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Patel R, Shames A, Sarkodieh J. Ultrasound features of benign paediatric lumps: radiology-pathology correlation. Clin Radiol 2024; 79:255-262. [PMID: 38320943 DOI: 10.1016/j.crad.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 02/08/2024]
Abstract
Ultrasonography is an appropriate first-line imaging technique for the characterisation of paediatric lumps, given its relative accessibility and absence of radiation exposure. Together with a thorough history and examination, ultrasonography can help to distinguish benign lesions from malignancy. It can also aid further characterisation of benign lesions to inform onward investigation and management. This review features the evaluation of common benign paediatric lumps together with their characteristic sonographic features, following correlation with histopathology results or clinical follow-up.
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Affiliation(s)
- R Patel
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK.
| | - A Shames
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
| | - J Sarkodieh
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
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2
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Biswas A, Wong OY, Aygun B, Gore S, Mankad K. Extraocular Orbital and Peri-Orbital Masses. Neuroimaging Clin N Am 2023; 33:643-659. [PMID: 37741663 DOI: 10.1016/j.nic.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
In this article, we will describe relevant anatomy and imaging findings of extraocular and orbital rim pathologic conditions. We will highlight important clinical and imaging pearls that help in differentiating these lesions from one another, and provide a few practical tips for challenging cases.
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Affiliation(s)
- Asthik Biswas
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK.
| | - Oi Yean Wong
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Berna Aygun
- Department of Neuroradiology, UK Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Sri Gore
- Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; UCL GOS Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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3
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Alexa AI, Leferman CE, Ciubotaru AD, Sandu IA, Sandu CA, Bogdănici CM. Therapeutic challenges in epidermal inclusion cysts with periocular localization: case reports. J Med Life 2023; 16:1575-1578. [PMID: 38313165 PMCID: PMC10835546 DOI: 10.25122/jml-2023-0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 02/06/2024] Open
Abstract
Epidermal inclusion cysts in the periocular region are distinctive pathologies exhibiting varied clinical and radiological features, and they should be taken into consideration in the differential diagnosis of cystic lesions near the orbit. This article discusses the clinical and radiological details, along with the surgical results, of two individual cases of epidermal inclusion cysts, with different localization and without any preceding trauma, surgical history, or eyelid inflammation. In the first case, a substantial spherical structure closely connected to the tarsal plate was identified via excisional biopsy, whereas the second case involved a soft, oval tumor located at the outer right orbital corner, as determined clinically and validated through computed tomography. The histological examination showed cysts lined with a keratinized squamous layer, confirming an epidermoid cyst. The surgical removal of the cysts led to esthetically satisfactory outcomes in both cases. The particularity of the presented cases lies in the locations and considerable sizes of the tumors, which have complicated their surgical management. Such instances of epidermal inclusion cysts attached to the tarsus are rarely reported in the literature.
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Affiliation(s)
- Anisia-Iuliana Alexa
- Department of Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
| | | | - Alin Dumitru Ciubotaru
- Department of Neurology, "Grigore T. Popa" University of Medicine and Pharmacy Iași, Romania
| | - Ioana Alexandra Sandu
- Department of Medical Specialties II, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Calina Anda Sandu
- Department of Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
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Gupta A, Terrell JA, Mudie LI, Shetlar DJ, Yen MT. Orbital Dermoid Cysts in Monozygotic Twins. Ophthalmic Plast Reconstr Surg 2023; 39:e150-e152. [PMID: 37133396 DOI: 10.1097/iop.0000000000002401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Two healthy 12-year-old monozygotic twin sisters presented with strikingly similar, painless orbital masses along their frontozygomatic suture line that had been slowly enlarging since birth. The masses were clinically consistent with orbital dermoid cysts and the patients underwent excision of their lesions, with the diagnosis confirmed by histological analysis. There are prior case reports of both nasal and ovarian dermoid cysts in twins, however, no prior case of orbital dermoid cysts in twins have been described. These dermoid cysts are generally thought to be a sporadic disorder of embryogenesis, yet the authors' case suggests genetics may play a role in the underlying etiology of dermoid cysts.
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Affiliation(s)
- Akash Gupta
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Jesse A Terrell
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Lucy I Mudie
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Debra J Shetlar
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, U.S.A
- Department of Pathology, Baylor College of Medicine, Houston, Texas, U.S.A
- Department of Ophthalmology, Michael E. DeBakey Veteran's Administration Medical Center, Houston, Texas, U.S.A
| | - Michael T Yen
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, U.S.A
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5
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Lam M, Suh D. Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121939. [PMID: 36553382 PMCID: PMC9777216 DOI: 10.3390/children9121939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities.
