眶区皮样囊肿的CT表现

目的 分析眶区皮样囊肿及表皮样囊肿的CT表现,揭示该病的特殊性CT征,作为诊断依据.方法 复习经手术及病理组织学证实的皮样及表皮样囊肿CT片共55例,分析其所在位置、范围、形状、边界、密度、CT值及继发改变.结果 55例病变均被CT发现,53例提示病理组织学诊断,2例眶缘有瘘管者缺乏特征性CT表现.病变位于眶内者44例:内上象限2例、外上象限36例、内下象限3例、外下象限3例;按所在间隙分析,中央间隙(肌锥内)1例、周围间隙9例、骨膜下间隙24例、眶骨壁内10例.眶缘者5例均位于眶上缘.颞窝者6例均位于颞肌下.囊肿密度不均,CT值-158.67Hu～+62.00Hu.典型的骨壁改变45例.结论 CT能够在术前对皮样囊肿作准确定性、定位诊断,对制定手术方案有很大帮助.     

Diagnostic Value of the Post-Processing Technique of Multi-Slice Spiral CT in Orbital Cyst Diseases

Purpose:To analyze the features of CT imaging of orbital cystic disease. Methods:.A total of 30 patients were pathologically confirmed with orbital cystic disease between January 2007 and March 2012. Prior to operation, the participants underwent CT scans with image processing by maximum intensity projection (MIP) and volume rendering (VR). Preoperative CT diagnostic outcomes were compared with postoperative pathological findings. Results:.The patients presented with round,.oval and dumbbell shaped masses. Fourteen cases of dermoid cyst and 8 cases of epidermoid cyst showed heterogeneous density. Among the dermoid cyst patients, 6 cases had demixing phenomenon, 3 cases had lipid drift and 5 cases showed mild or moderate intensity enhancement in the cyst wall. No intensity enhancement was observed in the epidermoid cyst patients. Five cases had high intensity due to hemorrhage and 3 patients presented with adjacent sclerotin arc compression;.5 cases of myxoid cyst had homogenous density and no intensity enhancement was found when iohexol was injected..Three patients with atheromatous cyst had heterogeneous density,.with CT value ranging from -36Hu to 191Hu. Floss was noted centrally in 1 case and mild to moderate intensity enhancement was observed in the cyst wall with iohexol injection. Conclusion:.Multi-slice CT is useful in the diagnosis of orbital cystic disease. Multi-slice CT combined with image processing can be helpful in displaying the location and size of masses, and revealing the relationship between masses and surrounding boney tissue, providing an objective basis for surgical planning when combined with 3D-CT imaging.     

Cavernous Hemangioma of the Bony Orbit

Purpose: To study the clinical features, diagnosis and management of intraosseous cavernous hemangioma of the orbit. Methods: Five cases of intraosseous cavernous hemangioma seen in our hospital from Jan 1, 1986 to Dec 31, 2000 were reviewed. Results: Among all five cases, two were male and three were female. The mean age was 47.6 years old, ranging from 39.0 to 55.0 years. The left orbit was affected in 4 cases and the right one in 1 case. The bony involvement occurred in frontal bone (two cases), zygomatic bone (two cases) and sphenoid bone (one case). A painless, slowly enlarging hard bony mass fixed to the bone with no pulsations was the main clinical sign. The x-ray and CT appearance of intraosseous cavernous hemangioma of the orbit were characteristic and usually diagnostic. The differential diagnosis of it included fibrous dysplasia, eosinophilic granuloma, multiple myeloma and metastatic carcinoma. Treatment is local removal of the bone containing the tumor. Conclusions: Intraosseous cavernous hemangioma is a rare tumor of the orbit and usually has good surgical result. Eye Science 2005;21:147-151.     

