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Based on the patient's presentation and imaging findings, namely a soft-tissue mass centered in the maxillary sinus with bony remodeling with hyperintensity on T2 MRI, a diagnosis of maxillary sinus mucocele was reached. This soft tissue mass eroded into the right orbital floor, extending into the right extraconal space.
Figures 3-5: Pansinusitis with heterogeneous mucosal thickening is seen in the bilateral maxillary sinuses, the nasal cavity, the ethmoid sinuses, the sphenoid sinuses, and the right frontal sinus. No bony erosion is evident.
CT of the orbits and the paranasal sinuses is essential. Evidence of sinusitis mandates otolaryngology involvement. Lumbar puncture is necessary if meningeal signs and symptoms develop. Conjunctival cultures add very little information. Nasal cultures may be appropriate if there is significant nasal discharge in the setting of sinusitis.
Since the cavernous sinus and its walls contain a component of the third, fourth, fifth (ophthalmic and maxillary branches), and sixth CN as well as the carotid artery and sympathetic plexus, a lesion that impinges or irritates the cavernous sinus can affect some or all of these structures.
This allows for expansion of orbital contents into the maxillary sinus. Decompression may be performed just medial to the infraorbital nerve (largest area with the most benefit in decompressing the optic nerve) or may be both medial and lateral to the infraorbital nerve. The optic strut is often left intact to minimize globe displacement.
A case report and treatment guide for idiopathic orbital myositis, a rare inflammatory condition of the extraocular muscles. Learn about the clinical presentation, differential diagnosis, imaging, and management of this disorder.
Figure 3: Coronal CTs of the parasinuses demonstrate completely opacified and atelectatic maxillary sinus with inward bowing of all of the left maxillary sinus walls; increased left orbital volume with enophthalmos; lateralized left uncinate process which apposes to the inferomedial orbital wall; deviated nasal septum; mild mucosal thickening of multiple ethmoid air cells bilaterally; enlarged ...
Learn about the causes, symptoms, and treatment of TED, an autoimmune inflammatory disease of the eye and surrounding tissues. TED can cause eyelid lag in downgaze, a sign of orbital congestion and inflammation.
Disease limited to the orbit alone or orbit and sinuses, such as in our patient, has been reported to show a more polymorphous pattern of infiltrative cells, which includes plasma cells, histiocytes, epithelioid cells and eosinophils compared to patients with systemic ANCA-associated granulomatous vasculitis (Ahmed 2008, Fecher 2002).
The patient also has glaucoma, redundant periumbilical skin, maxillary hypoplasia, and teeth anomalies. Posterior embryotoxon is a prominent white line running parallel to the limbus on the endothelial surface of the peripheral cornea. It is present in nearly all patients with Axenfeld-Rieger syndrome, but can also be seen in normal individuals.