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AIM: To assess the clinical presentations and outcomes of idiopathic orbital inflammatory pseudotumor (IOIP) patients with orbital wall bone destruction (OWBD) and to propose an expanded classification system that includes bone destruction. METHODS: The study retrospectively reviewed clinical presentations, imaging findings, treatment modalities, and outcomes of six patients diagnosed histopathologically with IOIP and OWBD at the Beijing Tongren Hospital, Capital Medical University between October 2018 and June 2021. RESULTS: Over two years, 6 (10%) of 60 IOIP patients at our hospital exhibited OWBD, but this may overrepresent severe cases. The cohort consisted of three men and three women, aged 17 to 60y (mean 35.5±16.1y). Presenting symptoms included proptosis, eyelid swelling, decreased visual acuity with pain, and palpable mass. Imaging revealed multiple anatomical structures involved with the medial wall being the most common site of bone destruction. Histopathological examination showed classic type in five patients and sclerosing type in one patient. All patients underwent surgical resection followed by methylprednisolone treatment. Follow-up (mean 30.3±3.1mo) indicated three patients had no recurrence, while others had varying degrees of symptom persistence or recurrence. CONCLUSION: IOIP with bone destruction is a rare but significant subtype that mimics malignancy, leading to potential diagnostic and therapeutic challenges. Our findings suggest that complete surgical resection combined with adjunctive glucocorticoid therapy can yield favorable outcomes. However, larger-scale studies are needed to further optimize therapeutic approaches.
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PURPOSE: Head and neck emergencies in children are frequent cause of visits to the hospital. Imaging plays a critical role in the management of these patients. This review article aims to familiarize radiologists with the common clinical presentations encountered, imaging characteristics of nontraumatic pediatric head and neck emergencies, and improve their ability to recognize associated complications as well as be aware of common mimics. METHODS: We researched our database for commonly encountered nontraumatic head and neck emergencies in children. A literature search was done to compare and complete the list of conditions to be discussed in this review. RESULTS: The review was organized according to anatomical location of the emergent condition. Relevant anatomy has been discussed along with clinical presentation, imaging characteristics and complications. We have presented common mimics with each set of disorders. Key imaging characteristics have been delineated using radiology images. CONCLUSION: Familiarity with the known complications of head and neck emergencies allows the radiologist to actively search for such findings, encourage early institution of appropriate therapy, and improve outcomes.
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TGF-ß plays a pivotal role in the pathogenesis of GO by promoting orbital tissue remodeling and fibrosis. This process involves the stimulation of orbital fibroblasts, leading to myofibroblast differentiation, increased production of inflammatory mediators, and hyaluronan accumulation. Studies have elucidated TGF-ß's role in driving fibrosis and scarring processes through both canonical and non-canonical pathways, particularly resulting in the activation of orbital myofibroblasts and the excessive accumulation of extracellular matrix. Additionally, recent in vitro and in vivo studies have been summarized, highlighting the therapeutic potential of targeting TGF-ß signaling pathways, which may offer promising treatment interventions for GO. This review aims to consolidate the current understanding of the multifaceted role of TGF-ß in the molecular and cellular pathophysiology in Graves' ophthalmopathy (GO) by exploring its contributions to fibrosis, inflammation, and immune dysregulation. Additionally, the review investigates the therapeutic potential of inhibiting TGF-ß signaling pathways as a strategy for treating GO.
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Oftalmopatía de Graves , Transducción de Señal , Factor de Crecimiento Transformador beta , Humanos , Oftalmopatía de Graves/metabolismo , Oftalmopatía de Graves/tratamiento farmacológico , Oftalmopatía de Graves/patología , Factor de Crecimiento Transformador beta/metabolismo , Animales , Fibrosis , Terapia Molecular DirigidaRESUMEN
Studies on the muscular-deep fascial system which connects the upper eyelid, brow, and glabella, are lacking. This study aimed to explore the fine anatomy of the muscular-deep fascial system in the region between the eyebrow and the superior orbital margin. We included eight formalin-phenol-embalmed cadavers (16 sides of specimens), and categorized them into anatomical dissections and histological sections. Five cadavers (10 sides) were dissected for gross anatomical observation, whereas all soft tissues of the other three cadavers (6 sides) were dissected for tissue sectioning and histological analysis. Three tissue blocks and 16 strips in each block were trimmed, numbered, and sliced into these specimens. Hematoxylin-Eosin and Masson's Trichrome staining were performed. In the region between the eyebrow and the superior orbital margin, the frontalis was covered by the orbicularis oculi. Fibers of the frontalis muscle penetrated into the orbicularis oculi muscle bundles, and crosslinked around the eyebrow level. Both the frontalis and the orbicularis oculi were attached to the thickened multilayered deep fascia in this region, which could be regarded as the muscular-deep fascial system. The muscular-deep fascial system connects the frontalis deep fascia and deep forehead compartments down to the orbicularis-supporting ligament. The precise anatomy of the muscular-deep fascial system in the region between the eyebrow and the superior orbital margin may provide a valuable reference for soft-tissue fixation and suspension in facial surgery.
