title: The Bell's toll.
abstract: A 70-year-old man presented complaining of lid and facial drooping and facial numbness, which progressed over several months. Magnetic resonance imaging of the head showed an enlarged right cavernous sinus. His past medical history was remarkable to squamous cell carcinoma of the face. The patient underwent a craniotomy with biopsy of the cavernous sinus that confirmed malignancy. High index of suspicion in a patient that presents facial drooping and/or numbness should alert ophthalmologists about the occurrence of perineural spread of a previous malignant lesion of the skin.
authors.affiliation: Department of Ophthalmology and Otolaryngology, Federal University of Minas Gerais, Brazil.
authors.forename: Luciano Mesquita
authors.initials: LM
authors.lastname: Simão
authors.forename: Ann P
authors.initials: AP
authors.lastname: Murchison
authors.forename: Jurij R
authors.initials: JR
authors.lastname: Bilyk
authors.forename: Peter A D
authors.initials: PA
authors.lastname: Rubin
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D002426:Cavernous Sinus / Q000473:pathology; D003390:Cranial Nerve Neoplasms / Q000473:pathology*; D003399:Craniotomy; D005158:Facial Paralysis / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009361:Neoplasm Invasiveness; D009886:Ophthalmoplegia / Q000175:diagnosis; D012878:Skin Neoplasms / Q000473:pathology*