impingement. Due in part to the rarity of this disorder, the optimal treatment of traumatic OAS has yet to be determined. We present a case in which traumatic OAS was caused by direct compression due to a displaced fracture segment from the superior orbit. The patient was successfully treated with a combination of emergent decompression and urgent reconstruction suggesting that this may be an effective strategy in OAS resulting from direct nerve compression as a result of craniomaxillofacial fracture.
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Affiliation(s)
- Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Brad E Zacharia
- Department of Neurosurgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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12
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Wadhwani M, Phuljhele S, Kumar R, Shameer A. Cervical carcinoma leading to orbital apex syndrome and blindness. BMJ Case Rep 2019; 12:12/3/e226587. [PMID: 30826777 DOI: 10.1136/bcr-2018-226587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Orbit is an unusual and rare site for metastases from cancer. The most frequent site of a primary malignancy to metastasise to the orbit is the breast, followed by the lung. The malignant mixed mullerian tumour is a rare uterine and cervical carcinoma and accounts for <5% of uterine cancers. It is the primary tumour of the uterus, and de novo involvement of the cervix itself is extremely rare. We report the first case of cervical carcinoma with mixed mullerian aetiology to be associated with orbital metastasis and eventually leading to blindness and death.
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Affiliation(s)
- Meenakshi Wadhwani
- Department of Ophthalmology, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Swati Phuljhele
- Department of Strabismus and Neuroophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Ritesh Kumar
- Radiation Oncology, All India Institute of Medical Sciences, Delhi, New Delhi, India
| | - Abdul Shameer
- Department of Strabismus and Neuroophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
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Kennedy TA, Corey AS, Policeni B, Agarwal V, Burns J, Harvey HB, Hoang J, Hunt CH, Juliano AF, Mack W, Moonis G, Murad GJ, Pannell JS, Parsons MS, Powers WJ, Schroeder JW, Setzen G, Whitehead MT, Bykowski J. ACR Appropriateness Criteria® Orbits Vision and Visual Loss. J Am Coll Radiol 2018; 15:S116-S131. [PMID: 29724415 DOI: 10.1016/j.jacr.2018.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 01/22/2023]
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14
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Jin H, Gong S, Han K, Wang J, Lv L, Dong Y, Zhang D, Hou L. Clinical management of traumatic superior orbital fissure and orbital apex syndromes. Clin Neurol Neurosurg 2018; 165:50-54. [DOI: 10.1016/j.clineuro.2017.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/25/2017] [Accepted: 12/26/2017] [Indexed: 12/20/2022]
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15
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Yang SC, Choi HY, Jeon H. Two Cases of Orbital Apex Syndrome after Blunt Orbital Trauma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.9.893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Cheol Yang
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Hee Young Choi
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyeshin Jeon
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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16
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Prado-Ribeiro AC, Luiz AC, Montezuma MA, Mak MP, Santos-Silva AR, Brandão TB. Orbital apex syndrome affecting head and neck cancer patients: A case series. Med Oral Patol Oral Cir Bucal 2017; 22:e354-e358. [PMID: 28390122 PMCID: PMC5432084 DOI: 10.4317/medoral.21506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/28/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Orbital apex syndrome (OAS) is a complex and uncommon disorder that typically damages multiple cranial nerves in association with optic nerve dysfunction. OAS is associated with several different pathologies, however; only a few cases have been reported in association with head and neck cancer (HNC) so far. MATERIAL AND METHODS A case series of HNC patients diagnosed with OAS is described including clinicopathological data, image findings, and disease outcome. RESULTS Ptosis and diplopia were diagnosed in four male patients with mean age of 61.2 years who were undergoing treatment for late-stage carcinomas of the tongue, larynx, and nasopharynx, eventually leading to the diagnosis of OAS. The mean overall survival rate after the diagnosis of OAS was 9.5 months. CONCLUSIONS The current study reinforces evidence that OAS indicates poor prognosis and highlights the importance of early diagnosis.
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Affiliation(s)
- A-C Prado-Ribeiro
- Instituto do Câncer do Estado de São Paulo, Avenida Doutor Arnaldo, 251, Segundo Andar - Sala 75, São Paulo - SP, Brasil,
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Yuen CA, Pula JH, Mehta M. Primary Ocular Adnexal Extranodal Marginal Zone Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma Presenting as Orbital Apex Syndrome. Neuroophthalmology 2017; 41:94-98. [PMID: 28348632 DOI: 10.1080/01658107.2016.1263343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 12/26/2022] Open
Abstract
A 75-year-old female with a past medical history significant for prior stroke and atrial fibrillation presented with acute onset of orbital apex syndrome with chemosis and periorbital ecchymosis. Following initial treatment to relieve intraocular pressure, she began spontaneously haemorrhaging retro-orbitally. Preliminary investigation with neuroimaging demonstrated a left orbital mass with extension into the orbital apex. A provisional diagnosis of cavernous haemangioma was made. She was treated with transorbital resection of the orbital mass. Subsequent histopathology revealed a diagnosis of ocular adnexal non-Hodgkin lymphoma of histologic type extranodal marginal zone of mucosa-associated lymphoid tissue (MALT lymphoma). MALT lymphoma should be considered in cases of orbital apex syndrome.
