Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2016 Sep;36(3):308-12.
doi: 10.1097/WNO.0000000000000354.

Orbito-Masticatory Syndrome

Pradeep Mettu  1 , M Tariq Bhatti, Mays A El-Dairi, Evan B Price, Amy Y Lin, Ali Alaraj, Pete Setabutr, Heather E Moss
Affiliations
Case Reports

Orbito-Masticatory Syndrome

Pradeep Mettu et al. J Neuroophthalmol. 2016 Sep.

Abstract

We describe 2 unique cases of visual symptoms occurring during mastication in patients with lateral orbital wall defects. A 57-year-old man reported intermittent double vision and oscillopsia after a right fronto-temporal-orbito-zygomatic craniotomy with osteotomy of the lesser wing of the sphenoid for a complex invasive pituitary adenoma. Proptosis of the right globe was present only during mastication. Computed tomography (CT) revealed a bony defect in the right lateral orbital wall. A 48-year-old man presented with transient diplopia and scotoma in the right eye elicited by chewing. CT and magnetic resonance imaging demonstrated a bilobed lesion connecting the temporal fossa to the orbit through a defect in the right lateral orbital wall. The regional neuroanatomy and pathophysiology as pertaining to these cases are discussed.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Appearance of patient at rest. D-F. With mastication, there is anterior movement of the right eye leading to increased fullness of the right lower lid (E compared to B). In addition there is inferior displacement of the right eye during mastication causing increased distance from the superior pupillary border to the right upper lid margin (F compared to C).
Figure 2
Figure 2
Case 1. A. Axial computed tomography (CT) demonstrates a bony defect (arrow) in the right lateral orbital wall. Case 2. Axial (B) and coronal (C) CT reveals a bony defect (arrows) in the right lateral orbital wall.
Figure 3
Figure 3
Case 2. Axial (A-C) and coronal (D) magnetic resonance images of dumbbell-shaped lesion with extracranial component in the temporalis muscle and extraconal orbitral component. E. Magnetic resonance angiography demonstrates possible flow-related signal in the region inferior to the extracranial portion of the dumbbell-shaped lesion.
Figure 4
Figure 4
Case 2. Histopathologic appearance of orbital and temporal muscle lesion. A. Arteries and veins of various sizes are present in a fibrous stoma (hematoxylin & eosin, × 50). B. A more magnified view shows no evidence of cytologic atypia or lymphoid aggregates (hematoxylin & eosin, × 400).
Figure 5
Figure 5
Following orbitozygomatic craniotomy (A), a defect in the greater wing of the sphenoid (inset) allows the force of the temporalis muscle to be transmitted into the orbit (inset and B) causing proptosis (arrow).
See this image and copyright information in PMC

References

    1. Thinda S, Vaphiades MS, Mawn LA. Mechanical Oscillopsia After Lower Eyelid Blepharoplasty With Fat Repositioning. J Neuroophthalmol. 2012;33:71–73. - PubMed
    1. Fayers T, Barker LE, Verity DH, Rose GE. Oscillopsia after lateral wall orbital decompression. Ophthalmology. 2013;120:1920–1923. - PubMed
    1. Militsakh O, Kriet J. Masticatory diplopia. Nose Throat J. 2008;87:39–47. - PubMed
    1. Whitney CE, Leone CR, Kincaid MC. Proptosis with mastication: an unusual presentation of an orbital dermoid cyst. Ophthalmic Surg. 1986;17:295–298. - PubMed
    1. Bullock JD, Bartley GB. Dynamic proptosis. Am J Ophthalmol. 1986;102:104–110. - PubMed

Publication types