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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    movable, there being still, however, a little motion inward. The cornea was slightly cloudy, but the iris and pupil were normal, and V =• ^5 . An ophthal- 0 moscopic examination showed the media clear, except the slight haziness of the cornea, and a moderate degree of neuro-retinitis, with not much swelling of the disk, except in the infero-nasal quadrant, where it had all the appearances of choked disk. There were three external openings, two in the cheek and one in the lower lid near the external canthus. All three pouted, resembling very closely the mouths of sinuses leading down to necrosed bone, and discharged a small amount of thin pus, of a very offensive odor. The patient was unusually stupid, and could with difficulty be communicated with. A probe, introduced into either of the three openings, passed for some distance into the orbit, but no dead bone was struck. The opening near the inner canthal ligament seemed to communicate with the nasal sinus and the ethmoid cells, for a probe passed into a cavity that led off' from the orbit. The eyeball could not be replaced in the slightest degree, and the growth in the orbit was very firm and dense. The patient was urged to have the eye removed and the entire contents of the orbit cleared out, but declined, as he still had considerable vision in the eye. He was not seen till the following June, when he presented a horrible appear- ance. Vision was entirely lost, the cornea had sloughed, the contents of the eye- ball had gradually been discharged, and the pairi was constant and very severe. The intra-orbital growth presented through the openings in the lids, the latter being distended to their utmost capacity. The tumor was not particularly Vas- cular, but its surface discharged a thin, offensive pus. It was hard, firm, closely attached to the periosteum of the orbital walls, and extended down upon the malar and superior maxillary bones, and outward upon the temple. From the intimate connection between the growth and the periosteum at the margin of the orbit, it was suspected that the bones forming the inner wall of the orbit were involved. The remains of the eyeball were first removed, and then the contents of the orbit dissected out. The adhesions to the periosteal lining were everywhere very close, and hence it was extremely uncertain whether the growth began in the loose connective tissue of the orbit or in the denser tissue of the periosteum. When the region of the ethmoid bone was reached, the os planum was found to have almost entirely disappeared, and the growth filled the ethmoid cells and extended into the nasal sinus. On lifting up the tumor, a hole was discovered in the floor of the orbit, leading into the antrum, through which, also, the growth extended, and, as far as could be judged by the introduction of a probe, it filled the antrum. It was not deemed wise to enlarge this opening, but as much of the tumor as could be reached with forceps and scissors was removed. The inte- rior of the ethmoid bone was softened and broken down and infiltrated with the cellular elements of the growth. A flap of skin was then dissected from the superior maxilla and malar bone, its apex being at the inner canthus, and the lines of incision running, one along the margin of the lower lid and trom the external canthus out half an inch upon the temple, and the other down the nasal furrow to the ala of the nose. The periosteum and growth attached to it in this region were then carefully removed as far as there appeared any morbid growth, and the bone was scraped. After the orbital cavity had been carefully washed out, the deep growth of the tumor was seen to penetrate so far into the cavities and sinuses connecting with the orbit that it was not thought advisable to attempt any further removal. It was seen that the lachrymal bone had disap-