Orbital and periorbital dermoid cysts: Comparison of clinical features and management outcomes in children and adults

Abstract

Purpose: To compare differences in clinical presentation and management outcomes of orbital and periorbital dermoid cysts in children and adults. Methods: A retrospective interventional comparative consecutive case series. 203 patients in (148 children [Age ⩽18 years] and 55 adults [Age >18 years]), who underwent excision biopsy for orbital/periorbital dermoid cyst were included. Outcome measures included the differences in demography, clinical presentations, radiological features, surgical outcomes and histopathology of cysts between children and adults with dermoid cysts. Results: The mean age noted at excision was 15 years in this cohort of 148 children and 55 adults. Commonest clinical finding observed was a subcutaneous painless mass (94%) and external angular dermoids were commonest in both groups 1 and 2 (51% and 56%). Diminution of vision ( p = 0.007), proptosis ( p = 0.008), extraocular motility limitation ( p = 0.001), strabismus ( p = 0.003) and relative afferent pupillary defect ( p = 0.02) were significantly more in adults. Orbital involvement and dumbbell dermoids were not significantly different between children and adults. Radiologically, bony fossa formation ( p = 0.03), temporal fossa extension ( p = 0.04), full thickness bony defect ( p = 0.03) and intraosseous presentation ( p = 0.005) were significantly more in adults. Comparison of proportion of lesions having intra-operative rupture of dermoid cyst ( p = 0.009) and evidence of inflammation on histopathology ( p = 0.01) were significantly more in adults. However, recurrence rates were not different between children and adults. Conclusions: Dermoid cysts are commoner in children, but can also present in adulthood. Secondary visual, orbital, radiologic changes and intra-operative rupture of dermoid cyst are more common in adults compared to children.

Persistent orbital inflammation following complete excision of deep dermoid cysts

“…4,6,9 Such Chronic inflammation after excision of orbital dermoid cysts piecemeal removal carries risk of sequestering epithelial fragments into orbital fat, such implanted epithelium being well-recognized to continue secreting oily debris that incites a chronic, often granulomatous, inflammation. 3,5,6,7,10 Inflammation persisting for years after complete excision of the epithelial lining of a dermoid cyst does not, however, appear to have been reported, and we describe the clinical course, imaging and histopathology for two such patients.…”

“…It is widely documented that epithelial desquamation and accumulation of glandular secretions causes slow enlargement of dermoid cysts, 2,3 and that lipid seepage from unoperated cysts causes chronic inflammation and foreign-body giant-cell granulomas. 2,3,6,7 Intramural and pericystic inflammation is common, even in childhood, 2,5 and pericystic lesions within the surrounding fat have been termed 'satellite inflammatory pseudocysts'. 3 Inadvertent intra-operative rupture of dermoids occurs in 10-28% of cases 1,5,8 and deep orbital or intraosseous dermoids, being larger or multiloculated, generally need piecemeal removal.…”

“…2,3,6,7 Intramural and pericystic inflammation is common, even in childhood, 2,5 and pericystic lesions within the surrounding fat have been termed 'satellite inflammatory pseudocysts'. 3 Inadvertent intra-operative rupture of dermoids occurs in 10-28% of cases 1,5,8 and deep orbital or intraosseous dermoids, being larger or multiloculated, generally need piecemeal removal. 4,6,9 Such Chronic inflammation after excision of orbital dermoid cysts piecemeal removal carries risk of sequestering epithelial fragments into orbital fat, such implanted epithelium being well-recognized to continue secreting oily debris that incites a chronic, often granulomatous, inflammation.…”

“…In the absence of infection, inflammation after excision of a dermoid cyst will arise from the response to necrotic tissues or to extracellular lipid outside the cyst lumen. Whilst the clinical and histopathological features for spontaneous lipid leakage from the cyst lumen --causing chronic, often granulomatous, inflammation within the cyst wall and neighboring tissues --is very well recognized and widely reported, [1][2][3][4][5] there does not appear to be any description of the pathological changes of persistent inflammation after excision of deep orbital dermoids and in the absence of any residual epithelium. Deep orbital dermoid cysts often occupy multiple cavities within the orbit and surrounding bones, making intact excision very unusual.…”

Three-Dimensional Computed Tomography Follow-Up on Spontaneous Bone Healing after Excision of Periorbital Dermoid Cyst: A Case Report

“…Surgical excision is recommended for dermoid cysts, since ruptures may result in inflammation and granulation reactions due to the extrusion of the keratinous contents of the cyst, and can subsequently lead to symptoms such as proptosis, visual field defects, and strabismus in the periorbital region [8]. However, after removal of a dermoid cyst, the remaining dead space created by the accompanying bone abnormalities may lead to adverse surgical outcomes such as bleeding, seroma formation, and delayed wound healing, along with secondary problems such as inflammation, open wounds, and tissue necrosis.…”