ABSTRACT
INTRODUCTION: Paranasal sinus mucoceles are epithelialized cystic masses formed through the accumulation of sterile mucus. Mucoceles are expansile lesions, and their symptoms change according to their extension into the surrounding structures: anteriorly to the subcutaneous tissue, laterally to the orbit, or posteriorly to the cranium. Herein, we report the case of a pediatric patient with an isolated subcutaneous mucocele with no sinus connection. PRESENTATION OF CASE: Physical examination revealed a non-tender fluctuating round mass approximately 4 cm in diameter in the right supraorbital region. Computed tomography and magnetic resonance imaging findings suggested a mucocele, and the diagnosis was confirmed via histopathological examinations postoperatively. The patient underwent a combined surgical approach that included an endoscopic transseptal approach to the frontal sinus with a right sub-brow incision and drain placement. The right frontal sinus was opened, and the mucocele was marsupialized. At the 3-month follow-up visit, the frontal sinus neo-ostium appeared patent on endoscopic examination, and the frontal sinuses were clear on imaging. DISCUSSION: The optimal treatment for frontal mucoceles is marsupialization and adequate sinus drainage. As the patient had an isolated subcutaneous extra-sinus mucocele above the orbit, a combined approach was used to ensure thorough removal of the lesion to reduce the recurrence rate. CONCLUSION: This report emphasizes the importance of using a combined approach for the removal of lesions and limiting the potential risk of recurrence in similar cases.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Adenoid cystic carcinoma (ACC) is an uncommon malignant epithelial tumor of the salivary and lacrimal glands. Orbital ACC is rare, originating commonly from the lacrimal gland, with only a few cases reported without lacrimal gland involvement. Deep orbital ACC may be associated with extension into skull base structures, and further intracranial invasion. CASE PRESENTATION: We report a 47-year-old gentleman who presented with insidious onset of bilateral proptosis, left ophthalmoplegia, and loss of vision. Imaging revealed left orbital infiltrative mass with intracranial invasion and bilateral cavernous sinus extension. The lacrimal gland was not involved clinically nor radiologically. Histopathology showed ACC with classical cribriform pattern. There was no evidence of primary source of tumor or metastasis. DISCUSSION: ACC of the orbit commonly originates from the lacrimal gland. Only a few cases of orbital ACC without lacrimal gland involvement were found in English literature. Workup for our patient did not reveal a primary source of tumor. Tumor may have risen from ectopic orbital lacrimal gland tissue, extension from non-orbital sites, or through perineural or hematogenous spread. Only one case of bilateral cavernous sinus extension has been previously reported. Treatment for advanced orbital ACC is exenteration in most cases. However, due to the advanced nature of disease in our patient, palliative radiotherapy was the treatment of choice. CONCLUSION: Orbital ACC of non-lacrimal origin is rare and is associated with high morbidity and mortality. Early recognition and treatment are key for preventing organ and life-threatening complications such as advanced intracranial spread.
ABSTRACT
PURPOSE: To evaluate treatment outcomes of unilateral versus bilateral congenital nasolacrimal duct (NLD) obstruction in patients with Down syndrome and highlight the effect of associated features that could result in poor outcomes. METHODS: A total of 34 lacrimal drainage systems (LDSs) were treated in 22 patients with Down syndrome who had a mean age of 47 (± 41.8) months. Charts of patients with Down syndrome with congenital NLD obstruction who had been treated in a university hospital with irrigation, probing, and intubation between 1998 and 2008 were reviewed. Clinical features were correlated to the documented intraoperative observations and postoperative results. RESULTS: Patients with unilateral disease had a higher success rate (n = 10; 90%) than bilateral cases (n = 24; 45.8%) regardless of the procedure type. Most of the treated LDSs in patients older than 64 months were successful (n = 11 of 12; 91.7%). Single LDSs that underwent irrigation only (2.9%) failed, probing had 60% success (n = 10; 29.4%), and intubation had 60.9% success (n = 23; 67.7%). Four LDSs were treated successfully by Y-V plasty simultaneously with intubation. Lower-end NLD obstruction at the level of Hasner's valve showed a 100% success rate (n = 7) compared with multiple obstructions with a 41.7% success rate (n = 27). CONCLUSION: Unilateral disease and lower-end NLD obstruction are good prognostic factors. Careful punctal evaluation and management is advisable, and a possible delay of operative intervention in bilateral cases in patients 5 years and older aimed at improving hypotonia may be a wise decision.
