背景:Mycetoma是一种被忽视的热带病,通常影响下肢。该疾病归因于皮下肉芽肿性炎症,导致逐渐无痛性肿胀伴有结节和引流的明显临床特征。眼眶肌瘤是该疾病的一种极为罕见的实体。我们报告了临床表现,诊断,与颅骨扩张的眼眶肌瘤的手术结果。
方法:一名25岁男性主诉左眼前凸8年,随后左眼视力完全丧失7年,最后一年左眼疼痛。左眼前后移位,眼球运动正常,绑架,和滑车检查。脑部CT扫描显示眶骨厚度随着前颅基部的延伸而增加,中颅底,和颧骨的眶突。MRI显示一个累及左额颞区并延伸至左眼眶的大病灶,左筛骨后气囊,和左侧颞上区。病变在对比下均匀增强。患者接受了左眶颌骨开颅术以切除病变。然而,由于骨病变一直延伸到岩骨,因此完全切除不适用。用钛网进行颅骨成形术。
结论:Mycetoma是一种慢性炎症性疾病,常影响下肢的皮下组织。该疾病可由真菌(Eumycetoma)或细菌(放线菌瘤)引起。眼眶肌瘤是该疾病的一种极为罕见的实体。然而,它通常与颅骨延伸有关。早期诊断和及时的手术和药物治疗是取得良好疗效的关键。
BACKGROUND: Mycetoma is a neglected tropical disease that commonly affects the lower extremity. The disease is attributed to subcutaneous granulomatous inflammation leading to distinct clinical features of gradual painless swelling accompanied by nodules and drains. Orbital mycetoma is an extremely rare entity of the disease. We reported the clinical presentation, diagnosis, and surgical outcomes in a
case of orbital mycetoma with cranial extension.
METHODS: A 25-years-old male complained of left eye protrusion for 8 years, followed by complete loss of vision on the left eye for 7 years and eventually left eye pain for the last year. The left eye was displaced anteriorly and inferiorly with normal oculomotor, abducent, and trochlear examination. Brain CT scan showed an increase in orbital bone thickness with extension to the anterior cranial base, middle cranial base, and the orbital process of the zygomatic bone. MRI revealed a large lesion involving the left frontotemporal region with extension to left orbit, left posterior ethmoid air cells, and left temporal suprasellar region. The lesion was homogenously enhanced with contrast. The patient underwent a left orbitozygomatic cranitomy for resection of the lesion. However, total resection was inapplicable due to the extension of the bony lesion up to the petrous bone. Cranioplasty was performed by titanium mesh.
CONCLUSIONS: Mycetoma is a chronic inflammatory disease affecting subcutaneous tissues commonly in the lower limbs. The disease can be caused by fungi (Eumycetoma) or bacteria (
Actinomycetoma). Orbital mycetoma is an extremely rare entity of the disease. However, it is commonly associated with the cranial extension. Early diagnosis and prompt surgical and medical treatment are the keys to good outcomes.