Tripod fractures consists of what?
Zygomaticomaxillary suture, zygomaticofrontal suture, and zygomatic arch
Orbital floor
Lefort I
low transverse fracture of maxillary bone above teeth
Lefort II
pyramidal fracture of nasal, lacrimal and maxillary bones
involves medial orbital floors
Lefort III
craniofacial dysjunction
orbital floor, lateral and medial walls
may involve optic canal
Atrophia bulbi
3 stages: without shrinkage, with shrinkage, with shrinkage and disorganization
Increased risk of malignancy
Annual B scan
Orbital psuedotumor
Bilateral in 33%
Eosinophilia, elevated ESR, positive ANA
Enlargement of EOM and tendons
B scan: acoustically hollow area corresponding to edematous Tenons
Orbital myositis
MR and LR most common (33% each), IR (10%)
Tolosa-Hunt syndrome
localized to superior orbital fissure, optic canal, cavernous sinus
-painful ophthalmoplegia and decreased vision
Neurosarcoid most commonly affects which CN
7
Direct carotid-cavernous sinus fistula
HIGH flow
assoc with head trauma (basal skull fx), spontaneous aneurysm rupture
-orbital bruit, proptosis, dilated vessels,chemosis, high IOP
-dilated superior ophth vein on imaging
-Tx: embolization, surgical ligation
Dural-sinus fistula
LOW flow
- fistula btwn meningeal branches of carotid artery and dural walls of cavernous sinus
- often asymptomatic
- assoc with HTN, atherosclerosis, CT disease
- diffuse enlargement of EOM
- dilated sup ophth vein
Cavernous hemangioma
- most common benign orbital tumor in adults
- slowly progressive proptosis
- retinal striae, elevated IOP
- growth may accelerate during pregnancy
Hemangiopericytoma
- abn pericytes surrounding blood vessels (reiculin surrounds individual cells)
- spindle cell tumor
- mets to lung, bone, liver
- slowly progressive proptosis, pain, diplopia, decreased vision
- Tx: complete surgical excision
Schwannoma
- can be painful due to perineural spread and compression of nerve
- superior orbit
- gradual proptosis
- Tx: complete excision
Pathology of schwannoma
Antoni A: spindle cells, verocay bodies (cells resemble sensory corpuscles)
Antoni B: stellate cells with mucoid stroma
Optic nerve sheath meningioma
33% of all primary optic nerve tumors
- increased incidence in NF
- Spencer’s triad: optociliary shunts, optic atrophy, optic nerve meningioma
- Tx: observation, complete surgical excision
Pathology finding optic nerve sheath meningioma
Psammoma bodies
What location of lymphoma has the highest association with systemic involvement?
Eyelid > orbit > conjunctiva
Fibrous histiocytoma
- distinguished from hemangiopericytoma on biopsy
- storiform pattern
- spindle cell tumor
- superonasal most common location
- Tx: excision
Pleomorphic adenoma (benign mixed tumor)
- represents 50% of epithelial lacrimal gland tumors
- M>F
- painless proptosis
- can indent bone
- Tx: en bloc excision without biopsy
Pleomorphic adenocarcinoma
- Rapid, progressive painful proptosis
- Tx: radical orbitectomy and bone removal
Adenoid cystic carcinoma
- most common malignant tumor of lacrimal gland
- rapidly progressive proptosis, pain and paresthesia due to perineural invasion and bony destruction
- swiss cheese pathology
- Tx: removal of involved bone, exenteration, radiation and chemo
Sinus mucocele
-entrapment of mucus due to obstruction of sinus ostia
Sinus carcinoma: what type
Squamous usually
-most common: maxillary
