A 75-year-old patient with complaints of swelling and pain on the right side of the face visited the hospital. Upon examination, he was oriented with normal gait. In addition there was ptosis and complete drooping of the right upper eyelid and corner of the mouth with drooling of saliva and absence of wrinkles in the right half of the forehead. Involvement of III, IV, VI, VII cranial nerves with no loss of taste was found.
The Subject was diagnosed with chronic generalized periodontitis, acute maxillary sinusitis with complete ophthalmoplegia and orbital cellulitis. Routine blood investigations were normal except for elevated ESR (>150 mm /hr) and hyperglycemia (random: 334 mg/dl).
Computed tomography (CT) revealed axial proptosis of the globe of the right eye and retro-orbital haziness, maxillary sinus was filled with soft tissue. Magnetic resonance imaging (MRI) brain revealed bilateral maxillary and ethmoidal inflammatory sinusitis extending into the right orbit causing orbital post septal cellulitis and proptosis. Patient was operated by functional endoscopic sinus surgery, a polypoidal mass of tissue was recovered as a biopsy specimen. Biopsy results are shown in the figure below.
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