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Affiliation(s)
- Carlen A Yuen
- Department of Neurology, University of Chicago , Chicago, Illinois, USA
| | - John H Pula
- Department of Neurology, NorthShore University HealthSystem , Chicago, Illinois, USA
| | - Milap Mehta
- Department of Ophthalmology, NorthShore University HealthSystem , Chicago, Illinois, USA
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Bouchaala W, Dammak M, Bouzidi N, Bellaj H, Gorbel M, Elloumi M, Mhiri C. [Orbital apex syndrome revealing multiple myeloma]. Presse Med 2017; 46:449-452. [PMID: 28233702 DOI: 10.1016/j.lpm.2017.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/06/2016] [Accepted: 01/24/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Wafa Bouchaala
- CHU Habib Bourguiba, service neurologie, 7, rue El-Ferdaous, 3029 Sfax, Tunisie; Université de Sfax, faculté de médecine, laboratoire de recherche en neurogénétique, maladie de Parkinson et maladies cérébro-vasculaires, LR-12-SP-19, boulevard Majida-Boulila, 3029 Sfax, Tunisie.
| | - Mariem Dammak
- CHU Habib Bourguiba, service neurologie, 7, rue El-Ferdaous, 3029 Sfax, Tunisie; Université de Sfax, faculté de médecine, laboratoire de recherche en neurogénétique, maladie de Parkinson et maladies cérébro-vasculaires, LR-12-SP-19, boulevard Majida-Boulila, 3029 Sfax, Tunisie
| | - Nouha Bouzidi
- CHU Habib Bourguiba, service neurologie, 7, rue El-Ferdaous, 3029 Sfax, Tunisie; Université de Sfax, faculté de médecine, laboratoire de recherche en neurogénétique, maladie de Parkinson et maladies cérébro-vasculaires, LR-12-SP-19, boulevard Majida-Boulila, 3029 Sfax, Tunisie
| | - Hatem Bellaj
- CHU Hédi Chaker, service d'hématologie, rue El-Ferdaous, 3029 Sfax, Tunisie
| | - Manel Gorbel
- CHU Hédi Chaker, service d'hématologie, rue El-Ferdaous, 3029 Sfax, Tunisie
| | - Moez Elloumi
- CHU Hédi Chaker, service d'hématologie, rue El-Ferdaous, 3029 Sfax, Tunisie
| | - Chokri Mhiri
- CHU Habib Bourguiba, service neurologie, 7, rue El-Ferdaous, 3029 Sfax, Tunisie; Université de Sfax, faculté de médecine, laboratoire de recherche en neurogénétique, maladie de Parkinson et maladies cérébro-vasculaires, LR-12-SP-19, boulevard Majida-Boulila, 3029 Sfax, Tunisie
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Yoo JH, Nam KY, Lee SU, Lee SJ. Orbital Apex Syndrome after Uneventful Phacoemulsification. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.12.1994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae Ho Yoo
- Department of Ophthalmology, Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Ki Yup Nam
- Department of Ophthalmology, Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Seung Uk Lee
- Department of Ophthalmology, Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Sang Joon Lee
- Department of Ophthalmology, Gospel Hospital, Kosin University College of Medicine, Busan, Korea
- Institute for Medicine, Kosin University College of Medicine, Busan, Korea
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Jensen H, Thomsen ST, Hansen SS, Munksgaard SB, Lindelof M. Superior Orbital Fissure Syndrome and Ophthalmoplegia Caused by Varicella Zoster Virus with No Skin Eruption in a Patient Treated with Tumor Necrosis Alpha Inhibitor. Case Rep Neurol 2015; 7:221-6. [PMID: 26600786 PMCID: PMC4649727 DOI: 10.1159/000441325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Varicella zoster virus lies dormant in the dorsal root ganglia after symptomatic chicken pox infection, usually in childhood. If the virus reactivates in the trigeminal ganglia, it can cause varicella zoster ophthalmicus, which can have severe ocular complications. We report a case of a 73-year-old woman in severe immunosuppression due to treatment with mycophenolate mofetil, glucocorticosteroids and a tumor necrosis factor alpha inhibitor. The reactivation caused superior orbital fissure syndrome, which has only rarely been described in relation to varicella zoster virus reactivation. In our case, the syndrome was seen along with severe encephalitis.
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Celik T. Ocular adnexal marginal zone B cell lymphoma presenting with orbital apex syndrome. J Fr Ophtalmol 2015; 38:e215-7. [PMID: 26314898 DOI: 10.1016/j.jfo.2015.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/31/2015] [Accepted: 04/10/2015] [Indexed: 11/15/2022]
Affiliation(s)
- T Celik
- Department of ophthalmology, Bolu Gerede State hospital, Seviller street, 14900 Gerede-Bolu, Turkey.
