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Updated: Apr 23, 2026
Lateral Molar Approach-Driven Transoral Endoscopic Procedure for Benign Infratemporal Fossa Tumor Resection
Published on: August 15, 2025
Silent squamous cell carcinoma invading the orbit following the course of the zygomaticotemporal nerve
Ronald O B de Keizer1, Didi de Wolff-Rouendaal, Rob J W de Keizer
1Department of Ophthalmology, Ocular-Oncology Unit, LUMC , Leiden , The Netherlands .
Purpose:
To evaluate the clinical and histopathological characteristics of silent skin squamous cell carcinomas (SCC) with invasion routes to the orbit.
Methods:
Retrospective case studies. Clinical records and histopathological material, therapy and complications were evaluated, together with MRI imaging analyses and literature review on the anatomy of the lateral orbital wall in relation to the zygomatico-temporal nerve channel.
Results:
Two recent cases of metastatic SCC from het lateral zygomatic region to het orbit are reported. Originally the skin tumors of the first case was diagnosed as benign, but a review of the pathology of these skin tumors showed an invasive SCC. The second case was diagnosed as an atypical SCC. Analysis of possible invasion routes, using both computer tomography (CT) and magnetic resonance imaging (MRI), indicated neither skin nor bone involvement. However, the lateral temporal fossa near the entrance of the zygomatico-temporal channel showed small tumors and pseudo-cysts. The original skin tumor specimens did not show malignant tissue in the surgical margins nor intra- or perineural invasion.
Conclusions:
Because the course of the zygomatico-temporal nerve bundle was exactly in line with the original skin tumor, the channel and the orbital tumors, this route should be considered when malignant orbital tumors have a history of or a relation with a periorbital skin-tumor.
Insights
Silent skin squamous cell carcinomas (SCC) can invade the orbit via the zygomatico-temporal nerve. This pathway should be considered in orbital tumors related to periorbital skin lesions.
Area of Science:
- Ophthalmology
- Dermatology
- Oncology
Background:
- Squamous cell carcinoma (SCC) is a common skin cancer.
- Orbital involvement by skin SCC is rare and often presents diagnostic challenges.
- Understanding invasion routes is crucial for effective treatment.
Observation:
- Two cases of metastatic SCC from the zygomatic region to the orbit were analyzed.
- Initial diagnosis of skin tumors varied, with one initially deemed benign and another atypical.
- Imaging (CT/MRI) revealed tumors and pseudo-cysts in the lateral temporal fossa near the zygomatico-temporal nerve channel, without apparent skin or bone invasion.
Findings:
- Histopathological review revealed invasive SCC in one case initially diagnosed as benign.
- Neither intra- nor perineural invasion was evident in the original skin tumor specimens.
- The zygomatico-temporal nerve pathway was identified as a likely route of orbital invasion.
Implications:
- The zygomatico-temporal nerve channel represents a potential route for orbital metastasis from periorbital SCC.
- Clinicians should consider this pathway when evaluating orbital tumors with a history of or association with periorbital skin lesions.
- Early recognition and consideration of this invasion route can improve diagnostic accuracy and patient outcomes.
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