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Steven A. Newman; Trans-antral Biopsy Of Infraorbital Nerve In Neurotrophic Spread Of Squamous Cell Carcinoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):718.
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Squamous cell involvement of the cavernous sinus may originate with tumors involving the skin. Neurotrophic spread along the major divisions of the trigeminal nerve are infrequent but possible source of cavernous sinus involvement. Multiple cranial nerve palsies including IIIrd, IVth, Vth, and VIth involvement may indicate cavernous sinus pathology confirmed on imaging studies. Craniotomy and direct biopsy of the involved cavernous sinus may yield a diagnosis. Less invasive techniques may also be possible in the case of neurotrophic spread.
A retrospective case controlled series of 3 patients presenting wit ocular motor nerve palsies and evidence of cavernous sinus pathology underwent trans-antral biopsy of the infraorbital nerve.
In all 3 cased a presumptive diagnosis of squamous cell carcinoma was based on gradual progression of numbness and cranial nerve palsies plus finding of cavernous sinus pathology on imaging studies. In 2 cases, the patient had a preceding history of lesions affecting the face. Trans-antral biopsy confirmed the presence of squamous cell carcinoma.
In the case of neurotrophic spread of squamous cell carcinoma, involvement of the infraorbital nerve may be detected by a biopsy within the roof of the maxillary sinus. This may preclude the need for intracranial biopsy prior to radiation therapy.
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