Elusively reaching the apex

Abstract

A 64-year-old man presented with a 3-month history of diplopia and left-sided proptosis. Examination was significant for impairment of his left second, third, fourth, fifth, sixth, and seventh cranial nerves. Magnetic resonance imaging revealed a left orbital apex and cavernous sinus lesion. However, subtle thickening of his left frontal and supraorbital nerve was not identified until later. A trial of steroids provided minimal effect. Biopsy of the lesion showed a well-differentiated squamous cell carcinoma. The patient was subsequently managed with palliative radiotherapy.

Keywords: frontal nerve; orbit; orbital apex syndrome; perineural invasion; squamous cell carcinoma.