A contribution to the pathology of orbital tumors : being a study of the secondary processes in the periosteum and bones of the orbit and vicinity / by Charles Stedman Bull.

  • Bull, Charles Stedman, 1844-1912.
Date:
[1881]
Catalogue details

Licence: Public Domain Mark

Credit: A contribution to the pathology of orbital tumors : being a study of the secondary processes in the periosteum and bones of the orbit and vicinity / by Charles Stedman Bull. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    was especially the case in the last growth, in the portions removed from the eth- moid and superior maxillary bones. Case II.—Intra-ocular Sarcoma ; Secondary Infiltration of the Optic Nerve and Orbit; Degeneration of the Bones of the Orbit and Face; Four Operations for the' Removal of the Growth.—Julia M., aged twenty-six, first seen July 7, 1879, gave the following history : Sixteen months before, while recovering from confinement, she found, one morning, that she was totally blind in the left eye, and that the eye diverged. It remained in this condition, quiet and painless, till six months ago, when she again became pregnant, and since then there has been constant pain in the eye, temple, and supra-orbital region. An examination showed a normal cornea, the anterior chamber almost abolished, the iris nearly in contact with the cornea, the pupil dilated ad maximum, and the lens pushed far forward toward the cornea. In the upper and outer quadrant there was a small ciliary staphyloma, and the tension was perceptibly increased. An intra- ocular growth being suspected, and there being no reflex from the fundus and no vision, enucleation was advised and consented to. Some difficulty was found in dividing the optic nerve, owing to the thick, hard nodule of tissue which sur- rounded the nerve at its entrance into the sclera, and extended for some distance backward along the nerve. The latter was therefore drawn as far forward from the optic foramen as possible before being divided. On opening the eyeball, an intra-ocular growth was found nearly filling the interior, apparently starting from the choroid, which had perforated the sclera in the vicinity of the nerve entrance. The vitreous was absorbed, the retina was entirely detached and jammed against the lens, and the iris was retracted at the periphery. The distal end of the optic nerve looked healthy, and there was no apparent infiltration of the orbital tissue. The patient was discharged at the end of a week, with directions to report once a week, but she was not seen till August 27th, when the growth was found to have returned in the orbit, and the conjunctiva bulged forward. As she was about to be confined, it was thought best to postpone the operation ; but when again seen, on October 30th, five weeks after confinement, she presented a horri- ble appearance. The tumor had grown with alarming rapidity, had entirely filled the orbit, and protruded through the widely distended lids for a distance of over two inches. There was great swelling of the skin of the forehead, temple, aud cheek, due to the great pressure produced by the tumor. The skin of the lids was livid, the palpebral aperture was distended almost to bursting, and there was an agonizing, gnawing pain in the orbit and head. The surface of the neo- plasm was bleeding, and discharged a thick puriform fluid of foetid odor. An in- cision was made with scissors along the ciliary margins of both lids, so as to free the conjunctiva completely from the lids, and then, by means of the blunt hook, scissors, and the finger, the adhesions of the growth to the orbital walls were broken up—none being found close and dense, except near the apex of the orbit. After the main mass of the tumor had been removed, an examination showed that the orbital margin at both the internal and the external cauthus was dis- eased, the periosteum being perforated and infiltrated, and the bone roughened. There was profuse haemorrhage, which was with difficulty controlled. The orbit was then thoroughly cleaned out, and as much as possible of the growth which projected from the optic foramen and sphenoidal fissure was cut off. The orbital margin was then cleared of its periosteum, and the bone was thoroughly scraped. The general periosteal lining of the orbit [did not seem to be diseased. The