Orbital dermoids: clinical presentation and management.

Abstract

SUMMARY The authors have reviewed 15 cases of orbital dermoids representing 6% of orbital tumours seen at the University of British Columbia Orbital Clinic. They tended to occur as either asymptomatic superficial lesions in children or as complicated deep lesions in adolescents and adults. The superficial lesions were as frequent medially as laterally and could be dealt with by a direct uncomplicated surgical approach. The deep lesions in contrast, were frequently extensive and difficult to remove, requiring careful preoperative planning. Sites of origin, presentation, differential diagnosis, and management are discussed.Dermoid cysts occur in the orbital and periorbital region presenting in a variety of ways depending upon the site of origin, size, and rapidity of growth. The frequency ofoccurrence varies with the age group being studied. 1-3 and the particular interest of the centre. In the University of British Columbia orbital clinic we have noted a range of presentations from benign, isolated masses, to complicated and frequently misdiagnosed recurrent tumours with and without fistulisation. From our experience there appear to be two types of dermoid cysts seen in clinical practice. One presents as a simple or localised lesion and the other as a complicated one. The difference is based on the site of origin, location within the orbit, and the histological structure of the dermoid. Materials and methodsWe have reviewed all cases of histologically concomputed tomography, plain and tomographic xrays, and ultrasound.Surgical approaches included two lateral, nine anterior, one combined orbitotomy, and one excision from the temporal fossa, the approach depending on preoperative localisation. At the time of surgery the site of origin was explored and identified when possible. Postoperatively tumours were submitted for routine pathological study. Follow-up

CT and UltraSound in the diagnosis of orbital dermoid cysts – A retrospective study at the University Teaching Hospital in Lusaka

“…However, hidden rupture of orbital dermoid cysts occurred proportionately most often at the age of 20 to 40 which results in perisitent granulomatous inflammations 4 . In case of rupture of a intraorbital demoid cyst with intracranial extension, a granulomatous inflammatory reaction is incited leading to chemical meningitis, seizures, vasospasm with infarction and death 5,6 . Thus Klin et al recommend an early operative removal of demoid cysts, if possible at the age of 3 or 4, but at least with in the first 10 years 5 .…”

Clinical, radiological and pathological examination of periocular dermoid cysts: evidence of inflammation from an early age

“…2,3,5,6,8,9 Although presenting at various ages over seven decades, most were symptomatic in the first decade (Table 1); the majority of cysts lie superficially at the superotemporal quadrant of the orbit (Table 3) and present as a painless lump (Table 2); a squamous epithelial lining is common, with keratin formation in most cases (Table 3).…”

“…More rarely the cyst may be asymptomatic until it presents with apparent enlargement or with inflammatory symptoms-such as pain, redness and eyelid swelling. [1][2][3] Dermoid cysts are generally the commonest periorbital mass presenting in childhood 2,4 and are thought to arise, at between 3 and 5 weeks gestation, 1 from an abnormal implantation of surface ectoderm along the embryonic lines of closure that form the facial features. 5,6 In the periorbital area, dermoid cysts are typically located near the zygomatico-frontal and fronto-ethmoidal sutures, sites of particularly complex embryology.…”

Craniectomy for a Bilobed Dermoid Cyst in the Temporal Fossa and Greater Wing of the Sphenoid Bone

“…Periorbital cysts are commonly located near the superolateral orbital rim and usually present in childhood as a painless, smooth, mobile mass near the lateral eyebrow. Intraorbital dermoid cysts generally present at an older age with painless ocular symptoms such as proptosis and limited ocular motility [1]. While they are histologically benign, dermoids can enlarge and destroy adjacent bony structures, resulting in ocular problems and vision loss [3].…”

“…Dermoid cysts are common, benign periorbital lesions [1, 2]. They occur when the surface ectoderm is sequestered along cranial suture lines during early embryological development and may contain hair follicles and lipid material.…”