眼眶嗜酸性粒细胞增生性淋巴肉芽肿的临床病理学观察

目的 探讨眼眶嗜酸性粒细胞增生性淋巴肉芽肿(Kimura病)的临床病理学特点.方法 回顾性系列病例研究.对天津市眼科医院病理科从1976年至2008年间诊断的9例Kimura病患者的临床和病理学特点进行总结,分析CD20、CD79a、CD3、CD45Ro、CD34、Ki67及IgE等抗体免疫组织化学染色特点.结果 9例中,男性7例,女性2例,发病年龄13～62岁,年龄中位数为25岁;7例为单眼眶内病变,2例为双眼眶内病变.病变均发生在眼眶上方或颞上方,多数病例侵及眶内深部组织,6例累及泪腺,5例累及外直肌.其中1例伴有左侧颌下3个肿大的淋巴结和双侧肘部各1个皮下肿块.临床主要表现为眼睑红肿、眼球突出和眶内肿物,发病时间为6个月～15年.3例患者外周血检查显示嗜酸性粒细胞数量增高(11%-14%).病理学特点为大量分化成熟的淋巴细胞增殖,其间有大小不一的淋巴滤泡、大量嗜酸性粒细胞浸润和增生的毛细血管.免疫组织化学染色显示淋巴滤泡内的细胞表达B细胞抗原,滤泡间的淋巴细胞多数表达T细胞抗原.结论 Kimura病是一种很少见的眶内淋巴组织增生病变,伴有大量嗜酸性粒细胞浸润和毛细血管增生,好发于眼眶外上方,容易累及泪腺和外直肌.

Abstract：

Objective To improve the knowledge of the clinicopathologic features of eosinophilic hyperplastic lymphogranuloma (Kimura disease) in the orbit. Methods It was a retrospective case series study. The clinical and pathological characteristic of 9 cases of Kimura disease from the pathology department of Tianjin Eye Hospital were reviewed, immunohistochemical staining was performed, including for CD20, D79a, CD3, CD45Ro, CD34, Ki67 and IgE. Results In the 9 cases, 7 cases were male, 2 cases were female; the age of onset were from 13 to 62 years, medium age was 25 years; 7 cases were simple, 2 case were bilateral orbit. These lesions occurred in the superior or superotemporal quadrant of the orbit and the majority of cases extended into deep orbital tissues, 6 cases involved the lacrimal gland, 5 case involved the lateral rectus muscle. The clinical features mainly included lid swelling, eye redness, proptosis and palpable mass, and the disease course ranged from 6 months to 15 years. 3 lymph node enlargements in the submandibular regions and 1 subcutaneous nodule on the bilateral elbow were found in one case. The documentation of peripheral-blood eosinophilia (11% - 14%) was found in 3 cases. The pathological characteristics of Kimura disease were lymphoid tissue hyperplasia with prominent lymphoid follicles, conspicuous eosinophils infiltration and capillary proliferation. Immunohistochemical study in our cases revealed B cells in lymphoid follicles and mostly T cells in the interfollicular regions. Conclusion Kimura disease of orbit is an uncommon lymphoid hyperplasia with prominent eosinophils infiltration and capillary vessels, which commonly occur superotemporal quadrant of the orbit, easy to involve lacrimal gland and lateral rectus muscle.     

Multiple cavernous hemangiomas of the orbit

 Purpose: Cavernous hemangioma of the orbit is often unilateral and solitary. Multiple cavernous hemangiomas of the orbit are extremely rare. The authors reported four patients who had more than two cavernous hemangiomas in one orbit. Methods:Case reports.The clinical features, imaging findings, differential  diagnosis and surgical management werepresented. Results: We found 4 cases of multiple cavernous hemangiomas of the orbit out of 214 records of all patients with orbital cavernous hemangiomas who were referred to us from Jan 1,1986 to Dec 31,2000. Two patients were female and two were male. The mean age was 46.5 years, ranging from 37.0 to 57.0 years. The left orbits were affected in all patients, with two, three, eight and ten tumors respectively. The most common complaint was a painless, gradually progressive proptosis. The characteristic CT imaging features were multiple well circumscribed, round or ovoid masses that were sharply delineated from the surrounding tissue. B-scan ultrasonography showed round-shaped orbital masses with high internal reflectivity. The therapeutic outcomes of lateral or anterior orbitotomy were excellent. Conclusion: Although rare, cavernous hemangioma should be considered in the differential diagnosis of patients with multiple orbital mass lesions.     