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Affiliation(s)
- Matthew Lam
- Creighton University School of Medicine Phoenix Regional Campus, Phoenix, AZ 85012, USA
| | - Donny Suh
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA
- Correspondence:
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6
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Diab MM, Allen RC, Abdel Ghafar AE, Elessawy KB. Comparison of three surgical techniques for internal angular dermoid cysts: a randomized controlled trial. Eye (Lond) 2022; 36:2253-2259. [PMID: 34802052 PMCID: PMC9674663 DOI: 10.1038/s41433-021-01851-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/10/2021] [Accepted: 11/09/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the outcomes of three techniques for removing internal angular dermoid cysts: lid crease, sub-brow, and direct mini-incision. METHODS In this single-center trial, 47 children with internal angular dermoids were enrolled and randomly assigned to one of three surgical groups: group A, sub-brow, group B, lid crease, and group C, direct mini-incision. Outcome measures were operative time, postoperative scar quality using Stony Brook Scar Evaluation Scale (SBSES), scar visibility, and family satisfaction. RESULTS In each group, fifteen patients completed follow-up and were analysed. The operation time (median/IQR) in Group C was significantly shorter (10/5 min) compared with group A (25/10 min) and B (35/20 min) (p < 0.001). Group B had the least visible scar at all follow-up visits. Both group B and C showed superior scar quality using SBSES compared with group A at 6 months (p < 0.001). All families in group B (100%) found the scar excellent compared to 11 families in group C (40%) and 6 families in group A (73.3%). Persistent postoperative inflammation was noticed in two patients in group C. No cases of recurrence were recorded. CONCLUSIONS Both the lid crease and direct mini-incision approaches result in superior scar quality with minimum visibility compared with the sub-brow technique, however, the lid crease technique shows a prolonged operation time particularly for cysts outside the rim.
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Affiliation(s)
- Mostafa M Diab
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt.
| | - Richard C Allen
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Ayman E Abdel Ghafar
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Kareem B Elessawy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Mead J, Kirkpatrick J, Murdoch J, Stringer MD. Is pre-operative imaging of external angular dermoid cysts in children necessary? J Paediatr Child Health 2022; 58:1420-1424. [PMID: 35506585 DOI: 10.1111/jpc.16008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
AIM To investigate the frequency and modality of pre-operative imaging in children with an external angular dermoid cyst and whether this influenced subsequent management. METHODS A retrospective study was undertaken to assess the presentation, investigation, treatment and outcomes in children aged less than 16 years with an external angular dermoid cyst. All children who underwent external angular dermoid cyst excision between January 2008 and April 2021 at a regional children's hospital were analysed. RESULTS Sixty-one patients (32 boys) were identified. Fifty-four were managed by paediatric surgeons and seven by ophthalmic surgeons. Pre-operative imaging was performed in 19 (31%) patients, including plain radiographs (3), ultrasound scan (14), computerised tomography scan (1), and magnetic resonance imaging scan (2). None of these investigations showed evidence of an intracranial or orbital extension of the cyst or changed management. All cysts were excised under day-case general anaesthesia. There was one minor postoperative complication and two recurrences. CONCLUSIONS External angular dermoid cysts rarely communicate through the bone with the orbit or anterior cranial fossa. Routine pre-operative imaging is unnecessary unless there are clinical features such as an atypical location (e.g. temporal), eye signs (e.g. strabismus, proptosis and globe displacement) or a draining sinus.
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Affiliation(s)
- Jessica Mead
- Department of Paediatric Surgery, Wellington Hospital, Wellington, New Zealand
| | | | - Jean Murdoch
- Department of Radiology, Wellington Hospital, Wellington, New Zealand
| | - Mark D Stringer
- Department of Paediatric Surgery, Wellington Hospital, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
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Joseph AK, Guerin JB, Eckel LJ, Dalvin LA, Keating GF, Liebo GB, Benson JC, Brinjikji W, Laack NN, Silvera VM. Imaging Findings of Pediatric Orbital Masses and Tumor Mimics. Radiographics 2022; 42:880-897. [PMID: 35245105 DOI: 10.1148/rg.210116] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric orbital masses are not common but encompass a wide spectrum of benign and malignant entities that range from developmental anomalies to primary and secondary orbital malignancies and metastatic disease. Certain orbital tumors are unique to pediatric patients, such as retinoblastoma and neuroblastoma. Clinical symptoms and signs are often insufficient to differentiate between orbital lesions, and imaging is essential for narrowing the diagnostic considerations and determining the most appropriate management strategy. MRI is the primary imaging modality for evaluating orbital masses in children, with US and CT playing complementary roles. The authors review a spectrum of masses and tumor mimics that affect the pediatric globe and orbit. The shared and differentiating characteristics of pediatric orbital lesions are reviewed. Emphasis is placed on utilizing an orbital compartment-based approach to narrow the differential diagnosis. By using this organizational scheme, the authors describe intraocular processes (retinoblastoma, persistent fetal vasculature, and Coats disease), intraconal lesions (lymphatic malformation, schwannoma, optic nerve sheath meningioma, and optic pathway glioma), extraconal lesions (infantile hemangioma, rhabdomyosarcoma, idiopathic orbital inflammation, lymphoma, venous varix, plexiform neurofibroma, and pleomorphic adenoma of the lacrimal gland), and lesions involving the bony orbit (dermoid cyst, metastatic neuroblastoma, and Langerhans cell histiocytosis). The authors describe the basic management of each entity. Orbital infections and traumatic lesions are beyond the scope of this article. ©RSNA, 2022.
