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P.246 Pleomorphic malignant flbrous histiocytoma of the orbital
Posters
Orbital pathology and surgery
S229
and maxillary sinuses. The patient was diagnosed with acute orbital infection and was started on IV antibiotic treatment. After 24 hours the eye examination revealed increasing tension of the periorbital swelling with marked proptosis and increased intraocular pressure. Visual acuity had decreased from 10/10 to 3/10. A new CT scan showed a retrobulbar orbital abscess. Orbital decompression using an infra-orbital approach was immediately performed under general anaesthesia. The Caldwell-Luc approach was used to drain the sinuses and an antrostomy was performed. Two drainage tubes were inserted along the orbital floor and one in the vestibular area. The proptosis and swelling began to settle postoperatively and visual acuity was 10/10 with a full range of ocular movements.
blepharoplasty approach, avoiding eyelid elevator in a safe plane under orbicularis. after the periostum was separated, we practised an osteotomy of the ridge in the middle portion. we extracted the osteoma through this osteotomy and then we proceded to reconstruct the defect with allogenous bone and a resorbable membrane, fixed with a miniplate to support the orbital roof. the follow-up extends for three months without any collateral effect. in conclusions: we think that this via of approaching is valid for some lessions in the supraorbital ridge and avoid adverse effects of others approaching systems. the aim of this paper is to describe the surgical technique and to show an alternative in the treatment of selected patients with these type of pathology.
P.246 Pleomorphic malignant fibrous histiocytoma of the orbital Jk. Kohlhof, O. Driemel, S. Vukelic-Markovic, M. Kochel, T. Reuther, U. M¨uller-Richter. Dpt. Oral and Maxillofacial Plastic Surgery, W¨urzburg, Germany
S. Kushida, T. Takemoto, N. Kakudo, T. Uesaka, A. Asai, K. Kusumoto. Department of Plastic and Reconstructive Surgery, Kansai Medical University, Moriguchi, Japan
Background: Pleomorphic malignant fibrous histiocytomas (undifferentiated pleomorphic sarcomas) belong to the soft tissue tumours and are more likely in elder patients. About 3% percent of all pleomorphic malignant fibrous histiocytomas arise in the head and neck region. 30% of these histiocytomas develop in the paranasal sinuses. Occurrence in the periorbital region is a very rare event. In spite of their pleomorphic pattern the treatment is solely surgical excision. Haematogenic or locoregional lymphogenic metastases are very rare. Patient: A 91 year old female patient presented because of a prominent tumour in the upper right periorbital region. As stated in the case history, the tumour had developed within the previous 6 months. The tumour measured about 3×4 cm. It was tight to resiliant and seemed to not be adherent to the underlying structures. Pain or hypesthaesia were not existent. Due to the mass of the tumour a ptosis was present. Additionally, there was a mechanical lack in the movement of the eyeball in the upper direction. The papilla was vital and differentiated. Visual acuity was decreased due to a mature cataract. Clinic: Neither CT nor MRI could give a clue to the tumour entity. Infiltration of the periorbital structures or the eyeball could not be ruled out. A biopsy was classified as a malignant fibrous tumour with the subclassification of an atypical fibroxanthoma. The final histopathological classification after total excision of the tumour showed perineural growth and angioinvasion. Therefore the tumour classification was changed to pleomorphic malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma). The defect was closed with a full skin graft on the basis of a galea periosteal flap. Conclusion: The histopathological examination could not provide the correct diagnosis initially. Immunohistochemical stainings (Vimentin) were carried out to characterise the tumour. This underlines that even with state of the art procedures the classification of neoplasias can be very difficult. In the process of finding the right diagnosis sometimes a change from benign to malignant occurs and alters the treatment regime. P.247 Sinus frontal osteoma: approach via upper blepharoplasty J. Plasencia, O. Altura Guillen, J.J. Sanchez Peraza, P. Martos, M. Suaer. Hospital NTRA. SRA. de Candelaria, Santa Cruz de Tenerife, Spain We present the case of a 42 years old male with a lession in the supraorbital rim that growth slowly for 2 years. CT scan showed a mass of 2 cms that involved the right portion of the frontal sinus, affecting the supraorbital ridge. the diagnosis was osteoma due to its character. the patient underwent surgery by means of
