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The Bell's Toll
Authors:Luciano Mesquita Simã  o,Ann P. Murchison,Jurij R. Bilyk,Peter A.D. Rubin
Affiliation:1 Department of Ophthalmology and Otolaryngology, Federal University of Minas Gerais, Brazil
2 Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Philadelphia, Pennsylvania, USA
3 Ophthalmic Plastics and Orbital Surgery, West Palm Beach , Florida, USA
4 Eye Plastics Consultants, Brookline, Massachusetts, USA
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.
Keywords:cavernous sinus syndrome   external ophthalmoplegia   facial numbness   facial palsy   perineural spread   squamous cell carcinoma
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