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Cadáver , Fascia , Órbita , Humanos , Órbita/anatomía & histología , Fascia/anatomía & histología , Masculino , Femenino , Anciano , Músculos Faciales/anatomía & histología , Párpados/anatomía & histología , Anciano de 80 o más Años , Cejas/anatomía & histología , Persona de Mediana EdadRESUMEN
Traumatic orbital fracture with prolapse of the globe into the paranasal sinuses is very rare. The visual prognosis is poor, and the medical and surgical management is still a topic of debate. We herein describe an extremely rare case of globe dislocation into the left maxillary sinus with complete recovery of visual acuity. A 67-year-old man presented with an isolated left-sided orbital floor fracture with dislocation of the globe into the maxillary sinus. The visual acuity was no light perception in his left eye. He was immediately taken to the operating room for globe repositioning and orbital floor reconstruction. The spectacular visual recovery allowed a return to normal visual acuity. We summarize the clinical outcomes of traumatic globe dislocations between 1971 and 2023 and suggest treatment guidelines. Among the 31 cases reported in the literature, 26 (83.9%) were into the maxillary sinus (vs. ethmoid), of which only 3 (11.5%) had a complete recovery of visual acuity.
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We herein report an 81-year-old woman with no significant medical history who developed a fever, headache, and right eyelid swelling. Magnetic resonance imaging (MRI) showed eye proptosis, sphenoid opacity, enlarged cavernous sinus, and dilated right superior ophthalmic vein (SOV). Subsequent enhanced MRI revealed intraventricular debris and thrombosis in the right SOV and the left transverse and sigmoid sinuses. Blood cultures were positive for Aggregatibacter aphrophilus, as identified by mass spectrometry. The patient responded well to antibiotics, anticoagulants, and surgical drainage of sphenoid sinusitis. To our knowledge, this is the first case of A. aphirophilus sphenoid sinusitis causing orbital cellulitis, meningitis, and venous sinus thrombosis.
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BACKGROUND: Malignant neoplasms of the paranasal sinuses and nasal cavity are rare, comprising only 3% of all head and neck malignancies. Sinonasal undifferentiated carcinoma is a rare malignancy and an aggressive neoplasm that was clinic-pathologically distinct from other poorly differentiated malignancies of the nasal cavity and sinuses. The lesion is thought to originate from the epithelium, grows rapidly and invades nearby structures, often resulting in bony destruction while rapid progression of symptoms over weeks to months is characteristic. CASE DESCRIPTION: A 75-year-old man initially presented to ophthalmologist due to blurry vision and diplopia for 2 months. There was also progressive right eye swelling and pain for the past 12 months. Further image study revealed a right superomedial orbital mass with frontal/ethmoid sinus and frontal base extension, causing significant right eye gaze limitation, visual loss, ptosis, chemosis and exophthalmos. He was then transferred to neurosurgical clinic for further treatment where combined surgery was advocated to relieve the mass effect and also for pathology proof. Orbital roof/medial wall and frontal skull base were invaded and destroyed by the tumor. A bicoronal craniotomy was performed and extensive tumor removal was achieved except the orbital fossa due to difficult separation from the ocular muscle and optic nerve. Frontal base was reconstructed in a layered fashion to avoid cerebrospinal fluid (CSF) leakage and infection. He was sent to intensive care unit (ICU) for overnight observation where no further neurologic deterioration occurred. Instant orbital pain relief was noted with significantly decreased proptosis and improving visual acuity. Detailed pathological staining and molecular tests revealed a sinonasal undifferentiated carcinoma, adjuvant chemotherapy was arranged, followed by 30 cycles of radiotherapy. Slight disease progression was noted 12 months after the surgery, chemotherapy regimen was adjusted according to clinical response and he is still currently under regular adjuvant treatment. CONCLUSIONS: Sinonasal undifferentiated carcinoma typically carries a poor prognosis despite aggressive medical and surgical treatment, as it always presents at an advanced stage. Different combinations of chemotherapy, radiotherapy, radical surgical resection have been used to improve the outcome yet there is still not a universal treatment strategy. Early diagnosis, prompt treatment, and comprehensive medical care are crucial to achieve the best possible outcome for affected patients.
