Ethmoid schwannoma: about the management of a rare tumor of sinonasal cavities manifested by an orbital complication

Introduction: To report a rare sinonasal tumor initially manifesting by orbital cellulitis with impaired oculomotricity, and to and to take stock of the management methods proposed in the literature. Case presentation: Case report of a 72 year old patient presenting in ophthalmology emergency department with acute orbital cellulitis. Computed tomography revealed an ethmoidal mass associated with frontoethmoidal muco-pyocele. It was fully endoscopically removed and pathological diagnosis of ethmoid schwannoma has been made. Magnetic resonance imaging after 4 months showed no sign of recurrence.
Discussion: The patient presented with an acute orbital cellulitis with acute loss of visual acuity and impaired oculomotricity within 24 hours associated with fever and local pain. There were no symptoms before this event. Tomodensitometry showed a large heterogeneous tumor arising from the anterior ethmoid sinus and extending to the frontoethmoidal recess and the orbital cavity with lamination of lamina papyracea. The tumor was removed by endonasal radical excision. The final pathological analysis revealed benign schwannoma. There was no sign of recurrence nor late complication during the 10 months follow up. Schwannomas of the nasal cavities are rare tumours but must be mentioned among the differential diagnoses of endonasal and endosinusal masses with sometimes orbital complications. Depending on the location and extension, endoscopic resection is a valid strategy.