The Bell's Toll

• Published in: Survey of ophthalmology Vol. 55; no. 6; pp. 590 - 597
• Main Authors: Simão, Luciano Mesquita, MD, Murchison, Ann P., MD, MPH, Bilyk, Jurij R., MD, Rubin, Peter A.D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2010; Elsevier
• Subjects: Aged; Biological and medical sciences; Carcinoma, Squamous Cell - pathology; Cavernous Sinus - pathology; cavernous sinus syndrome; Cranial Nerve Neoplasms - pathology; Craniotomy; Dermatology; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; external ophthalmoplegia; facial numbness; facial palsy; Facial Paralysis - pathology; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Miscellaneous; Neoplasm Invasiveness; Non tumoral diseases; Oculomotor disorders; Ophthalmology; Ophthalmoplegia - diagnosis; Otorhinolaryngology. Stomatology; perineural spread; Skin Neoplasms - pathology; squamous cell carcinoma; Tumors of the skin and soft tissue. Premalignant lesions; facial palsy; perineural spread; cavernous sinus syndrome; facial numbness; external ophthalmoplegia; squamous cell carcinoma; Skin disease; Nervous system diseases; Squamous cell carcinoma; Basal cell carcinoma; Motor system disorder; Facial paralysis; Facial nerve; Malignant tumor; Eye disease; Cranial nerve disease; External; Ophthalmoplegia; ENT disease; Ophthalmology; Oculomotor syndrome; Neurological disorder; Face; Cancer
• ISSN: 0039-6257; 1879-3304
• DOI: 10.1016/j.survophthal.2009.12.004

Abstract A 70-year-old man presented complaining of lid and facial drooping and facial numbness, which progressed over several months. Magnetic resonance imaging of the head showed an enlarged right cavernous sinus. His past medical history was remarkable to squamous cell carcinoma of the face. The patient underwent a craniotomy with biopsy of the cavernous sinus that confirmed malignancy. High index of suspicion in a patient that presents facial drooping and/or numbness should alert ophthalmologists about the occurrence of perineural spread of a previous malignant lesion of the skin.