Periocular squamous cell carcinoma

The definitive version is available at www.blackwell-synergy.comSquamous cell carcinoma (SCC) is the second most common eyelid malignancy and its incidence is increasing. Because of its variable clinical presentation, SCC may be difficult for even the experienced clinician to diagnose. Hence, all suspicious lesions warrant biopsy. As SCC behaviour may range widely in aggression, management should be individualized based on tumour (e.g. size, location, grade, histological subtype, previous recurrence, perineural invasion) and patient factors (e.g. age, health). Treatment of eyelid SCC should include margin control whenever possible for the highest cure rate in this high-risk area. Immediate histological monitoring of surgical margins with frozen sections or Mohs’ micrographic surgery also allows for smaller margins of excision in an area where tissue conservation is important. Other special considerations in the periocular area include maintaining a high level of suspicion for perineural invasion as this may be associated with a poorer prognosis.Vanessa Limawararut, Igal Leibovitch, Tim Sullivan and Dinesh Selv

Squamous cell carcinoma presenting as an orbital cyst with radiologic evidence of perineural invasion

PurposeTo report clinical and radiologic findings of cystic squamous cell carcinoma (SCC) of the orbit with evidence of perineural involvement.MethodsAnalysis of clinical findings and radiology with a literature review.ResultsA 66-year-old man with SCC of the forehead 8 years prior presented with paraesthesias, diplopia, and proptosis. Magnetic resonance imaging showed a well-defined, cystic mass of the orbit with a single, linear structure running through its center. Lateral orbitotomy revealed a cyst adherent to adjacent periorbita containing viscous, clear, yellow substance and a nerve coursing through the center. Histopathology confirmed poorly differentiated spindle cell carcinoma with positive staining for cytokeratin markers, consistent with SCC.ConclusionsOrbital cysts associated with altered sensation are suggestive of SCC with perineural spread, requiring prompt investigation and treatment to minimize morbidity and mortality. The involved nerve may be seen as a single, linear structure within the mass on imaging

Recurrent multiple cavernous hemangiomas of the orbit in association with systemic tumors

PurposeTo report the clinical findings and management of multiple, recurrent cavernous hemangiomas of the orbit in a patient with concurrent liver involvement.DesignInterventional case report.MethodsAn analysis of clinical findings, radiology and treatment was conducted with a literature review.ResultsA 35-year-old woman with blurry vision and proptosis was found to have multiple cavernous hemangiomas of the orbit. The tumors were excised completely without complication, and the patient subsequently regained her vision. Fifteen years later, the patient had recurrent, multiple cavernous hemangiomas in the same orbit. Further investigations for vague back pain revealed a presumed cavernous hemangioma in the liver and a presumed schwannoma arising from the neural foramen of the spine at the level of T2 through T4.ConclusionMultiple cavernous hemangiomas may recur after complete excision and may exist with concurrent systemic tumors.Vanessa Limawararut, Garry Davis, John Crompton, Igal Leibovitch and Dinesh Selvahttp://www.elsevier.com/wps/find/journaldescription.cws_home/601028/description#descriptio

Novel technique to control hypersecretion from a transplanted autologous submandibular salivary gland for keratoconjunctivitis Sicca

PurposeTo present a novel technique to control hypersecretion from a transplanted autologous submandibular gland (SMG) in a patient with keratoconjunctivitis sicca.MethodsA 65-year-old man presented with corneal epithelial edema and suspicious ocular surface dysplasia secondary to hypersecretion from a transplanted autologous SMG. The location and function of the gland were evaluated perioperatively using technetium-99m-pertechnetate scintigraphy. The course of the duct was marked with a radiation probe, surgically exposed, and partially ligated with titanium clips.ResultsMarked reduction in salivary flow and resolution of corneal edema and ocular surface changes were noted. Conjunctival biopsy showed no evidence of malignancy. Symptoms were stable during a 1-year follow-up period.ConclusionPartial ligation of the transplanted SMG duct may be a simple and reversible technique to control hypersecreting glands with secondary corneal edema and ocular surface changes.Igal Leibovitch, Erika Hoyama, Vanessa Limawararut, John Crompton and Dinesh Selv