泪腺腺样囊性癌CT表现的研究

目的 分析泪腺腺样囊性癌常见的CT图像特征,从而探讨CT(computed tomography)影像对于泪腺腺样囊性癌的诊断价值.方法 病历来源为天津医科大学眼科中心及天津医科大学第二医院,经病理确诊的眼眶腺样囊腺癌39例.其中原发肿瘤20例,复发肿瘤19例,均为单眼发病,所有患者均行眼眶CT检查,获取水平及冠状扫描图像.结果 泪腺腺样囊性癌中原发肿瘤形状多为厚扁平状,贴附于眶壁增长,在体层像上呈锥形者10例、不规则形5例;复发肿瘤形状为不规则型8例、厚扁平状,贴附于眶外上壁向后增长者8例.原发与复发泪腺腺样囊腺癌的好发位置位于眶外上方分别为18例与11例.结论 CT可清晰显示肿瘤的位置,形状,范围、眶骨壁改变,对于泪腺腺样囊性癌的诊断和制定治疗方案具有重要指导意义.

Abstract：

Objective To analyze imaging characteristics of adenoid cystic carcinoma(ACC)of lachrymal gland on CT for the diagnosis of ACC in clinic. Methods Thirty-nine patients with ACC consisting of 20 cases of primary tumor and 19 cases of recurred tumors confirmed by pathology were collected from The Eye Centre of Tianjin Medical University and The Second Hospital of Tianjin Medical University. All the patients were unilateral, and examined by CT. The imaging characteristics of ACC on CT were analyzed. Results The most common shape of primary ACC included 10 cases of conical-shape, 5 cases of irregular-shape. The recurred cases contained 8 cases of irregular-shape, 8 cases of conical-shape. The primary and recurred ACC usually existed on superior-external side, with which there were 18 cases and 11 cases respectively. Conclusions CT examination can exactly reveal the shape, size, position, and ossa orbitale destruction of ACC and played an important role in the diagnosis of ACC.     

Idiopathic Orbital Inflammation Associated with Panuveitis in an Adult and a Review of the Literature

 PURPOSE:To report an unusual case of idiopathic orbital inflammation associated with panuveitis.  CASE REPORT:We report a case of a 47-year-old female with a history of uveitis who presented with abrupt and painful proptosis with complete vision loss  unresponsive to antibiotic therapy. B-scan ultrasonography and magnetic resonance imaging both showed retinal detachment and an orbital space-occupying mass. The patient underwent orbitotomy and the diagnosis of idiopathic orbital inflammation was confirmed by histopathology. Anterior uveitis is rarely seen in idiopathic orbital inflammation in adults. We report for the first time an unusual case of idiopathic orbital inflammation associated with panuveitis. CONCLUSION:Inflammation involving both the eye and the orbit is rarely seen in adults. Idiopathic orbital inflammation and panuveitis may share a similar mechanism in this case.       

三维眶底重建钛网在复合性眼眶骨折中的应用

目的 探讨应用三维眶底重建钛网治疗复合性眼眶骨折修复眶底缺损的手术方法和临床效果.方法 回顾性系列病例研究.回顾性分析13例(13只眼)行三维眶底重建钛网植入眼眶骨折修复眶底重建手术的复合性眼眶骨折患者的临床资料.其中眶颧颌骨折6例,鼻眶筛骨折5例,眼眶四壁多发性骨折2例.术中联合行颧骨、上颌骨骨折、鼻骨以及额骨骨折修复,8例眼球重度凹陷的患者同时行高密度聚乙烯眶内充填.手术前后测量眼球突出度、眼球运动以及眼眶CT扫描(水平位、冠状位以及三维重建).术后随访3～6个月.结果 术前患眼眼球凹陷平均(3.9±1.7)mm,眼球下移(3.1±2.6)mm.13例患者中,12例存在眼球运动障碍,其中Ⅰ级有4例,Ⅱ级有7例,Ⅲ级有2例.术后除3例患者残存眼球凹陷1.0 mm,其余10例患者眼球凹陷矫正;8例患者眼球下移完全矫正,3例残留眼球下移1.0 mm,2例患者眼球上移1.0 mm;术后3个月后8例患者眼球运动受限完全矫正,其余5例眼球运动障碍减轻,其中残留Ⅱ级运动障碍2例,Ⅰ级运动障碍3例;随访过程中未发现三维眶底重建钛网移位、排斥、感染及其他不良反应.结论 三维眶底重建钛网具有良好的生物相容性,采用三维眶底重建钛网治疗复合性眼眶骨折,可有效恢复眼眶容积,矫正眼球内陷和下移,改善眼球运动.