P.248 Subperiosteal hematoma of the orbit with bone resorption
Orbital hematoma is mostly associated with injury to the head/neck, but occasionally with hematological disease, vascular abnormalities, or the spread of inflammation due to paranasal sinus disease. The patient was a 54-year-old male without a history of trauma and underlying disease whose chief complaint was exophthalmos. MRI and CT scan revealed orbital mass with Peripheral bone resorption. Considering the possibility of malignancy accompanied by bone infiltration, the tumor was resected by temporal craniotomy. Based on findings during surgery and those of pathological examination, orbital hematoma was diagnosed. The patient’s clinical course was favorable without major complications. P.249 Two cases of idiopathic orbital inflammation T. Minakata, K. Kusumoto, A. Simotsuma, T. Matsushima, S. Fukuda, S. Onishi. Kansai Medical University, Osaka, Japan The idiopathic orbital inflammation (IOI), which is a pseudotumor, occurs in orbit. IOI gradually grows and occupies the orbital space in sometimes. The clinical features are often as same as in the other genuine orbital tumors. The histo-pathological diagnosis is much indispensable. Here two cases, which have developed to different clinical courses and were lastly diagnosed as IOI on histo-pathological examination, are presented. The first case, a 61 year-old man, complained double vision. Orbital fractures was confirmed in CT. When the scar contracture in the orbit was released, the small tissue sample was taken because it was very hard. Postoperatively the eye ball movement was improved for short period. After that the visual ability weakened, at last resulted in blind. At the time periorbital and cheek skin have become hard. The degree of opening mouth has been limited in 25 mm. Angitis (Wegener granuloma or Periarteritis Nodosa) was noted as a result of lung biopsy in another hospital and now are treated. In the second case, a 55 year-old man, eyelid swelling was a main complaint. The tumor like shadow at supra-lateral orbit was confirmed in MRI. Although biopsy was performed percutaneously, the histo-pathological diagnosis couldn’t be gained. In the operation under general anesthesia malignancy was not confirmed, and partial resection of the tumor was performed. Postoperativly the tumor shadow and the lid swelling have gradually reduced.
Orbital pathology and surgery
S229
and maxillary sinuses. The patient was diagnosed with acute orbital infection and was started on IV antibiotic treatment. After 24 hours the eye examination revealed increasing tension of the periorbital swelling with marked proptosis and increased intraocular pressure. Visual acuity had decreased from 10/10 to 3/10. A new CT scan showed a retrobulbar orbital abscess. Orbital decompression using an infra-orbital approach was immediately performed under general anaesthesia. The Caldwell-Luc approach was used to drain the sinuses and an antrostomy was performed. Two drainage tubes were inserted along the orbital floor and one in the vestibular area. The proptosis and swelling began to settle postoperatively and visual acuity was 10/10 with a full range of ocular movements.
blepharoplasty approach, avoiding eyelid elevator in a safe plane under orbicularis. after the periostum was separated, we practised an osteotomy of the ridge in the middle portion. we extracted the osteoma through this osteotomy and then we proceded to reconstruct the defect with allogenous bone and a resorbable membrane, fixed with a miniplate to support the orbital roof. the follow-up extends for three months without any collateral effect. in conclusions: we think that this via of approaching is valid for some lessions in the supraorbital ridge and avoid adverse effects of others approaching systems. the aim of this paper is to describe the surgical technique and to show an alternative in the treatment of selected patients with these type of pathology.