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Abstract
A 68-year-old man presented with periorbital pain with progressive decrease in visual acuity of the right eye. The patient began to experience these symptoms 6 months ago, but they had become significantly worse in the last month. On examination, the patient had ptosis, proptosis, and impaired movement of the right eye. His medical history was notable for peripheral T-cell lymphoma. During chemotherapy, he had developed pulmonary aspergillosis, which resolved with antifungal medication. The magnetic resonance imaging scan, which was taken because of orbital symptoms, was suggestive of optic neuritis. For 6 months, his visual symptoms deteriorated and improved with intermittent steroid treatment. However, the patient began to experience worsening pain and visual disturbance for the month leading up to the referral visit and could not recognize light in the involved eye. A repeat magnetic resonance imaging study revealed a diffuse involvement of right orbital apex. Subsequent to this finding, an endoscopic biopsy was performed. The pathologic examination confirmed the diagnosis of invasive aspergillosis. Orbital pain, ptosis, and limitation of eye movements improved with antifungal medication, and the patient was able to recognize hand movements.
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Shazly TA, Mitchell EB, Bonhomme GR, Schuman JS. Lymphoma of the orbit masquerading as Tolosa-Hunt syndrome. BMC Ophthalmol 2015; 15:51. [PMID: 25971316 PMCID: PMC4450859 DOI: 10.1186/s12886-015-0037-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/19/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tolosa-Hunt syndrome is a rare clinical syndrome characterized by painful ophthalmoplegia and ipsilateral cranial neuropathies. It is caused by an inflammatory process of unknown etiology. CASE PRESENTATION We present a case of a 77-year-old white man with history of Waldenstrom's macroglobulinemia transforming to large B-cell lymphoma who presented to a community physician complaining of 4 months of isolated right retro-orbital pain and later with diplopia, ptosis, 6th nerve and pupil-sparing partial 3rd nerve palsies as well as progressive neurological findings. His clinical course was complicated by debilitating neurological symptoms and multiple hospitalizations leading to a delay in diagnosis caused by incomplete initial workup. CONCLUSION This case is a reminder that lymphoproliferative disorders often mimic other neurologic disorders and that Tolosa-Hunt is a rare diagnosis that must be considered a diagnosis of exclusion.
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Affiliation(s)
- Tarek A Shazly
- UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,, 203 Lothrop St, Pittsburgh, PA, 15213, USA.
| | - Ellen B Mitchell
- UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Gabrielle R Bonhomme
- UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Joel S Schuman
- UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Gupta R, Khan YA. Traumatic orbital apex syndrome. Can J Ophthalmol 2015; 50:e8-e11. [DOI: 10.1016/j.jcjo.2014.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/21/2014] [Accepted: 10/13/2014] [Indexed: 11/25/2022]
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Singh H, Kandel R, Nisar S, Das CJ, Dey AB. An unexpected cause of orbital apex syndrome in an immune-competent elderly male. Oxf Med Case Reports 2014; 2014:115-7. [PMID: 25988050 PMCID: PMC4369989 DOI: 10.1093/omcr/omu045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/28/2023] Open
Abstract
Invasive aspergillosis causing orbital apex syndrome (OAS) in an immune-competent individual is a very rare phenomenon, scarcely reported in medical literature. A 68-year-old male presented with progressive loss of vision in the right eye, starting after a cataract surgery. Neurological examination suggested OAS. Imaging was suggestive of mass lesion causing destruction of ethmoid bone. Biopsy of the lesion could not be done initially in view of its proximity to the major neuro-vascular bundle in the orbital apex and cavernous sinus and the major risk involved in the procedure relative to its yield. There was no response to empirical therapy with antibacterials, steroids or Amphotericin-B. Gradually the mass increased in size and was amenable to biopsy. Endoscopy guided biopsy revealed invasive aspergillosis. Switching over to voriconazole lead to successful management. This case highlights the importance of early diagnosis and selection of an appropriate antifungal therapy in the management of invasive aspergillosis.
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Affiliation(s)
- Harjit Singh
- Department of Geriatric Medicine , All India Institute of Medical Sciences , New-Delhi , India
| | - Ramesh Kandel
- Department of Geriatric Medicine , All India Institute of Medical Sciences , New-Delhi , India
| | - Sobia Nisar
- Department of Geriatric Medicine , All India Institute of Medical Sciences , New-Delhi , India
| | - Chandan J Das
- Department of Radiology , All India Institute of Medical Sciences , New-Delhi , India
| | - Aparajit Ballav Dey
- Department of Geriatric Medicine , All India Institute of Medical Sciences , New-Delhi , India
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Métastase orbitaire d’un cancer du sein révélée par un syndrome de l’apex orbitaire : à propos d’un cas. IMAGERIE DE LA FEMME 2014. [DOI: 10.1016/j.femme.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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