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Carcinoma , Neoplasias de los Senos Paranasales , Humanos , Masculino , Anciano , Neoplasias de los Senos Paranasales/patología , Pronóstico , Estesioneuroblastoma Olfatorio , Neoplasias Orbitales/patología , Neoplasias del Seno MaxilarRESUMEN
Eruptive calcified nodules (CNs) are a manifestation of severely calcified plaques, which exist in acute coronary syndrome (ACS), non-ACS lesions. Optical coherence tomography is crucial for diagnosing and treating eruptive CNs in clinical practice. Management of eruptive CNs is still a challenge for interventional cardiologists. There have been significant advances in the treatment of eruptive CNs such as intravascular lithotripsy, excimer laser coronary atherectomy, rotational atherectomy, and orbital atherectomy. We find a range of treatment modalities to be effective under different conditions. The selection of these devices should be considered based on guidewire position, lesion characteristics, clinical manifestations, and operator's experiences.
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Purpose: Orbital inflammatory disease has been historically diagnosed with computed tomography (CT) and magnetic resonance imaging (MRI). Orbital ultrasound has served as a non-radiation alternative that has been successful at diagnosing many orbital pathologies but is not commonly used in clinical practice due to need for specialized ultrasound training and equipment needs. We demonstrate use of handheld ultrasound for detecting orbital inflammation. Observations: We present five patients with orbital inflammation where a handheld ultrasound probe was able to capture features consistent with concurrent CT scans. Conclusions and importance: Handheld ultrasound is an accessible and portable method that can assist in the diagnosis and monitoring of orbital pathology.
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BACKGROUND: Spheno-orbital meningiomas are rare, slow-growing tumors originating from the sphenoid ridge, causing proptosis and visual impairment. Surgical intervention can be complex due to the tumor's proximity to critical structures. CASE DESCRIPTION: A 67-year-old woman presented with a gradually enlarging protrusion of her left eye over three years. Referred to the neurosurgery clinic at Hasan Sadikin Hospital, Bandung, she underwent a craniectomy with concomitant cranioplasty to remove the tumor. The surgery included resection of tissue beneath the dura. Postoperatively, the patient's eye returned to its normal position, and her vision improved to 4/60. Spheno-orbital meningiomas, though primarily involving the sphenoid wing, can extend to surrounding tissues, complicating surgical resection. The patient's gradual proptosis over three years signifies the slow-growing nature of these tumors. Preoperative imaging and careful surgical planning are crucial for optimal outcomes. The craniectomy approach, combined with cranioplasty, allows for effective tumor removal and restoration of cranial aesthetics. The inclusion of subdural tissue resection addresses potential residual tumor cells, minimizing recurrence risk. Postoperative recovery in this case was favorable, with significant improvement in both ocular alignment and vision. However, the vision improved to 4/60 suggests some degree of irreversible optic nerve damage, which is a common challenge in these cases. Continuous monitoring and adjunct therapies may be necessary to manage any long-term sequelae. CONCLUSIONS: The patient's significant improvement in visual acuity and visual field following craniectomy and tumor removal demonstrates the potential for successful treatment of these conditions. Early detection and treatment are crucial in preventing long-term visual impairment and blindness.
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Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/cirugía , Meningioma/complicaciones , Meningioma/patología , Femenino , Anciano , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/patología , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/patología , Neoplasias Orbitales/complicaciones , Duramadre/cirugía , Duramadre/patologíaRESUMEN
Immune checkpoint inhibitors, which are a type of cancer immunotherapy, have been associated with the development of adverse events related to an overactive immune system caused by the effect of this type of therapy. It affects a wide range of organs, including the ear and eye. Ophthalmic toxicity related to immune checkpoint inhibitors usually occurs bilaterally. Corneal toxicity (mainly dry eye disease) and uveitis are the most commonly reported patterns of toxicity. Other patterns of involvement include optic neuritis, serous retinal detachment, keratitis, ophthalmoplegia, and ocular myasthenia, but are not limited to them. Potential factors contributing to the development of toxicity are age, previous history of ocular immune disease, type, doses, and duration of treatment, and race. Ototoxicity is also reported in the literature, usually manifesting as bilateral, symmetrical/asymmetrical hearing loss. Ear toxicity presenting as ear fullness, tinnitus, and vertigo has also been mentioned in the literature. Hearing loss is often associated with word/speech recognition. An audiogram usually shows a pattern of sensorineural hearing loss. Otitis media has also been reported to be a potential cause of ear toxicity. Immune checkpoint inhibitor toxicity was present more commonly when used along with other anti-neoplastic agents. Ear toxicity, which presumably results from damage to the melanocytes in the ear, often presents with other melanocytotic manifestations, like uveitis and vitiligo. According to the literature, some agents (ipilimumab, nivolumab, atezolizumab, and pembrolizumab) were more commonly associated with toxic effects on the eye and ear and more when combined with each other.
