Orbital affection in nasal and paranasal neoplasms

A study of tumours giving rise to unilateral proptosis

Study of distribution, clinical features, radiological features, histopathological aspects, management and outcomes of tumours giving rise to unilateral proptosis. This is a prospective study including 40 patients with benign and malignant tumours of orbital, paraorbital and other sites giving rise to unilateral proptosis. Final diagnosis was made following detailed radiological and histopathological examination. Then, treatment modality was decided, which included surgery, radiotherapy, chemotherapy or required combination. Proptosis was measured by simple/plastic ruler exophthalmometry method. The maximum number of cases 8(20%) were in age group 31-40 years. The youngest patient was 4 year old and the oldest was 80 years. M:F ratio was 1.85:1. Malignant tumours were 32(80%) and benign tumours were 8(20%). 12 cases were having 3 mm proptosis (minimum) and one case having 18 mm (maximum). Only 4(10%) orbital tumours were responsible for unilateral proptosis. Paraorbital tumours 34(85%) was the major cause for unilateral proptosis and 2(5%) were from distant sites. Surgery was the mainstay of treatment 14(35%), followed by combined (surgery + radiotherapy) 5(12.5%), chemotherapy 4(10%), There was 4(10%) mortality, 16(40%) improved 3(7.5%) had same status and 17(42.5%) deteriorated. Thus nasal obstruction is the commonest ENT presenting complains in these patients. The major cause of unilateral proptosis was found to be paraorbital tumours (34%). Thus, a case of proptosis should never be ignored but a thorough ENT and ophthalmic examination is necessary. As malignancy is one of the major cause of unilateral proptosis catching and treating them early will reduce mortality.

Tuberculosis of the orbit and lacrimal gland: a clinical study of 14 cases

Fourteen patients with tuberculosis of the orbit and lacrimal gland seen over a period of 20 years have been presented. The majority of them were between the ages of 4 to 15 years. Males were affected twice as frequently as females. Left side was affected four times as frequently as the right side. There were eight patients of periostitis of orbital margin, one patient of dacryoadenitis, three patients of tuberculoma of orbital tissues, and two patients of tuberculoma of maxillary sinus. One patient with periostitis had involvement of the greater and lesser wings of sphenoid in addition to the involvement of upper-outer orbital margin. Two periostitis patients had prolapse of the palpebral portion of the lacrimal gland. The clinical presentation and gross appearance of the tuberculoma of the lacrimal gland was similar to those found in benign mixed tumor. The patients with tuberculoma of orbital tissues presented as pseudotumors. The mimicry of tuberculoma of maxillary sinus to carcinoma has been mentioned. Associated tuberculous lesions were pulmonary in eight patients, cervical lymphadenitis in ten patients, intestinal in one patient, and caries spine in one patient. In two patients the disease developed in the absence of any other tuberculous lesion discovered in the body. The cases were cured by wide surgical removal of all the diseased tissues combined with antituberculous chemotherapy.