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Affiliation(s)
- Annie K Joseph
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Julie B Guerin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Laurence J Eckel
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Lauren A Dalvin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Gesina F Keating
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Greta B Liebo
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - John C Benson
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Waleed Brinjikji
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Nadia N Laack
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - V Michelle Silvera
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Jones DL, Ma J, Yang M, Duong A, Richani K. Pediatric Ptosis: A Review of Less Common Causes. Int Ophthalmol Clin 2022; 62:177-202. [PMID: 34965234 DOI: 10.1097/iio.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Orbital inflammatory disease in a child caused by a ruptured dermoid cyst misdiagnosed as orbital cellulitis. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.1013321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Giant Deep Orbital Dermoid Cyst Presenting in Infancy. J Craniofac Surg 2021; 32:e813-e814. [PMID: 34238883 DOI: 10.1097/scs.0000000000007860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Orbital dermoid cysts are benign choristomas that are very common in children and occur most often as a lateral or medial mass associated with the frontozygomatic or frontoethmoidal suture line. The authors present an unusual case of an occult giant deep orbital dermoid cyst in infancy that initially presented with a small, benign appearance and central upper eyelid location on clinical exam. Orbitotomy with complete excision prevented further ocular sequelae in this 11-month-old.
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12
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Dobbs NW, Budak MJ, White RD, Zealley IA. MR-Eye: High-Resolution Microscopy Coil MRI for the Assessment of the Orbit and Periorbital Structures, Part 2: Clinical Applications. AJNR Am J Neuroradiol 2021; 42:1184-1189. [PMID: 33737269 DOI: 10.3174/ajnr.a7080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/20/2020] [Indexed: 11/07/2022]
Abstract
In the first part of this 2-part series, we described how to implement microscopy coil MR imaging of the orbits. Beyond being a useful anatomic educational tool, microscopy coil MR imaging has valuable applications in clinical practice. By depicting deep tissue tumor extension, which cannot be evaluated clinically, ophthalmic surgeons can minimize the surgical field, preserve normal anatomy when possible, and maximize the accuracy of resection margins. Here we demonstrate common and uncommon pathologies that may be encountered in orbital microscopy coil MR imaging practice and discuss the imaging appearance, the underlying pathologic processes, and the clinical relevance of the microscopy coil MR imaging findings.
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Affiliation(s)
- N W Dobbs
- From the Department of Clinical Neuroscience (N.W.D.), Royal Hospital for Children and Young People, Edinburgh, UK
| | - M J Budak
- Qscan Radiology Clinics (M.J.B.), Brisbane, Queensland, Australia
| | - R D White
- Department of Clinical Radiology (R.D.W.), University Hospital of Wales, Cardiff, UK
| | - I A Zealley
- Department of Clinical Radiology (I.A.Z.), Ninewells Hospital, Dundee, UK
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13
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Hatcher J, Sarma A, Sobel R, Padovani-Claudio DA. Sphenofrontal intradiploic dermoid cyst with cutaneous dermal sinus tract. J AAPOS 2021; 25:56-59. [PMID: 33338585 DOI: 10.1016/j.jaapos.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/13/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022]
Abstract
We report the case of a 5-year-old boy who presented with a draining cutaneous pit temporal to the lateral canthus, with recurrent periorbital infections. MRI and CT revealed a sinus tract leading from the pit at the skin surface to a 5 mm lesion located in the sphenoid bone near the left sphenofrontal suture. Intraoperative facial nerve monitoring and a lacrimal probe inside the sinus tract were used to guide dissection to the cyst through a minimally invasive temporal approach, without need for neurosurgical intervention.
