Lateral Transorbital Endoscopic Access to the Hippocampus, Amygdala, and Entorhinal Cortex: Initial Clinical Experience.

Background/aims: Transorbital approaches traditionally have focused on skull base and cavernous sinus lesions medial to the globe. Lateral orbital approaches to the temporal lobe have not been widely explored despite several theoretical advantages compared to open craniotomy. Recently, we demonstrated the feasibility of the lateral transorbital technique in cadaveric specimens with endoscopic visualization.

Management of an expansile orbital mass: Plexiform neurofibroma decompression by orbitozygomatic approach.

Neurofibromatosis types 1 (NF-1) and 2 are significant entities to otolaryngologists because they frequently involve head and neck skin, brain, skull base, orbits, and surrounding neural and vascular structures. We present the case of a 52-year-old male with progressive, marked unilateral proptosis due to a multilobulated orbital mass, secondary to biopsy-proven plexiform neurofibroma (PN). Acute worsening of proptosis leading to corneal abrasion, diplopia, and pain required debulking surgery, for which an orbitozygomatic approach was utilized.

Oral methylphenidate for the treatment of refractory facial dystonias.

Oral methylphenidate (Ritalin, Novartis) has been reported to alleviate symptoms of benign essential blepharospasm in an off-label application. This series presents 3 patients with refractory periorbital and facial dystonias, including blepharospasm, apraxia of eyelid opening, and oromandibular dystonia unresponsive to standard treatments who experienced a response to oral methylphenidate therapy. While the mechanisms for facial dystonias have not been elucidated, there is evidence to suggest that they are on the spectrum with Parkinson disease.

Traumatic arteriovenous fistula of the superficial temporal artery: a histopathologic report.

Traumatic aneurysms, pseudoaneurysms, and arteriovenous (AV) fistulas of the superficial temporal artery (STA) are uncommon, accounting for only 0.5% to 2.0% of all aneurysms subjected to surgery.

Optic nerve biopsy in the management of progressive optic neuropathy.

Background: In cases of progressive optic neuropathy, diagnostic uncertainty often persists despite extensive work-up. Optic nerve biopsy (ONB) can be considered, especially when visual decline of the affected or fellow eye ensues despite empiric therapy. We aimed to evaluate both diagnostic and therapeutic utilities of ONB based on the long-term experience at a tertiary care institution.

Blepharospasm and apraxia of eyelid opening associated with anti-Hu paraneoplastic antibodies: a case report.

Purpose: To report a case of blepharospasm associated with anti-Hu paraneoplastic antibodies that was treated successfully with botulinum toxin A.

Design: Case report.

Participants: A 57-year-old man had altered mental status and a 20-pound weight loss at presentation.

Presence of Erdheim-Chester disease and Langerhans cell histiocytosis in the same patient: a report of 2 cases.

The histiocytic disorders Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD), can both present with multisystem involvement, with the central nervous system and the bone, skin, neuroendocrine, cardiac, respiratory, and gastrointestinal systems potentially affected. The 2 entities occasionally can be difficult to distinguish. Both rarely affect the orbit and the central nervous system, and although there are rare reports of patients with coexistent LCH and ECD, there are no reported cases of the 2 diseases that involve both the orbital and neuroendocrine systems.

Orbital lymphoma in the setting of idiopathic CD4+ lymphocytopenia (HIV-negative AIDS).

A 43-year-old Asian man with idiopathic CD4+ lymphocytopenia (human immunodeficiency virus [HIV]-negative acquired immunodeficiency syndrome [AIDS]) noted blurred vision OD. Visual acuity was 20/30 OD and 20/15 OS. The right eye showed features of axial proptosis (2 mm), blepharoptosis, upgaze restriction, conjunctival chemosis, color desaturation, and choroidal folds.

Tarsal dermoid cyst: clinical presentation and treatment.

The authors present 2 cases of eyelid dermoid cyst attached to tarsus in pediatric patients. Both patients were infants who presented with a firm, nontender upper eyelid mass firmly adherent to tarsus. In both cases, the lesion was excised en bloc, and histopathology revealed a dermoid cyst.

Botulinum toxin as novel treatment for excess mucous membrane graft secretions.

Salivary gland secretion is an unusual complication of mucous membrane grafting. The authors report a case in which botulinum toxin was successfully used to treat graft secretions after buccal mucous membrane autograft for recurrent pterygium repair.

Transient descent of the contralateral eyelid in unilateral ptosis surgery.

Purpose: To report novel findings regarding contralateral eyelid height (i.e., intraoperative descent, followed by postoperative elevation) during unilateral ptosis surgery and to comment on their relevance in surgical planning.

Sarcoid-like granulomatous orbital inflammation induced by interferon-alpha treatment.