Tarsomarginal graft in upper eyelid coloboma repair

Copyright © 2007 American Association for Pediatric Ophthalmology and Strabismus Published by Mosby, Inc.Eyelid colobomas are congenital defects caused by failure of fusion of the mesodermal lid folds. The timing and approach to surgical repair depend on the severity of the defect and exposure keratopathy. Tarsomarginal grafts have been well described in eyelid reconstructions following tumor excision. Descriptions of lid coloboma repair using this approach are limited. We describe a series of upper lid colobomas repaired with the tarsomarginal graft.Erika Hoyama, Vanessa Limawararut, Raman Malhotra, James Muecke and Dinesh Selvahttp://www.elsevier.com/wps/find/journaldescription.cws_home/623140/description#descriptio

Blinding orbital cellulitis: A complication of strabismus surgery

A 56-year-old healthy man underwent left medial rectus recession and lateral rectus resection for esotropia. The next day he developed severe left periocular pain with decreased vision, an afferent pupillary defect, periorbital edema, limited ocular motility, and proptosis. Computed tomography showed fat stranding and less than 90 degrees of posterior globe tenting. Despite intravenous antibiotics to treat orbital cellulitis, and a lateral canthotomy and cantholysis to decompress the orbit, visual acuity worsened to no light perception. The patient underwent emergent orbital decompression including release of the superior and inferior septum and outfracturing of the orbital floor and medial wall; however, there was no recovery of vision. Blinding orbital cellulitis is a rare complication after strabismus surgery. Despite poor prognosis, prompt diagnosis and aggressive treatment may maximize visual potential

Sino-orbital fistula - A complication of exenteration

Purpose: To report the incidence, characteristics, and management of sino-orbital fistulas, a complication of orbital exenteration. Design: Retrospective interventional case series. Participants: One hundred ten patients who underwent orbital exenteration at 2 orbital units. Methods: Retrospective chart review of all cases of orbital exenteration between 1993 and 2005 at one orbital unit and between 1999 and 2005 at a second orbital unit. Main Outcome Measures: Incidence of sino-orbital fistulas. Results: Seventy-three and 37 orbital exenterations were performed at the first and second orbital units, respectively. Five patients developed sino-orbital fistulas, 1 of whom developed 2 fistulas at separate sites. In the first unit, 4 fistulas developed in 3 of 73 (4.1%) patients who underwent orbital exenteration. In the second unit, 2 fistulas developed in 2 of 37 (5.4%) exenterated orbits. The majority (5/6) of fistulas occurred medially to the ethmoid sinus, whereas 1 occurred superiorly to the frontal sinus. Risk factors that may have contributed to fistula formation include radiotherapy (3/6), sinus disease (3/6), intraoperative penetration into a sinus (3/6), and immunocompromise (1/6). Management was tailored to the individual case and ranged from conservative socket hygiene to surgical repair with grafts or flaps. Four of the 6 fistulas recurred after repair. Three of these subsequently were closed successfully. Only 1 fistula persisted until the patient died from malignant disease. Conclusions: Sino-orbital fistulas are uncommon but not rare complications of orbital exenteration that may be predicted by several risk factors. Bothersome symptoms may necessitate treatment, which can range from conservative management to surgical repair with various grafts or flaps. Despite repair, fistulas may be difficult to eradicate

Cerebrospinal fluid leaks in orbital and lacrimal surgery

Copyright © 2008 Elsevier Inc. All rights reserved.Cerebrospinal fluid leakage is an uncommon but significant complication of orbital and rarely lacrimal surgery which may have serious consequences including death. In a retrospective review of four orbital units, we report an incidence of cerebrospinal fluid leak (diagnosed intraoperatively) during exenteration, orbital decompression, and dacryocystorhinostomy of 1/154 (0.6%), 4/397 (1%), and 0/3,504 (0%), respectively. We found two additional cases of cerebrospinal fluid leaks associated with excision of orbital masses involving the orbital roof. In the literature, the incidence of cerebrospinal fluid leaks associated with orbital exenterations and decompressions was 1.6-16.7% and 0-10%, respectively. Cerebrospinal fluid leaks occur very rarely in dacryocystorhinostomies with only a few case reports found in the literature. Preventative measures, diagnosis, and management of this complication are discussed. Knowledge of anatomy and thorough preoperative assessment may predict areas at high risk for encountering cerebrospinal fluid leaks. Proper surgical technique further minimizes the risk for this complication. If a cerebrospinal fluid leak occurs, however, prompt diagnosis and management usually results in uncomplicated recovery.Vanessa Limawararut, Alejandra A. Valenzuela, Timothy J. Sullivan, Alan A. McNab, Raman Malhotra, Garry Davis, Nigel Jones and Dinesh Selvahttp://www.elsevier.com/wps/find/journaldescription.cws_home/600337/description#descriptio