Clinical Presentations of Perineural Invasion from Squamous Cell Carcinoma

Perineural invasion in squamous cell carcinoma of the head and neck has been associated with locoregional recurrence and decreased survival in various studies. Periocular squamous cell carcinoma spreads intraorbitally along the supraorbital and infraorbital nerves into the cavernous sinus. Patients with perineural invasion can present with clinical signs and symptoms of cranial nerve involvement, with or without magnetic resonance imaging (MRI) evidence. The recognition of perineural spread is crucial in that the treatment approach will often be altered.