Orbit hair1/28/2024 ![]() ↑ 7.0 7.1 7.2 Shields J and Shields C.Ophthalmic Pathology and Intraocular Tumors. ↑ 6.0 6.1 Basic Clinical and Science Course.Orbital dermoids: clinical presentation and management. Orbital Dermoid Cyst of Childhood: Clinical Pathologic Findings, Classification and Management. Prognosis is excellent following successful early surgical intervention. Notice significant periocular and eyelid ecchymosis that developed immediately after dermoid cyst surgical removal Prognosis They inflammation from remaining dermoid tissue may also result in an orbitocutaneous fistula. If incompletely removed, cysts may recur or lead to abscess formation. Cysts extending through bony sutures often cannot be removed without rupture. This can be mitigated by copious irrigation at the time of surgery. If the cyst ruptures during surgery, a lipogranulomatous inflammatory reaction may occur. Rarely it is massive like in the figure presented here. Various amounts of ecchymosis is common after surgical removal. If possible, the surgeon attempts to remove the cyst in total without rupture. For deep lesions, anterior, lateral, or combined orbitotomy is indicated. For superficial lesions, an incision in the eyebrow, upper eyelid crease or directly over the lesion is often used. However, some surgeons opt for early excision to avoid the risk of traumatic rupture in the future. They may stabilize or even decrease in size over years. Small, asymptomatic cysts may not require treatment. Immediately after dermoid cyst removal General treatment Differential diagnosis of lateral lesions includes lacrimal tumors. Medial lesions in infants may be confused with congenital encephaloceles, dacryoceles, and mucoceles. Computed tomography can also rule out a dumbbell configuration, with part of the lesion in the orbit and part in the temporal fossa, connected through a bony defect at the suture line. Bony remodeling is present in 85% of cases. It is described as a well-circumscribed lesion with a hyperdense wall and hypodense contents. If a deeper cyst is suspected, a computed tomography (CT) or magnetic resonance imaging (MRI) is indicated. ĭermoids, especially if superficial, may be diagnosed through physical exam. Diplopia if present within the orbit, but can often be asymptomatic.Deep cysts may cause progressive proptosis, strabismus or diplopia. They are usually diagnosed in older children or adults. ĭeeper orbital cysts may be partially palpable or non-palpable. If large, they may cause mechanical ptosis. They are more common than deep cysts and usually become apparently during the first decade of life. ![]() If the cyst leaks or ruptures with extrusion of oil and keratin into adjacent tissues, granulomatous inflammation may be present. Physical examinationĪ superficial cyst usually presents as a smooth, painless mass in the superotemporal quadrant, but it may also be found in the superonasal quadrant. Older children and adults may present with diplopia or proptosis. Patients with superficial dermoids are usually children presenting with a slowly progressive, nontender mass near the lateral eyebrow. Imaging modalities may also assist in some cases. Superficial dermoide are easily diagnosed clinically due to characteristic location at the suture lines and firm consistency. ![]() Cysts that are only lined with epithelium without adnexal elements are termed epidermoid cysts. General Pathologyĭermoid cysts are composed of keratinized stratified squamous epithelium with dermal appendages and adnexal structures, including hair follicles, sebaceous glands, sweat glands, smooth muscle, and fibroadipose tissue. The most commonly involved suture is the frontozygomatic suture, although they may also occur at the frontoethmoidal or frontomaxillary sutures. When fetal suture lines close during embryogenesis, embryonic epithelial nests may become entrapped and form a cyst. CT scan of a dumbbell dermoid cyst Etiology
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