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The skull base and orbit have complicated anatomical structures where various tumors can occur. The tumor may present with neurological symptoms; however, its diagnosis is clinically difficult owing to accessibility issues. Therefore, diagnostic imaging is crucial in assessing tumors in the skull base and orbit and guiding subsequent management. Notably, some tumors have a predilection for a specific site of origin, and identifying the site of origin on imaging can help narrow the differential diagnosis. At the skull base, chordomas typically occur in the clivus, chondrosarcomas in the paramedian areas, paragangliomas in the jugular foramen, neurogenic tumors, and perineural spread in the neural foramen. Among orbital tumors, cavernous hemangiomas usually occur in the intraconal space, and pleomorphic adenomas and adenoid cystic carcinomas occur in the lacrimal glands. Some skull base and orbital tumors exhibit distinctive imaging features. Chordomas and chondrosarcomas of the skull base show high signal intensities on T2-weighted images, with chondrosarcomas often displaying cartilaginous calcifications. Paragangliomas are characterized by their hypervascular nature. In the orbit, cavernous hemangiomas and pleomorphic adenomas present unique dynamic patterns. Immunoglobulin G4-related disease forms lesions along the nerves. Identifying the tumor origin and its imaging characteristics can help narrow the differential diagnosis of skull base and orbital tumors.
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The approach to manage breast cancer has undergone a significant transformation, leading to longer survival rates. However, there is still a rise in metastasis occurring in less common locations such as the orbit. We report the case of a 40-year-old female diagnosed with luminal A, left-side breast cancer, back in September 2020. She presented with de novo metastatic diseases to the liver, bone, lung, and orbit. She received palliative radiation therapy (RT) to the orbit at the dose of 25 Gray (Gy) in five fractions, and follow-up brain magnetic resonance imaging (MRI) indicated a positive response to treatment with a slight reduction in the size of the left infraorbital lesion. Systemic treatment was started with hormonal therapy fulvestrant and luteinizing hormone-releasing hormone (LHRH), leuprolide, accompanied by palbociclib. As the incidence of ocular metastasis from breast cancer increases, oncologists need to be vigilant about symptoms and use appropriate diagnostic techniques.
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Objective: To determine the relative frequency of orbital lesions based on the site of origin and histopathology at a Tertiary care hospital (Mayo Hospital, Lahore Pakistan) from 1996 till 2022 (27 years). Methods: This descriptive case series included 2651 patients of all age groups presenting with orbital lesions who initially got enrolled at Institute of Ophthalmology Mayo Hospital, Lahore from 1996 till 2022. Of these, 583 patients left against medical advice. So, clinical data of 2068 patients were completely analyzed. Lesions were managed medically and/ or surgically. Final clinical diagnosis, with the help of histopathology, was used to classify the lesions. Results: There were 1258 (60.9%) adults and 810 (39.1%) children, 1358 (65.66%) were neoplastic while 710 (34.33%) non-neoplastic lesions. Amongst the neoplastic lesions, 405 (29.8 %) were benign and 953 (70.2%) malignant. Primary orbital lesions were 1676 (81.04%), Secondary orbital lesions were 300 (14.51%), Endocrine/ hematopoietic reticulo-endothelial system lesions were 84 (4.06%) and Metastatic lesions from distant organs were 08 (0.39%). Conclusion: Retinoblastoma, rhabdomyosarcoma, optic nerve gliomata were common in children. Pleomorphic adenoma & adenocystic carcinoma of lacrimal gland, cavernous hemangioma, optic nerve meningioma, neurofibroma, schwannoma, squamous cell carcinoma of eyelid, carcinoma of maxillary antrum and lymphomas were more common in adults.
