Idiopathic orbital myositis mimicking orbital cellulitis.

Kim DS, Lee JH, Oh DY, Seo JW, Ahn ST, Rhie JW.

Department of Plastic Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea.

J Craniofac Surg. 2010 May

Journal of Craniofacial Surgery:

May 2010 - Volume 21 - Issue 3 - pp 932-934

doi: 10.1097/SCS.0b013e3181d7f0df

Brief Clinical Studies

Abstract

Idiopathic orbital myositis (IOM) is a subtype of orbital inflammatory disease characterized by primarily involving the extraocular muscle. The signs and symptoms of IOM may also be seen in such processes as orbital cellulitis, primary or metastatic orbital neoplasm, carotid-cavernous fistulae, arteriovenous malformations, cavernous sinus thrombosis, and thyroid eye disease, and because there is no pathognomonic sign, symptoms, laboratory test, or radiologic findings, its diagnosis is often provisional.

In our case, diagnosis of IOM was more difficult because our patient presented with proptosis after alloplastic implant insertion in the blow-out fracture. After considering radiologic and physical findings, we concluded that cellulitis was more likely as initial diagnosis. To remove foreign body or pus, surgical exploration was done, but intraoperative findings did not show any pus or sign of infection but diffuse enlargement and swelling of inferior rectus muscle. The diagnosis was confirmed as IOM, and the patient was treated with systemic corticosteroid. Although proptosis after alloplastic insertion in blow-out fracture is usually a sign of cellulitis, this case illustrates that it may also occur in patients with IOM.

Journal of Craniofacial Surgery

Intracranial brain abscess preceded by orbital cellulitis and sinusitis.

J Craniofac Surg. 2010 May

Journal of Craniofacial Surgery:

May 2010 - Volume 21 - Issue 3 - pp 934-936

doi: 10.1097/SCS.0b013e3181d84124

Brief Clinical Studies

Yeh CH, Chen WC, Lin MS, Huang HT, Chao SC, Lo YC.

Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan. shium8852@gmail.com

Abstract

A 17-year-old boy with pyrexia, headache, and frequent drop attacks reported an acute onset of periorbital pain and swelling 1 month previously. Coronal computed tomography (CT) identified an ethmoid sinusitis, which was treated with functional endoscopic sinus surgery and intravenous gentamicin, prostaphylline, and metronidazone. Because of persistent symptoms, the patient returned 1 month later.

The CT identified accumulation of debris in both frontal sinuses and a multilobulated lesion over the right frontal lobe. Bicoronal craniotomy was performed, and a mass located in the right frontal lobe was excised; the mass comprised chronic inflammatory tissues without evidence of malignancy. A postoperative brain CT confirmed the absence of a residual mass, and no recurrence or neurologic deficits were noted during the 3-month follow-up period. Intracranial complications cannot be prevented entirely even with the judicious use of antibiotics. Early application of the appropriate imaging modality and institution of aggressive therapy in any patient, not just pediatric patients, to prevent potential long-term disabilities and death are essential.

Journal of Craniofacial Surgery