Infraorbital approach for retrobulbar orbital neurofibroma: a case report

Authors

  • Harshitha N. Department of ENT and Head and Neck Surgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka
  • Azeem Mohiyuddin S. M. Department of ENT and Head and Neck Surgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka
  • Supreeth C. S. Department of Neurosurgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka
  • K. C. Prasad Department of ENT and Head and Neck Surgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka
  • Brindha H. S. Department of ENT and Head and Neck Surgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka
  • H. Mohan Kumar Department of Ophthalmology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20192740

Keywords:

Infraorbital approach, Retrobulbar orbital tumor, Neurofibroma

Abstract

Retrobulbar orbital tumours are rare and treatment is challenging. These tumors include cavernous hemangioma, neurofibroma, A-V malformations, glioma etc. A variety of approaches have been used in resection of these tumours. The various approaches in literature include endoscopic transethmoidal and sphenoidal, lateral orbitotomy, transmaxillary infraorbital, and cranial and sub cranial approaches. Such tumours located inferior to the optic nerve can be reached through infraorbital approach avoiding traction on optic nerve or pressure on globe. We are reporting a retrobulbar orbital neurofibroma in a middle aged lady who presented with unilateral loss of vision, episodic giddiness, severe left sided headache, left orbital pain and epiphora on exposure to sunlight. MRI showed well defined 1.8×1.8×1.7 cm enhancing lobulated solid left intraorbital mass extending along the substance of inferior aspect of left optic nerve with mass effect. With transmaxillary infraorbital endoscope assisted approach, the retrobulbar tumor was exposed and enucleated. Floor of orbit was reconstructed with tensor fascia lata and nasal septal cartilage graft. The patient had uneventful recovery and immediate post operative visual acuity was perception of light and likely to improve further. Histopathology revealed neurofibroma. This case report highlights the advantages of infraorbital approach as it is a simple approach along the suture lines through the orbital floor with the help of endoscopic guidance. It has the advantages of avoiding traction on optic nerve or optic chiasma, no retraction of brain, no communication with cranial cavity, no pressure on globe and easy reconstruction of orbital floor.

Author Biographies

Harshitha N., Department of ENT and Head and Neck Surgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka

ENT 

Junior resident 

Azeem Mohiyuddin S. M., Department of ENT and Head and Neck Surgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka

Head of department
Ent and head and neck surgery

Supreeth C. S., Department of Neurosurgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka

Consultant 

Department of neurosurgery 

K. C. Prasad, Department of ENT and Head and Neck Surgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka

Professor

Department of ent and head and neck surgery 

Brindha H. S., Department of ENT and Head and Neck Surgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka

Junior resident 

Department of ent 

H. Mohan Kumar, Department of Ophthalmology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka

Professor 

Department of ophthalmology

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Published

2019-06-27

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Section

Case Reports