Abstract：

Objective To evaluate the outcomes of the clinical application of three-dimensionally preformed titanium mesh plates for posttraumatic complex orbital bone fracture reconstruction. Methods Thirteen patients (13 eyes) manifested with complex orbital fractures (including orbital-zygomatic- maxillary bone fracture in 6 patients,nasal-orbital-ethmoid bone fracture in 5 patients and complex multiple periorbital bone fracture in other 2 patients ) underwent the reconstructive surgery by using three-dimensionally preformed titanium mesh plates. Eight cases underwent high density porous polyethylene implantation simultaneously. Evaluation of enophthalmos,eyeball movement,and orbit CT scan were taken pre- and post-operatively. Results The average enophthalmos was (3.9 ± 1.7 ) mm and the position of the affected eyeball was( 3. 1 ± 2. 6)mm bellow the contralateral side preoperatively. Twelve patients suffered from eyeball movement restriction,including grade Ⅰ in 4 cases,grade Ⅱ in 7 cases and grade Ⅲ in 2 cases. During the 3 to 6 months post operative follow-up,enophthalmos was completely corrected in 10 patients while the other 3 patients had residual 1.0 mm enophthalmos. The affected eyeballs were repositioned in 8 cases and 3 cases had residual 1 mm lower position and 2 cases with a 1 mm higher positioned eyeball. Eye movement was not restricted in 8 patients,whereas 3 patients had grade Ⅰ movement restriction and 2 patients had grade Ⅱ movement restriction. There were no rejection,infection and other complications during follow-up.Conclusions Three-dimensionally preformed titanium mesh plates can be used to reconstruct posttraumatic complex orbital bone fractures in order to improve the orbital volume and to correct enophthalmos effectively.     

眶内非金属异物25例临床分析

目的 总结眶内非金属异物的临床特征及诊治方法.方法 回顾性系列病例研究.收集2002至2009年经手术证实的眶内非金属异物患者资料25例,总结临床表现、影像学征象、治疗与随访结果.结果 外伤性异物23例,包括:植物性异物11例,玻璃、油脂和石块各3例,塑料笔头2例,爆竹残渣1例.另2例为医源性异物.特征性临床表现为眶周皮肤或结膜瘘道,共11例,发生率为44%,以植物性异物最为多见.CT征象因异物性质不同而各异.植物性异物在外伤早期呈低密度,随时间延长密度逐渐增高,压缩窗宽,异物显示更加清晰.油脂异物表现为与脂肪相近的低密度,石块和玻璃表现为高密度块影.植物性异物在MRI的T1和T2加权像均呈低信号,周围的脓液在T2加权像呈环形高信号影,异物周围的炎性组织强化明显.油脂异物在T1和T2加权像均呈高信号,脂肪抑制显像呈低信号.所有患者均在全身麻醉下接受眶内异物清除术,均经一次手术清除全部异物及周围腐烂组织,感染伤口一期不予缝合.术后半年随访,伤口愈合良好,症状改善,未见与手术相关并发症.结论 眶内非金属异物种类较多,病情复杂各异,处置不当易眶内残留.CT为首选检查方法.正确认识病史及临床表现,运用恰当的手术技巧,彻底清除异物,预后良好.

