PMC9578500_01
Orbit Computed Tomography (A) and Magnetic Resonance Imaging (B-H) at presentation depicted a defect on the lateral wall of the right sphenoid sinus (arrows in (A-D) and in (G) and (H)), that was partially opacified by hyperintense content on T2 weighted-images (B). It was observed an enlargement of the right orbital fissure and optic canal, with abnormal contrast enhancement that extended to the ipsilateral cavernous sinus, orbital apex and orbital fat, accompanied by right inferior rectus muscle enlargement and enhancement. Thickening of the right optic nerve and nerve sheath enhancement were also present. Post-operative Orbit Magnetic Resonance Imaging (I-L) showed right orbit exenteration, without abnormal enhancement in the orbital compartment and remaining focal enhancement of tissues around the anterior clinoid process and adjacent to the defect on the lateral wall of the right sphenoid sinus.
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Thickening of the right optic nerve sheath and contrast capture of ipsilateral inferior rectus muscle were also present (Figure 1).
Intra-operative evaluation of the patient. Lateral (A) and anterior (B) evidence of right orbit proptosis and inflammatory signs. Demarcation of the surgical site, with lid-sparing (C). Intra-operative surgical locus (D) and post-operative care with calcium alginate dressing (E). Anterior (F) and posterior (G) aspects of the surgical piece.
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Ophthalmology, Infectious Diseases, Neuroradiology, and Neurosurgery and considering clinical aggravation despite medical therapy and a first surgical debridement, the decision was to perform right orbit exenteration with lid sparing, which took place on the following day (Figure 2). Once again, laboratory examination of the specimen could not provide a definite diagnosis as specific fungal staining, fungal culture, and pan fungal and Mucorales-specific PCR were all negative. 
Wound Aspect during the follow-up. Wound healing with partial epithelization at 7 months post-surgery.
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The wound had both a good healing and a good cosmetic result (Figure 3).