Mucoepidermoid carcinoma of the lacrimal gland: 25 cases and a review and update of the literature.

Twenty-five cases of mucoepidermoid carcinoma of the lacrimal gland are compiled, the largest series reported to date. Five of these have not been previously reported. Additional follow-up is presented for seven cases previously reported in the literature, and 13 other cases from the literature are reviewed. This study suggests that histologic grading of the tumor into low- (grades 1 and 2) and high-grade (grade 3) tumors is most predictive of prognosis and can be used to formulate a therapeutic plan. Of the 16 patients with a known histologic grade for their tumors, 8 had low-grade tumors and 7 of these patients survived after extirpation with or without radiotherapy. On the other hand, only 1 of the 8 patients with high-grade tumors for which extended follow-up was available has remained tumor free. The authors suggest that low-grade tumors can be treated with complete extirpation with or without adjuvant radiation and that these tumors generally have a good prognosis. Grade 3 tumors, on the other hand, may be treated aggressively with exenteration and excision of bone, if needed, as well as adjuvant radiation. But these tumors, despite this treatment, carry a poor prognosis.

Myositis ossificans masquerading as a recurrent spindle cell lipoma of the orbit.

A spindle cell lipoma developed in the right orbit of a 43-year-old woman whose medical history was only significant for chronic asthma. Sixteen months after nearly complete excision of the tumor, the patient presented with eyelid swelling, orbital pain, and a calcified apical mass as demonstrated by computerized tomography (CT). Recurrent tumor or a second neoplasm was suspected. Histologic examination revealed myositis ossificans. To our knowledge, this is the first reported case of myositis ossificans in the orbit.

Current techniques of enucleation: a survey of 5,439 intraorbital implants and a review of the literature.

Enucleation is a commonly performed procedure. A multitude of intraorbital implants are available for use following enucleation. Each has advantages and disadvantages. This survey report represents the most comprehensive evaluation yet of the current trends in the rehabilitation of the anophthalmic socket. The membership of the American Society of Ophthalmic Plastic and Reconstructive Surgeons (ASOPRS) was surveyed. Information was requested regarding preferred intraorbital implants, complications associated with each implant, and some details of current surgical techniques. Hydroxyapatite (HA) was used in 56% of primary enucleations by this group as compared to 1% in 1989. In comparison to other leading implants, HA was found to have equally low or lower complication rates when poor motility, infection, extrusion, migration, superior sulcus deformity, enophthalmos, lower lid malposition, and contracted fornices were assessed. A detailed discussion of these various complications is presented. The majority (59%) of ophthalmic plastic surgeons use donor sclera when placing an intraorbital implant. HA was clearly the implant material most used by ophthalmic plastic surgeons in 1992, and may be the material of choice for enucleation. To date it has achieved better postoperative results and a favorable side effect profile. Because it has been available for only 5 years, more time is necessary to determine its long-term success rate. Despite theoretical concerns of the transmission of infectious agents with the use of donor sclera, the majority of surgeons use this material when placing an intraorbital implant.

Malignant peripheral nerve sheath tumor of the orbit in a 15-month-old child. Nine-year survival after local excision.

BACKGROUND: Malignant peripheral nerve sheath tumors are extremely rare orbital tumors that carry a poor prognosis despite wide excision with disfiguring surgery, chemotherapy, or radiotherapy. The authors present the youngest reported case, a 15-month-old boy who underwent an orbitotomy to excise a bilobed tumor from the right orbit. FINDINGS: Histologic examination revealed a malignant peripheral nerve sheath tumor; standard treatment options, including orbital exenteration, chemotherapy, and radiotherapy, were denied and instead the patient was followed with serial computed tomography scans and magnetic resonance imaging. RESULTS: Nine years later, the patient remains without evidence of recurrent tumor and visual acuity is 20/20. CONCLUSION: This patient's course suggests that orbital malignant peripheral nerve sheath tumors, if believed to be completely excised at the time of surgery, might be followed with careful neuroimaging studies for signs of recurrence.