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Gradenigo syndrome (GS) is characterized by a triad of clinical features: abducens nerve palsy, retro-orbital pain, and otorrhea, arising as a complication of suppurative otitis media. Herein, we present a case of GS in a 15-year-old male patient, secondary to left otitis media. The patient exhibited fever, otorrhea, accompanied by diplopia, retrobulbar pain, and headache. Imaging studies demonstrated petrous bone destruction and inflammatory changes with opacification of petrous bone, mastoid cells and surrounding structures, confirming the diagnosis of GS. Treatment included intravenous antibiotics and anticoagulants, resulting in the resolution of symptoms and radiological improvement. GS, though rare, warrants prompt recognition and appropriate management to prevent severe complications. Diagnostic imaging plays a crucial role in evaluation, and treatment often involves prolonged antibiotic therapy and, in severe cases, surgical intervention. Understanding the clinical presentation and management strategies is essential for clinicians encountering this condition.
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Pain assessment in animal models is essential for understanding mechanisms underlying pathological pain and developing effective pain medicine. The grimace scale (GS), facial expression features in pain such as orbital tightening (OT), is a valuable measure for assessing pain in animal models. However, the classical grimace scale for pain assessment is labor-intensive, subject to subjectivity and inconsistency, and is not a quantitative measure. In the present study, we utilized machine learning with DeepLabCut to annotate the superior and inferior eyelid margins and the medial and lateral canthus of the eyes in animals' video images. Based on the annotation, we quantified the eyelid distance and palpebral fissure width of the animals' eyes so that the degree of OT in animals with pain could be measured and described quantitatively. We established criteria for the inclusion and exclusion of the annotated images for quantifying OT, and validated our quantitative grimace scale (qGS) in the mice with pain caused by capsaicin injections in the orofacial or hindpaw regions, the Nav1.8-ChR2 mice following orofacial noxious stimulation with laser light, and the oxaliplatin-treated mice following tactile stimulation with a von Frey filament. We showed that both the eyelid distance and the palpebral fissure width were shortened significantly in the animals in pain compared to the control animals without nociceptive stimulation. Collectively, the present study has established a quantitative orbital tightening for pain assessment in mice using DeepLabCut, providing a new tool for pain assessment in preclinical studies with mice.
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BACKGROUND: To review the characteristics of all Slovenian patients with ocular adnexal lymphoma (OAL) in the period of 24 years with the aim of evaluating demographic data, lymphoma location and type, disease stage, treatment modality, local control rate and survival rate. PATIENTS AND METHODS: All patients with histologically diagnosed OAL in the main tertiary centre of Slovenia, Eye Hospital, University Medical Centre Ljubljana, who were treated at Institute of Oncology Ljubljana were included in the study. Patients' data were collected from October 1995 through April 2019. RESULTS: Seventy-four patients were included in the study having a median age of 68 years at diagnosis. The majority of lymphomas were of B-cell origin (98.6%). The most frequent type was the extranodal marginal zone B-cell lymphoma (MALT) (71.6%). Orbital lymphomas were diagnosed in 56 cases (75.7%) and conjunctival in 18 cases (24.3%). Ocular manifestation was the first sign of the disease in 78.4% of patients and in 67.6% of patients ocular adnexa were the only disease location. Fifty-one patients (68.9%) were treated with radiotherapy, 7 patients (9.4%) with systemic treatment, 5 patients (6.8%) with combined radiotherapy and systemic treatment and in 11 patients, biopsy and active surveillance strategy was applied (14.9%). Local control of the disease was achieved in 96.6% of treated patients. Median overall survival of the whole study group has not been reached yet. Five-year overall survival rate was 80.1% (95% CI 68.1% - 88.5%) and 5-year lymphoma specific survival rate was 87.2% (95% CI 83.2%-91.2%). CONCLUSIONS: OALs comprise a group of heterogeneous diseases with variable outcomes depending predominately on the patient's age and lymphoma type, with low grade lymphomas carrying good prognosis even in elderly patients.