P.246 Pleomorphic malignant fibrous histiocytoma of the orbital Jk. Kohlhof, O. Driemel, S. Vukelic-Markovic, M. Kochel, T. Reuther, U. M¨uller-Richter. Dpt. Oral and Maxillofacial Plastic Surgery, W¨urzburg, Germany
S. Kushida, T. Takemoto, N. Kakudo, T. Uesaka, A. Asai, K. Kusumoto. Department of Plastic and Reconstructive Surgery, Kansai Medical University, Moriguchi, Japan
Background: Pleomorphic malignant fibrous histiocytomas (undifferentiated pleomorphic sarcomas) belong to the soft tissue tumours and are more likely in elder patients. About 3% percent of all pleomorphic malignant fibrous histiocytomas arise in the head and neck region. 30% of these histiocytomas develop in the paranasal sinuses. Occurrence in the periorbital region is a very rare event. In spite of their pleomorphic pattern the treatment is solely surgical excision. Haematogenic or locoregional lymphogenic metastases are very rare. Patient: A 91 year old female patient presented because of a prominent tumour in the upper right periorbital region. As stated in the case history, the tumour had developed within the previous 6 months. The tumour measured about 3×4 cm. It was tight to resiliant and seemed to not be adherent to the underlying structures. Pain or hypesthaesia were not existent. Due to the mass of the tumour a ptosis was present. Additionally, there was a mechanical lack in the movement of the eyeball in the upper direction. The papilla was vital and differentiated. Visual acuity was decreased due to a mature cataract. Clinic: Neither CT nor MRI could give a clue to the tumour entity. Infiltration of the periorbital structures or the eyeball could not be ruled out. A biopsy was classified as a malignant fibrous tumour with the subclassification of an atypical fibroxanthoma. The final histopathological classification after total excision of the tumour showed perineural growth and angioinvasion. Therefore the tumour classification was changed to pleomorphic malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma). The defect was closed with a full skin graft on the basis of a galea periosteal flap. Conclusion: The histopathological examination could not provide the correct diagnosis initially. Immunohistochemical stainings (Vimentin) were carried out to characterise the tumour. This underlines that even with state of the art procedures the classification of neoplasias can be very difficult. In the process of finding the right diagnosis sometimes a change from benign to malignant occurs and alters the treatment regime. P.247 Sinus frontal osteoma: approach via upper blepharoplasty J. Plasencia, O. Altura Guillen, J.J. Sanchez Peraza, P. Martos, M. Suaer. Hospital NTRA. SRA. de Candelaria, Santa Cruz de Tenerife, Spain We present the case of a 42 years old male with a lession in the supraorbital rim that growth slowly for 2 years. CT scan showed a mass of 2 cms that involved the right portion of the frontal sinus, affecting the supraorbital ridge. the diagnosis was osteoma due to its character. the patient underwent surgery by means of
P.248 Subperiosteal hematoma of the orbit with bone resorption
Orbital hematoma is mostly associated with injury to the head/neck, but occasionally with hematological disease, vascular abnormalities, or the spread of inflammation due to paranasal sinus disease. The patient was a 54-year-old male without a history of trauma and underlying disease whose chief complaint was exophthalmos. MRI and CT scan revealed orbital mass with Peripheral bone resorption. Considering the possibility of malignancy accompanied by bone infiltration, the tumor was resected by temporal craniotomy. Based on findings during surgery and those of pathological examination, orbital hematoma was diagnosed. The patient’s clinical course was favorable without major complications. P.249 Two cases of idiopathic orbital inflammation T. Minakata, K. Kusumoto, A. Simotsuma, T. Matsushima, S. Fukuda, S. Onishi. Kansai Medical University, Osaka, Japan The idiopathic orbital inflammation (IOI), which is a pseudotumor, occurs in orbit. IOI gradually grows and occupies the orbital space in sometimes. The clinical features are often as same as in the other genuine orbital tumors. The histo-pathological diagnosis is much indispensable. Here two cases, which have developed to different clinical courses and were lastly diagnosed as IOI on histo-pathological examination, are presented. The first case, a 61 year-old man, complained double vision. Orbital fractures was confirmed in CT. When the scar contracture in the orbit was released, the small tissue sample was taken because it was very hard. Postoperatively the eye ball movement was improved for short period. After that the visual ability weakened, at last resulted in blind. At the time periorbital and cheek skin have become hard. The degree of opening mouth has been limited in 25 mm. Angitis (Wegener granuloma or Periarteritis Nodosa) was noted as a result of lung biopsy in another hospital and now are treated. In the second case, a 55 year-old man, eyelid swelling was a main complaint. The tumor like shadow at supra-lateral orbit was confirmed in MRI. Although biopsy was performed percutaneously, the histo-pathological diagnosis couldn’t be gained. In the operation under general anesthesia malignancy was not confirmed, and partial resection of the tumor was performed. Postoperativly the tumor shadow and the lid swelling have gradually reduced.