Transorbital Penetrating Brain Injury from Pressure Cooker Blast: An Unusual Case Report

The incidence of a penetrating brain injury due to a pressure cooker blast is quite rare. We are presenting this case of a 24-year-old female who sustained anterior skull base injury, with the nozzle of the pressure cooker penetrating through left orbit on account of the blast. A combined multidisciplinary approach was utilized and the patient recovered uneventfully.

Normative Orbital Measurement Based on Computed Tomography Imaging in Tertiary Care Hospital, Bangalore, Karnataka

Introduction: The orbit is an anatomically complex region. Clear idea of the normal orbital measurements is needed for the diagnosis and management of the various diseases that may affect the orbit like optic neuritis, optic nerve glioma, meningioma, proptosis and exophthalmos. Aim: To evaluate normative orbital measurement at tertiary care hospital in Bangalore, Karnataka in Indian population based on Non Enhanced Computed Tomography (NECT) imaging. Materials and Methods: A cross-sectional observational study of 100 patients referred to a tertiary care centre for NECT of the brain for diseases other than those of the orbits was conducted. Patients having any orbital disorder, surgery or trauma and having metallic implants were excluded from the study. The patients of all age groups and either sex were included. The horizontal orbital diameter, vertical orbital diameter, orbital index, optic nerve complex, globe position, interorbital diameter and interzygomatic line measurements were calculated for 100 patients, i.e., total of 200 orbits using both axial and direct coronal CT images. Mean measurements of these parameters were calculated. Scans were performed on Siemens Somatom Perspective 128 slice multi- detector CT scanner. All statistical analysis was performed using Statistical Package for The Social Sciences (SPSS) for windows software (SPSS Inc. Illinois, Chicago, USA). Results: The mean orbital index was 118.6 and 118.3 for right and left orbit, respectively. It was derived from mean horizontal orbital diameter of 32.5 mm and 31.7 mm of right and left orbit, respectively and mean vertical orbital diameter of 38.4 mm and 37.4 mm of right and left orbit, respectively. Mean optic nerve sheath complex diameter was 5.2 mm and 5.4 mm for right and left orbit, respectively, while mean globe position measurements 6.7 mm and 6.8 mm of right and left orbit, respectively. Average interorbital distance was 22.9 mm and average interzygomatic distance 97.1 mm. Conclusion: The present study has given normative mean measurements for various orbital structures that are essential to ophthalmologists and radiologists to differentiate normal from abnormal dimensions which is likely to be helpful in accurate assessment of various orbital pathologies.

Primary orbital extraskeletal osteosarcoma and review of literature

Background Extraskeletal osteosarcoma is a malignant tumour composed of an osteoid and/or cartilaginous matrix; it arises in soft tissues without connection to the skeleton, and to our knowledge, this type of tumour is extremely rare. Case presentation The present study reports a 57-year-old man with primary orbital extraskeletal osteosarcoma who presented with a history of painful swelling in the left orbit that had occurred for 11 months. Imaging of the orbit showed an atypical, well-defined heterogeneous mass attached to the posterior globe of the left orbit. The patient underwent an anterior orbitotomy and complete excision of the tumour. The mass was originated from neither the globe nor the bony orbital wall but from the soft tissue. Histopathology demonstrated an extraskeletal osteosarcoma. After 13 months of follow-up, there was apparent recurrence of the tumour. The medical history showed no complaints of previous trauma or radiotherapy. Conclusions ESOS is a highly malignant tumour. Immunosuppression, trauma and adjuvant radiotherapy are possible predisposing factors in the development of this tumour. Prompt recognition and thorough treatment are essential for preventing orbital lesions and presence of metastasis from other organs.

Combined Extraskeletal Chondrosarcoma of Left Orbit : A Rare Second Primary Tumor of Retinoblastoma Survivor A Case Report

Retinoblastoma, a rare eye malignant tumor of childhood, is generally responsive to chemotherapy or radiation therapy, but the survivors have high risk to development of second primary tumors (SPTs) due to genetic susceptibility and/or prior radiation therapy. The SPTs predominantly occured among heritable form of Retinoblastoma and show worse prognosis than Retinoblastoma itself. A 13 years old girl underwent enucleation to remove tumor mass within her left orbit. This tumor initially appeared 4 years after the patient undergoing right bulbar enucleation and receiving chemotherapy due to Retinoblastoma in her right eye. Clinical and radiologic examination suspected the left one as a late presentation of bilateral Retinoblastoma, but microscopic examination revealed a combined Extraskeletal Chondrosarcoma. The histologic type of this SPT is rare, so does it occurance at younger age and in a survivor with unilateral Retinoblastoma wihout a history of radiation therapy. The treatment of choice is combine surgery and chemo/radiation therapy, and the prognosis is poor.

Orbital Teratoma: A rare congenital tumour

Background: Orbital teratomas are congenital, unilateral germ cell tumors, which are present at birth with moderate to massive proptosis. The rare tumour has to be managed individually and is at times difficult. Case: A female child in her 2nd day of life was brought to our department with complains of forward bulging of the left eye which was noticed since the time of her birth. Observation: Examination and investigations revealed a mass with scattered foci of calcification. The mass was causing expansion of left orbit with thinning and scalloping of bony boundaries of left orbit with no intracranial component. The scan suggests the diagnosis of orbital teratoma which was further confirmed by histopathological examination. Conclusion: The rare tumour presents a challenge in management. The aim of management depends upon the extent of tumour, preservation of vision whenever possible, promotion of normal orbital growth and cosmesis.

Paranasal Rosai-Dorfman Disease with Osseous Destruction

Rosai-Dorfman disease is a rare histiocytic proliferative disorder of unknown etiology typically characterized by cervical lymphadenopathy. Extranodal involvement often manifests in the head and neck region. We present a 10-year-old male who presented to our hospital with left epiphora from an aggressive paranasal mass invading the left orbit with osseous destruction. The mass was surgically biopsied and debulked with histopathological examination revealing Rosai-Dorfman disease. Although rarely found in the sinuses, Rosai-Dorfman disease should be considered when evaluating sinonasal masses.