Abstract：

Objective To evaluate the clinical features,diagnostic methods and treatment of intraorbital nonmetallic foreign body injuries. Methods In a retrospective study,the records of 25 consecutive cases with nonmetallic foreign bodies in the orbit confirmed by surgery were analyzed with special attention to the types of injury,history,clinical manifestations,imaging findings,treatment and follow-up results. Results Among 25 cases with nonmetallic foreign bodies,23 cases were caused by trauma,including 11 cases with wooden bodies,3 cases with glass,grease,or stone,2 cases with plastic pen point,and one case with firecrackers. The remaining two cases had iatrogenic foreign bodies. The distinctive clinical manifestation was the periorbital fistula recorded in 11 (44%) cases,mostly in patients with wooden foreign bodies. The CT findings were different in various foreign bodies. The wooden foreign bodies showed low density in the acute stage and the density increased gradually from the acute to the chronic stage. CT images with lower windows could distinguish a wooden foreign body better. The grease was seen as low density mimicking orbital fat on CT. The stone or glass showed as masses with high density. Wooden foreign bodies displayed low signals on both MRI T1- and T2-weighted images. The surrounding pus was seen as a ring with high signal on T2-weighted images. The inflammatory infiltration showed marked enhancement. The grease displayed high signal on both T1- and T2-weighted images and showed lower signal than that of the fat. All patients underwent surgical removal of retained foreign bodies and the surrounding decomposed tissues. The infected wounds were not sutured at one stage operation. After follow-up for 6 months,all wounds healed normally and all patients recovered well No complications were encountered.Conclusions There are various types of intraorbital nonmetallic foreign bodies. The clinical manifestations of these different foreign bodies are complex. CT is the preferred examination for this condition. With the combination of correct diagnosis,proper surgical skills,and complete removal of foreign bodies and surrounding decomposed tissues,nonmetallic foreign bodies can be treated efficiently.     

Mantle Cell Lymphoma in a Lacrimal Gland in a Female and a Review of the Literature

Purpose： To report a rare case of Mantle cell lymphoma in lacrimal gland and review of the literature Case report： We report a case of a 59-year-old female who presented with an upper eyelid mass in the right eye for 3 months, without pain and irrigation. A computerized tomog- raphy （CT） scan showed a mass in the bilateral lacrimal gland region, more significant in right eye. The patient underwent a lacrimal gland mass excision surgery and diagnosis of mantle cell lymphoma by histopathology. Immunochemistry for CD20, CD79a, CD5, and CyclinD1 was positive. She was recommended to the Shantou cancer hospital for chemothera- pY.     

Epithelial Cyst of the Superior Oblique Muscle Trochlea

Abstract

Most of the congenital orbital cysts are choristomas such as dermoid or epidermoid and only in a few cases they are epithelial. Clinically, they manifest as cystic movable formations mostly localized in the upper temporal quadrant of the orbit. We describe here the case of a 49-year-old man with an orbital cyst localized in the upper-nasal quadrant of the orbit and which was showing signs of a gradual enlargement and progression over the past weeks. Computed tomography revealed a cyst of 1.9?×?1.6?cm in size and located within the trochlea of the upper oblique muscle. The cyst was completely extirpated after orbitotomy performed by superciliary approach. Histopathology revealed a cyst with nonkeratinized cuboidal epithelium. Postoperative course was uneventful, without inflammation signs, and after 5 weeks excellent functional and aesthetic effects were achieved with no iatrogenic alteration of the ocular motility.     

