J Rhinol.  2022 Mar;29(1):52-55. 10.18787/jr.2021.00381.

A Case of Oculomotor Nerve Paralysis Caused by Cavernous Sinus Metastasis of Tonsil Cancer

• Kim Y
• Chung MK
• Hong SD

• KMID: 2528321
• DOI: http://doi.org/10.18787/jr.2021.00381

Abstract

Oropharyngeal squamous cell carcinoma (OSCC) with metastasis to the cavernous sinus (CS) is uncommon, and only a few cases have been described in the literature. The highest age-adjusted incidence rate for OSCC including the tonsil in males occurs in South Asians, and more cases should be reported to establish earlier identification and treatment. We report a case of OSCC in a 59-year-old male who underwent prompt endoscopic biopsy and early palliative radiation therapy to allow complete recovery of cranial nerve palsies to improve his quality of life, despite having a poor prognosis. Furthermore, this report emphasizes his dramatic resolution of symptoms after radiation therapy, highlighting the importance of rapid recognition and proper management.

Keyword

Tonsil cancer; Oropharyngeal squamous cell carcinoma; Cavernous sinus; Oculomotor nerve paralysis

Figure

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  Fig. 1. Preoperative radiologic image of the patient. Axial contrast-enhanced magnetic resonance imaging scan shows a 1.2 cm-sized right palatine tonsil mass with large ipsilateral cervical lymph node metastasis.

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  Fig. 2. Photograph of the eye examination. A 9-gaze photo demonstrates the patient’s complete ptosis and limitation of extraocular muscle movement.

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  Fig. 3. Radiologic, intraoperative image of cavernous sinus lesion. A: Coronal gadolinium-enhanced magnetic resonance imaging shows a mass-like lesion (arrow) in the cavernous sinus. B: Intraoperative view; after the cavernous medial dura was incised, a biopsy was performed.

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  Fig. 4. Pathologic findings of the mass. Hematoxylin and eosin (H&E) stain (×100) (A) and P16 stain (×40) (B) shows tumor consists of non-keratinizing P16 stain positive metastatic squamous cell carcinoma.

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  Fig. 5. Dose distribution of adjuvant radiotherapy and postoperative eye photograph. (A) The patient received an additional 6,000 cGy in 20 fractions to the right cavernous sinus, (B) and the ptosis improved within one month.

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