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Neoplasias del Ojo , Linfoma de Células B de la Zona Marginal , Humanos , Estudios Retrospectivos , Anciano , Masculino , Femenino , Persona de Mediana Edad , Anciano de 80 o más Años , Eslovenia/epidemiología , Adulto , Neoplasias del Ojo/terapia , Neoplasias del Ojo/mortalidad , Neoplasias del Ojo/patología , Linfoma de Células B de la Zona Marginal/terapia , Linfoma de Células B de la Zona Marginal/patología , Linfoma de Células B de la Zona Marginal/mortalidad , Linfoma/terapia , Linfoma/patología , Linfoma/mortalidad , Tasa de Supervivencia , Neoplasias Orbitales/patología , Neoplasias Orbitales/mortalidad , Neoplasias Orbitales/terapia , Estadificación de Neoplasias , Neoplasias de la Conjuntiva/terapia , Neoplasias de la Conjuntiva/patología , Neoplasias de la Conjuntiva/mortalidadRESUMEN
PURPOSE: To characterize trends in orbital cellulitis (OC) severity and management from 2016 through 2022, including assessment of effects from the COVID-19 pandemic. METHODS: A retrospective chart review was conducted at a tertiary care center using an electronic medical record search of OC from January 1 2016 to January 1 2023. Radiography was used to categorize patients into three cohorts - OC without abscess, OC with subperiosteal abscess (SPA), and OC with orbital abscess (OA). Infection cohort and age group [pediatric (<9 years old), adolescent (9-18 years), adult (>18 years)] were compared across years. Subgroup analysis was performed in the SPA cohort. Comparisons were made between the time periods prior to and after the start of the COVID-19 pandemic. RESULTS: From 2016-2022, there were 247 (67.3%) cases of OC, 103 (28.1%) SPA, and 17 (4.6%) OA. The year 2022 incurred higher rates of SPA and OA (p = 0.035), pediatric infections (p = 0.008), and co-morbid sinusitis (p = 0.005) compared to all preceding years. Rates were similar from 2016 through 2021. Within the SPA cohort, rates of surgical intervention and outcomes were similar across all years. Rate of abscess formation was significantly higher during the COVID-19 pandemic compared to the pre-pandemic era (p = 0.033). CONCLUSION: The severity of OC leading up to the COVID-19 pandemic appeared steady. After pandemic onset, a delayed increase in abscess formation, predominantly affecting pediatric patients and correlating with a greater rate of sinusitis, was observed in 2022.
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BACKGROUND: Spheno-orbital meningiomas (SOM) are known to invaded critical skull base areas. The authors report a series of WHO I SOM, propose a subclassification of this tumor according to its extension to critical positions and analyze the impact of extent of resection and the role of stereotactic radiotherapy in tumor recurrence. METHODS: A prospective maintained university medical center registry was utilized to undertake a retrospective review of patients operated with WHO I SOM. Details related to critical skull base region's extension (superior orbital fissure, cavernous sinus, orbital apex), extent of resection and adjuvant radiosurgery were collected. Statistical calculations were preformed using IBM SPSS Statistics version 25. A p value < 0.05 was considered significant. Survival analysis was performed using Kaplan-Meier survival analysis and the log rank test. RESULTS: A total of 77 patients operated from 2002 to 2021 were included. There were 65 women (84.4 %) and 12 men (15.6 %). Mean age at surgery was 54.8 years (median 53 years, range 23 - 88). Tumors were defined as local in 28 (35.4 %) and with extension into the skull base critical structures in 51 (64.6 %). GTR was achieved in 35 (44.3 %), STR in 40 (50.6 %), and PR in four (5.1 %). Surgical morbidity was 10 %. There was no surgical mortality. 28 patients with STR or PR were treated with adjuvant radiotherapy. The total length of follow up was a mean of 172.3 months. There were 14 recurrences/progressive growth (17.7 %), 63 patients (79.7 %) had no recurrence/progressive growth, and two patients (2.5 %) were lost to follow-up. PFS was significant statistically different in patients with invasive tumors in whom the extent of resection was subtotal, with a longer PFS in patients that were treated with adjuvant radiotherapy. (P value < 0.001). CONCLUSIONS: SOM could be divided in two groups according to its skull base extension facilitating decision management and outcome prediction. Patients with local WHO I SOM had higher rate of GTR and better PFS than tumors extending to involve critical regions. When STR or PR is achieved postoperative adjuvant radiotherapy is advised if there is evidence of previous tumor growth.
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Orbital defects due to congenital causes, cancer, and trauma can compromise appearance and function, creating a deep psychological impact on an individual's life. The prosthetic rehabilitation of such patients is challenging. The objective of prosthetic treatment of an ocular defect is to provide a well-fitting ocular prosthesis that closely resembles the original eye, restoring the patient's self-confidence and social acceptance. Ocular prostheses can be customized or prefabricated. The challenge encountered with prefabricated eye prostheses is a poor fit. Customized prostheses exhibit better fit, aesthetic outcome, and comfort to the patient in the long term. The article describes a technique to fabricate an ocular prosthesis with a stock iris and customized sclera that is both functional and aesthetically pleasing.