aCase 10

by Dr.Chua

A 7-year-old boy who had learning difficulty was referred to our department from another eye unit because of a one-week history of progressive left proptosis. He was initially managed as orbital cellulitis because of a recent history of dental cary. CT scan showed a lateral orbital mass with extension into the temporal fossa and the cranium. The maxillary sinus was opaque.
Examination revealed an otherwise well child with left severe proptosis and swellings of the ipsilateral cheek and temporal fossa. There was no afferent pupillary defect. Palpation showed the proptosis was not reducible and the swellings of the cheek and temporal region were firm.

Figure 1. One-week history of progressive left proptosis with cheek

and temporal fossa swellings.

Figure 2. CT scans of the maxillary sinus and orbit showing opacity in the left

maxillary sinus (above) and lateral orbit, cranium and the temporal fossa.

a. Why is orbital cellulitis an unlikely diagnosis in this patient?

b. What is the most likely diagnosis?

c. How would you manage this patient ?