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Endoscopic treatment of a periorbital fat herniation caused by spontaneous solution of continuity of the papyracea lamina
  1. Bruno Galletti,
  2. Francesco Gazia,
  3. Cosimo Galletti and
  4. Francesco Galletti
  1. Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, Universita degli Studi di Messina, Messina, Italy
  1. Correspondence to Dr Francesco Gazia, ssgazia{at}


We present a case of a 16-year-old girl with interruption of papyracea lamina and herniation of the periorbital fat covered by a bone shell. The patient presents with a history of diplopia and visual disturbances ever since she can remember. Thanks to radiological imaging and biopsy, we have done differential diagnosis with periorbital lipoma, intraosseous lipoma and intramuscular lipoma of medial rectus. Diagnostic for images is necessary for a correct operative planning. Endoscopic sinus surgery with computer-assisted navigation is the safest and most effective method to remove the lesion that was closely related to the medial rectum muscle and to the anterior ethmoidal artery. The patient after surgery and in 1 year of follow-up reports the disappearance of symptoms.

  • ear, nose and throat/otolaryngology
  • ophthalmology

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  • Contributors BG developed the concept and design of the study and treated the patient. FGazia is corresponding author, was preparing the manuscript. CG performed follow-up examinations and literature research. FGalletti critically revised the manuscript for important intellectual content and gave the final approval of the version to be submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.