Clinical, radiological and histological characteristics of orbital lesions and treatment options [Elektronische Ressource] : a study of 132 cases / vorgelegt von Manousaridis, Kleanthis

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Informations

• Publié par: universitat_rostock
• Publié le: 01 janvier 2009
• Nombre de lectures: 11
• Langue: English
• Poids de l'ouvrage: 7 Mo

Extrait

Aus der Klinik und Poliklinik für Augenheilkunde
Direktor: Prof. Dr. Rudolf F. Guthoff



Clinical, radiological and histological characteristics of orbital lesions
and treatment options: a study of 132 cases
urn:nbn:de:gbv:28-diss2009-0222-8


Inauguraldissertation
zur
Erlangung des akademischen Grades
Doktor der Medizin
der Medizinischen Fakultät
der Universität Rostock

vorgelegt von

Manousaridis, Kleanthis
aus Ptolemaïda, Griechenland






Rostock, 2009
Dekan: Prof. Dr. Emil Reisinger 2














































1. Gutachter: Prof. Dr. med. R. F. Guthoff
2. Gutachter: Prof. Dr. med. K. H. Emmerich
3. Gutachter: Prof. Dr. med. H. Busse 3






























For my parents 4

Table of contents

1. Introduction....................................................................................................... 6
1.1. Anatomy of the orbit................................................................................. 6
1.1.1. Bony Anatomy .................................................................................... 6
1.1.2. Orbital spaces................................................................................... 10
1.1.3. Orbital extraocular muscles........................................................... 10
1.1.4. Orbital arteries and orbital venous drainage.............................. 12
1.1.4.1. Ophthalmic artery ..................................................................... 12
1.1.4.2. Orbital venous drainage .......................................................... 15
1.1.5. Orbital nerves 17
1.2. Classification of orbital disease 20
1.3. Pathophysiological and anatomical patterns of orbital disease ... 23
1.4. Examination ............................................................................................. 25
1.4.1 Clinical examination of the orbital patient ................................... 25
1.4.2. Orbital imaging techniques............................................................ 26
1.4.2.1. Ultrasonography ....................................................................... 26
1.4.2.2. Computed tomography (CT) ................................................... 27
1.4.2.3. Magnetic Resonance Imaging (MRI)...................................... 28
1.5. Orbital surgery......................................................................................... 29
2. Material and methods.................................................................................... 31
2.1. Patients ..................................................................................................... 31
2.2. Exclusion criteria 31
2.3. Data............................................................................................................ 31
Aim ........................................................................................................................ 32
3. Results.............................................................................................................. 33
3.1. Epidemiologic characteristics.............................................................. 33
3.1.1. Distribution of lesions by age and histological correlations.. 33
3.1.2. Distribution of lesions by pathophysiological mechanism..... 35
3.1.3. Distribution of lesions by anatomical pattern............................ 36
3.1.4. Histology of neoplastic lesions..................................................... 37
3.1.5. Histology of lacrimal gland lesions.............................................. 38
3.2. Clinical presentation and treatment of disease on the basis of
histology and pathophysiology................................................................... 39
3.2.1 Inflammatory disease....................................................................... 39
3.2.2. Neoplasia ........................................................................................... 45
3.2.2.1. Malignant tumors ...................................................................... 45
3.2.2.2. Benign tumors ........................................................................... 55
3.2.3. Vascular lesions............................................................................... 59
3.2.4. Structural and degenerative lesions ............................................ 63
4. Discussion....................................................................................................... 65
4.1. Inflammatory disease............................................................................. 65
4.1.1. Non-specific inflammation (NSI) ................................................... 65
4.1.2. Specific inflammation 72
4.2. Neoplasia .................................................................................................. 74
4.2.1. Malignant tumors 74
4.2.1.1. Neoplasia of the haemopoietic system ................................ 74
4.2.1.2. Mesenchymal tumors............................................................... 82 5
4.2.1.3. Tumors of the lacrimal gland.................................................. 90
4.2.1.4. Metastasis................................................................................... 93
4.2.2. Benign tumors .................................................................................. 94
4.2.2.1. Vascular tumors ........................................................................ 94
4.2.2.2. Tumors of the lacrimal gland.................................................100
4.2.2.3. Neurogenic tumors..................................................................101
4.3. Vascular lesions.....................................................................................102
4.3.1. Arteriovenous fistulas....................................................................102
4.3.2. Orbital Venous malformation (OVM)-Thrombosis of the
superior ophthalmic vein (SOV)..............................................................106
4.3.3. Orbital hematic cyst........................................................................109
4.4. Structural lesions...................................................................................111
4.5 General considerations regarding the therapeutic approaches
to orbital lesions............................................................................................112
SUMMARY………………………………………………………………………...……………. 117
THESES ………………………………………………………..121
PERSONALIEN...................................................................................................125
REFERENCES ....................................................................................................126 6

1. Introduction

1.1. Anatomy of the orbit

1.1.1. Bony Anatomy

The orbits are bony cavities situated at either sides of the nasal fossa,
between the anterior compartment of the base of the skull and the superior
portion of the facial bones occupied by the maxillary sinuses. The orbit
displays a pyramidal and irregular shape with a square base directed
anteriorly, corresponding to the facial opening of the orbit. The orbital vertex
is located in the posterior extreme of the orbit. The orbit represents an
anatomical unit with an approximate volume of 30 cc. In it converge complex
structures such as bones, muscles, sensory and motor nerves, vascular
elements as well as fat and connective tissue, while the globe occupies a
volume of approximately 7cc.
The medial walls of the orbit are 2,5cm apart, roughly parallel, and 4,4cm to
5cm long. The lateral walls are 4,5cm to 5cm long and lie at right angles to
each other. The distance from the inferior orbital rim anteriorly to the
infraorbital groove posteriorly is 2,5cm to 3cm. The depth of the temporalis
fossa laterally is 2cm.
Orbital roof: It is triangular. It is composed by the horizontal plate of the frontal
bone anteriorly and the lesser wing of the sphenoid bone posteriorly.
Orbital floor: It is triangular. Anteromedialy it is composed by the orbital plate
of the pyramidal process of the maxillary bone. The horizontal portion of the
orbital process of the zygomatic bone contributes anterolaterally. Its vertex is
composed by the orbital process of the palatine bone. The inferior orbital wall
is a thin bony wall that separates the orbit from the adjacent maxillary sinus.
The infraorbital sulcus is a fissure located on the orbital plate of the maxillary
bone that runs the orbital floor displaying a posteroanterior direction. After a
2cm trajectory it transforms into the infraorbital canal and exits the orbit
through the infraorbital foramen, located 5mm below the inferior orbital rim. 7
The maxillary sinus and often some of the ethmoid sinuses are i