CC BY-NC-ND 4.0 · Annals of Otology and Neurotology 2020; 3(02): 100-102
DOI: 10.1055/s-0041-1724217
Case Report

Vertical Strabismus and Positive Bielschowsky Head-Tilt Test: Atypical Presentation of a Maxillary Mucocele

Filipe André Correia
1  Serviço de Otorrinolaringologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
2  Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
,
Gustavo Filipe Antunes de Almeida
1  Serviço de Otorrinolaringologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
2  Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
,
Carolina Fernandes Pereira Bruxelas
2  Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
3  Serviço de Oftalmologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
,
Pedro Alberto Batista Brissos de Sousa Escada
1  Serviço de Otorrinolaringologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
2  Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
› Author Affiliations

Abstract

Test of skew has become a cornerstone in the approach of a patient with vestibular symptoms but a detected vertical misalignment may be caused by an oculomotor disturbance and not a skew deviation. We report the case of an elderly patient with a 1-month history of dizziness and visual disturbance that revealed on bedside examination a spontaneous left head-tilt and a pathologic alternate cover test, with right eye hypertropia and excyclotorsion, worse with right head-tilt. Dizziness was assumed to have a visual origin with unrecognized binocular diplopia, caused by an acquired right eye superior oblique muscle palsy. However, imaging revealed a right maxillary mucocele that eroded the orbit floor into the orbit. The change of the intraorbital component of the maxillary fluid-filled mass with head-tilt through a dehiscent orbital floor may explain the findings of vertical strabismus and positive Bielschowsky head-tilt test in this case. Endoscopic treatment improved symptoms and findings.



Publication History

Publication Date:
28 February 2021 (online)

© 2021. Indian Society of Otology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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