A 56-year-old black woman presented with bilateral orbital swelling in the lacrimal gland region 4 months after initiation of interferon-alpha and ribavirin treatment for occupationally-acquired hepatitis C infection. Histopathologic evaluation of bilateral lacrimal gland biopsy specimens revealed granulomatous inflammation. All other tests were negative for sarcoidosis including angiotensin converting enzyme level and chest x-ray.

Langerhans cell histiocytosis of the orbit 10 years after involvement at other sites.

Langerhans cell histiocytosis within the orbit generally occurs in children and is marked by periorbital pain and swelling. Although these lesions respond well to minimal local curettage and concomitant corticosteroid injection, this disorder can be extremely aggressive and destructive. Recurrences usually occur within 12 months to 18 months after diagnosis.

Waldenström macroglobulinemia of the orbit.

A 77-year-old man with known Waldenström macroglobulinemia was examined for unilateral proptosis and periorbital swelling. The patient was found to have an orbital mass involving the lateral wall. Histologic and immunophenotypic matching of the orbital mass to the patient's systemic findings were used to diagnose the orbital mass as a Waldenström macroglobulinemia tumor.

Lymphangiogenesis concurrent with haemangiogenesis in the human cornea.

Background: Corneal transplant rejection can occur with and without neovascularization; therefore, it is necessary to elucidate what other factors allow for rejection. It has been suggested that the lymphatic system may play a role in graft failure, but it has also been held that the cornea is devoid of lymphatics. Use of a new monoclonal antibody against a lymphatic endothelial marker, D2-40, has been used to detect lymphatics in other tissues.

Nasolacrimal metastasis from heptocellular carcinoma masquerading as dacryocystitis.

A 69-year-old man presented with a "lump" on his nose, after antibiotic therapy and warm compresses failed to resolve his presumed dacryocystitis. Because this disorder displayed atypical features (no tenderness, no redness, evidence of the greatest expansion of the nasolacrimal system inferior to the lacrimal sac fossa), a neoplastic process was considered. Orbital CT showed a mass obliterating the nasolacrimal system and maxillary sinus.

Newly recognized ocular side effects of erlotinib.

An 85-year-old man had a bilateral periorbital rash and conjunctivitis leading to lower eyelid ectropion and epiphora within 6 weeks of treatment with erlotinib (Tarceva, Genentech, Inc., San Francisco, CA, and OSI Pharmaceuticals, Melville, NY), a second-line antineoplastic agent. The treatment was discontinued secondary to toxicity, and the periorbital rash completely resolved within 6 weeks of cessation of the drug.

D2-40 expression demonstrates lymphatic vessel characteristics in the dural portion of the optic nerve sheath.

Purpose: To investigate the presence or absence of lymphatic vessels in the human optic nerve by means of immunohistochemistry.

Methods: Use of selective molecular markers to differentiate lymphatics from blood vessels in optic nerve specimens obtained after enucleation or exenteration procedures. Specifically, the lymphatic-specific monoclonal antibody D2-40 was used to identify lymphatic endothelial cells in contrast to CD-34 identification of endothelial cells of blood vessels.

Advances in applied anatomy of the eyelid and orbit.

Purpose Of Review: The oculofacial surgeon seeking to achieve ideal outcomes and avoid complications in aesthetic, functional and reconstructive surgery must have an understanding of the three-dimensional anatomic features, as well as the dynamic aspects, of the eyelid and orbital region. Knowledge of the orbital and periorbital region may be the last frontier of human anatomy, as new information is still being uncovered every year and each clarification of anatomy leads to a new level of sophistication in the understanding and treatment of orbital and eyelid disease both medically and surgically.

Recent Findings: Recently, a great deal of attention has been focused on better understanding of the vasculature, fatty tissue, fascial attachments, and lymphatic drainage of the orbital and periorbital region.

Malignant solitary fibrous tumor metastatic to the orbit.

A 61-year-old man with a history of malignant solitary fibrous tumor of the chest had development of unusual sites of metastasis involving the sphenoid wing of the orbit and soft tissues of the cheek. He was found to have a solitary fibrous tumor, an uncommon type of spindle cell neoplasm that most often arises in the pleura, which was metastatic to the orbit. This is the first reported case of malignant solitary fibrous tumor metastatic to the orbit.

A systematic comprehensive approach to management of irreversible facial paralysis.

Irreversible facial palsy (IFP) presents a multitude of problems arising from a paretic periorbital and facial complex, the solutions to which cross the spectrum of multiple specialties. The process of facial rehabilitation can be simplified by subdividing the face into functional units. These units consist of the brow complex, the periorbital complex, the midface complex, and the lower face/oral complex.