The pathologic diagnosis of a paraffinoma was difficult to understand on the basis of the patient’s history up until this point. After thorough discussion, the patient added that he had sustained a wartime injury in Vietnam (29 years prior to his surgery). His description of the injury suggested that he had a right tripod fracture repaired by a Caldwell-Luc approach. After this surgery, he recalled HAVING several yards of Vaseline-impregnated gauze packing in his nasal sinuses. It is important to note that patients frequently omit historical information that they have simply forgotten or that they feel is irrelevant.
The pathologic DATA and the additional clinical DATA provided good evidence for a paraffinoma. Vaseline (similar to paraffin oil) is postulated to percolate through various tissue planes forming small collections of oil scattered within the tissues of the orbit. These collections subsequently incite a granulomatous response in the involved tissues.
One unique aspect of this case was the 29 year symptom-free interval between the surgery and the onset of orbital symptoms. In a recent series of 10 similar cases, Witschel and Geiger found that the interval between sinus procedures and orbital symptoms varied between several months and 4 years with recurrences as late as 15 years. Several possible scenarios can be postulated. Perhaps the Vaseline material was sequestered in the maxillary sinus until a recent event allowed the material to infiltrate the orbit, inciting a granulomatous response. Alternatively, the material may have been present within the orbit for many years before triggering an inflammatory response. It remains to be seen whether this procedure will alleviate his symptoms permanently.