Orbital disorders

Question 1

Tripod fractures consists of what?

Answer 1

Zygomaticomaxillary suture, zygomaticofrontal suture, and zygomatic arch
Orbital floor

Question 2

Lefort I

Answer 2

low transverse fracture of maxillary bone above teeth

Question 3

Lefort II

Answer 3

pyramidal fracture of nasal, lacrimal and maxillary bones

involves medial orbital floors

Question 4

Lefort III

Answer 4

craniofacial dysjunction
orbital floor, lateral and medial walls
may involve optic canal

Question 5

Atrophia bulbi

Answer 5

3 stages: without shrinkage, with shrinkage, with shrinkage and disorganization
Increased risk of malignancy
Annual B scan

Question 6

Orbital psuedotumor

Answer 6

Bilateral in 33%
Eosinophilia, elevated ESR, positive ANA
Enlargement of EOM and tendons
B scan: acoustically hollow area corresponding to edematous Tenons

Question 7

Orbital myositis

Answer 7

MR and LR most common (33% each), IR (10%)

Question 8

Tolosa-Hunt syndrome

Answer 8

localized to superior orbital fissure, optic canal, cavernous sinus
-painful ophthalmoplegia and decreased vision

Question 9

Neurosarcoid most commonly affects which CN

Answer 9

7

Question 10

Direct carotid-cavernous sinus fistula

Answer 10

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

Question 11

Dural-sinus fistula

Answer 11

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

Question 12

Cavernous hemangioma

Answer 12

• most common benign orbital tumor in adults
• slowly progressive proptosis
• retinal striae, elevated IOP
• growth may accelerate during pregnancy

Question 13

Hemangiopericytoma

Answer 13

• 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

Question 14

Schwannoma

Answer 14

• can be painful due to perineural spread and compression of nerve
• superior orbit
• gradual proptosis
• Tx: complete excision

Question 15

Pathology of schwannoma

Answer 15

Antoni A: spindle cells, verocay bodies (cells resemble sensory corpuscles)
Antoni B: stellate cells with mucoid stroma

Question 16

Optic nerve sheath meningioma

Answer 16

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

Question 17

Pathology finding optic nerve sheath meningioma

Answer 17

Psammoma bodies

Question 18

What location of lymphoma has the highest association with systemic involvement?

Answer 18

Eyelid > orbit > conjunctiva

Question 19

Fibrous histiocytoma

Answer 19

• distinguished from hemangiopericytoma on biopsy
• storiform pattern
• spindle cell tumor
• superonasal most common location
• Tx: excision

Question 20

Pleomorphic adenoma (benign mixed tumor)

Answer 20

• represents 50% of epithelial lacrimal gland tumors
• M>F
• painless proptosis
• can indent bone
• Tx: en bloc excision without biopsy

Question 21

Pleomorphic adenocarcinoma

Answer 21

• Rapid, progressive painful proptosis

- Tx: radical orbitectomy and bone removal

Question 22

Adenoid cystic carcinoma

Answer 22

• 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

Question 23

Sinus mucocele

Answer 23

-entrapment of mucus due to obstruction of sinus ostia

Question 24

Sinus carcinoma: what type

Answer 24

Squamous usually

-most common: maxillary