眼眶囊性病变134例临床诊治分析

目的 描述眼眶囊性病变病例的临床表现、诊断和治疗.方法 回顾性研究2001年1月至2009年3月期间诊治的眼眶囊性病变134例,分析其临床特征,影像学表现和手术治疗效果等.结果 134例眼眶囊性病变中,男性68例;女性66例,右眶63例;左眶71例;年龄6个月至84岁,平均42岁.最常见症状为肿块、眼球突出和复视等.超声波检查示肿物多呈边界清楚的无回声或低回声区,内部无明显血流信号.CT示囊肿内密度较均匀,CT值-198Hu～77.5Hu,增强扫描示囊壁增强,而囊内容物不被强化.MRI检查T1WI为低或等信号,T2WI呈高信号.全部病例经手术完整切除或部分切除等治疗.术后病理诊断眼眶皮样囊肿46例,表皮样囊肿58例,黏液囊肿11例,单纯性眼眶血肿12例,眼眶脓肿3例,寄生虫性囊肿2例,泪腺起源的单纯性上皮细胞囊肿及先天性囊性眼各1例.术后随访3月至8年,平均2.10年,治愈率98.50%,复发率1.50%.结论 眼眶囊性病变的诊断应综合病史和临床表现,影像学检查有助于准确的诊断,手术治疗效果好.     

Atypical choristomatous cysts of the orbit

Background: The commonest choristomatous cysts of the orbit are dermoid and epidermoid cysts, which are lined by kerantinizing seuamous epithelium. They typically occur in the superior orbit, most commonly superotemporally. Other types, lined by different epithelia, and other orbital sites are much less common. Methods: Five cases of atypical orbital cystic choristomas that presented over the past 6 years are reported. The clinical and radiological features, surgical approach and findings, and histology are described. Similar cases from the literature are reviewed, and possible aetiology discussed. Results: Four of the cysts were lined by a non-keratinizing epithelium resembling conjunctiva; two had adnexal structures in their walls. Compared with typical dermoid and epidermoid cysts, these ‘conjunctival dermoids’ and ‘conjunctival cysts’ of the orbit tended to present later in life, none were associated with bony defects, and three of the four occurred in the superomedial quadrant. One case occurred inferiorly, a rare site for orbital conjunctival dermoids and cysts, or typical dermoids and epidermoids. The fifth case, also inferior; is an example of a cyst within choristomatous lacrimal tissue. Conclusion: Choristomatous cysts of the orbit may occur with non-keratinizing epithelial linings, and such cysts tend to differ clinically from the commoner dermoids and epidermoids. They may also occur in atypical sites such as the inferior orbit.     

Differentiating intradiploic orbital dermoid and epidermoid cysts utilizing clinical features and machine learning

Purpose:The purpose of this study was to characterize intradiploic dermoid and epidermoid orbital cysts to determine any differences in clinical, radiographic, or surgical features.Methods:A retrospective review was performed of patients presenting with intradiplopic dermoid or epidermoid cysts. Additionally, a complete review of the literature was performed to identify cases of intradiplopic orbital dermoid and epidermoid cysts. Data collected included age, sex, presenting symptoms, location of intradiplopic cyst, ophthalmic findings, treatment, and follow-up. Clinical features of dermoid versus epidermoid cyst were compared. Additionally, machine-learning algorithms were developed to predict histopathology based on clinical features.Results:There were 55 cases of orbital intradiploic cysts, 49 from literature review and six from our cohort. Approximately 31% had dermoid and 69% had epidermoid histopathology. Average age of patients with dermoid cysts was significantly lesser than that of patients with epidermoid cysts (23 vs. 35 years, respectively; P = 0.048). There was no difference between sex predilection, presenting symptoms, radiographic findings, or surgical treatment of dermoids and epidermoids. The majority of patients (64%) underwent craniotomy for surgical removal. Machine-learning algorithms KStar and Neural Network were able to distinguish dermoid from epidermoid with accuracies of 76.3% and 69%, respectively.Conclusion:Orbital intradiploic cysts are more commonly epidermoid in origin. Dermoid cysts presented in younger patients; however, there were no other significant differences in features including ophthalmic or radiographic findings. Despite similar features, machine learning was able to identify dermoid versus epidermoid with good accuracy. Future studies may examine the role of machine learning for clinical guidance as well as new surgical options for intervention.     

Ct-criteria of orbital hemangiomas and their importance in differential diagnosis of intraconal tumors (author's transl)]

CT-scans of 29 histologically proven cavernous hemangiomas were evaluated with respect to their location, shape, delineation from surrounding tissue, contrast-enhancement, and secondary changes of the bony orbit. Whenever a round or oval tumor, located in the outer upper muscle cone, sharply delineated from surrounding tissue, unattached to optic nerve and ocular muscles, spares a small triangular space in the orbital apex, it is in all probability a cavernous hemangioma. Evaluation of the tumors shape and its separation from surrounding tissues requires imaging in multiple sections in two planes oriented, if possible, at right angles. -- Changes in position of the optic nerve and eye muscles in different directions of gaze demonstrated by CT rule out significant tumor-attachments. The portion of the intraconal space least affected by optic nerve shifts and muscle contractions during eye movements, as demonstrated by CT, is the upper outer quadrant, the site preferred by the mobile tumor. -- Tumors which cannot be differentiated from cavernous hemangiomas by CT-criteria are rare usually benign. Reports of rare examples of well delineated or encapsulated malignant intraconal lesions indicate the possibility -- however remote -- of mistaking a malignant tumor for a cavernous hemangioma by CT.     

改良美蓝染色法在眼眶复杂性皮样囊肿摘除术中的应用

分析改良美蓝染色法在眼眶复杂性皮样囊肿摘除术中的应用及病例随访结果。方法：回顾性分析。收集2014年6月至2017年12月在复旦大学附属眼耳鼻喉科医院采用改良美蓝染色法进行复杂性（表）皮样囊肿摘除的患者8例（8眼），详细阐述该方法的操作步骤及注意事项。结果：8例患者中首次手术7例、外院术后复发1例。肿块均位于眼眶外上方，其中1例有瘘管形成，1例有眶内外沟通。就诊时症状包括复视（2例）、眼位偏移（5例）和眼球突出（6例）等。术中行改良美兰染色，囊壁均清晰着色并完全剥离。术后平均随访2.9年，CT检查示囊肿无复发，8例患者均无复视、眼位偏移。病理证实表皮样囊肿2例，皮样囊肿6例。结论：改良美蓝染色法有助于完全剥离囊壁，是眼眶复杂性皮样囊肿摘除术的重要辅助手段。     

The frequency and clinical significance of bone involvement in outer canthus dermoid cysts.

Periorbital dermoid cysts should be removed because they commonly leak their irritant contents into the surrounding tissues. The underlying bone may, however, be involved in patients with dermoid cysts at the outer canthus. Computed tomography studies of 70 patients (43 men and 27 women, aged 30 months to 63 years, mean 29 years) with proved dermoid cysts of this type were reviewed. The lesion was always unilateral; 34 were on the left. The bone of the lateral wall and superotemporal angle of the orbit showed the following abnormalities, often in combination: pressure erosion in 61 cases and an otherwise abnormal shape, probably developmental, in 55; the dermoid cyst entered a tunnel or canal through the lateral wall in 24; a blind pit or crater in 15; and a cleft in 20; many patients also showed abnormal bone texture. These findings are extremely important for planning adequate surgery, and indicate that bony involvement is much more frequent than previously appreciated.     

Respiratory epithelial orbital cysts

Congenital or post-traumatic respiratory epithelial lined cysts of the orbit are very rare, and such cysts more commonly occur as mucocoeles secondary to chronic paranasal sinus disease. Four new cases of such cysts are described herein, three presumed choristomas and one occurring after trauma. Two of three presumed choristomatous (congenital) cysts occurred in sites that were atypical for the commoner dermoid cyst. One occurred in the superior orbit between the superior rectus and levator palpebrae superioris muscle and one in the temporal fossa and lateral orbit. The third choristomatous lesion occurred in the superotemporal orbit with a well-defined bony defect, a typical pattern of the commoner dermoid cyst. The fourth case, a presumed traumatic respiratory epithelial cyst, probably arose from ethmoidal sinus mucosa. Respiratory epithelial orbital cysts are very rare and may occur in sites that are atypical for the commoner orbital dermoid cyst.