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Affiliation(s)
- Jeremy Hatcher
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Asha Sarma
- Department of Radiology, VUMC, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
| | - Rachel Sobel
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Nashville, Tennessee
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14
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Dave TV, Gupta Rathi S, Kaliki S, Mishra D. Orbital and periorbital dermoid cysts: Comparison of clinical features and management outcomes in children and adults. Eur J Ophthalmol 2020; 31:2631-2638. [PMID: 33198489 DOI: 10.1177/1120672120964686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Shweta Gupta Rathi
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Dilip Mishra
- Ophthalmic Pathology laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India
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15
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Combined minimally invasive surgical management of a nasal dermoid sinus cyst affecting the frontal sinus: literature review and new classification. Wideochir Inne Tech Maloinwazyjne 2020; 15:632-644. [PMID: 33294080 PMCID: PMC7687672 DOI: 10.5114/wiitm.2020.93327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/10/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Nasal dermoid sinus cysts (NDSCs) are the most common lesions associated with midline craniofacial anomalies, in the majority of cases diagnosed during childhood. NDSCs affecting the frontal sinus are rare. Aim To demonstrate the clinical, radiological and diagnostic pitfalls of NDSCs affecting the frontal sinus. Material and methods A retrospective analysis of NDSCs affecting the frontal sinus with a literature review and a novel classification is presented. Results We present a rare and complex case of an NDSC in an adult patient that affected the frontal sinus. Endoscopic-assisted open rhinoplasty with endoscopic sinus surgery – Draf type 2B approach – was performed as an effective removal method of choice. A literature review supports our report. Conclusions NDSCs affecting the frontal sinus can mimic complications of sinusitis. A minimally invasive combined technique of endoscopic-assisted open rhinoplasty with endoscopic sinus surgery – Draf type 2B frontal sinus approach – is recommended for treatment.
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16
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Pushker N, Meel R, Kumar A, Kashyap S, Sen S, Bajaj MS. Orbital and periorbital dermoid/epidermoid cyst: a series of 280 cases and a brief review. Can J Ophthalmol 2019; 55:167-171. [PMID: 31712044 DOI: 10.1016/j.jcjo.2019.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To report one of the largest case series on periorbital and orbital dermoid/epidermoid cyst and to highlight some important and unusual findings. METHODS Retrospective analysis of 280 cases with orbital or periorbital dermoid/epidermoid cyst that presented over a period of 14 years. RESULTS Periorbital cyst was more than twice as common as orbital cyst. Majority of patients had bony changes with some unusual findings seen in cases with orbital cysts, that is, presence of fluid-fluid level, calcification in the wall, and coexistent double cysts in 19 (6.8%), 5 (1.8%), and 4 (1.5%) cases, respectively. Dumbbell dermoid cyst with connection in temporal fossa was seen in 16 (5.7%) cases. Subperiosteal location of orbital dermoid cyst was most destructive because of extensive bony invasion. Most of the periorbital cysts were removed in toto, whereas orbital cysts required decompression before removal. The histopathological diagnosis was dermoid cyst in 250 (89%) cases and epidermoid cyst in 30 (11%) cases. In 69 (25%) cases, there was a chronic inflammatory response. CONCLUSIONS We recommend imaging in all patients with orbital dermoid to rule out dumbbell or subperiosteal extension. Also, we advocate early removal of all dermoid cysts in view of bone changes seen in majority of our cases and presence of inflammatory cells in 25% of cases.
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Affiliation(s)
- Neelam Pushker
- Oculoplastic, Orbit and Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Meel
- Oculoplastic, Orbit and Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Anand Kumar
- Oculoplastic, Orbit and Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sen
- Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep S Bajaj
- Oculoplastic, Orbit and Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Tengku-Fatishah A, Abdullah B, Sanjeevan N, Nurul-Shuhada AH, Sharifah-Emilia TS, Haron J, Shatriah I. Dermoid cyst simulating recurrent dacryocystitis in a toddler. Can J Ophthalmol 2019; 54:e196-e199. [PMID: 31358169 DOI: 10.1016/j.jcjo.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Amir Tengku-Fatishah
- Departments of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Baharudin Abdullah
- Departments of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nadarajah Sanjeevan
- Departments of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | | | - Juhara Haron
- Departments of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ismail Shatriah
- Departments of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
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Abstract
PURPOSE The purpose of this study is to describe a spectrum of surgical approaches to orbital dermoid cysts, influenced by the anatomic location of the expanded cyst wall and other factors. METHODS In this retrospective case series, we reviewed cases of dermoid cysts surgically excised during a 39-year period (1977-2016). Cysts were categorized according to the location of the expanded cyst wall and other considerations. The impact of these factors on surgical management was determined. RESULTS We identified six dermoid cyst growth patterns based on the anatomic location of the expanded cyst wall that influence the surgical approach: anterior to the frontozygomatic suture (FZS), superior to the FZS, medial to the FZS and other lateral wall sutures, traversing the FZS and other lateral wall sutures, nasoglabellar, and sinus tract from the orbit to the skin. Two additional factors influencing surgical methodology included satellite inflammatory pseudocysts and recurrence after surgical resection. CONCLUSION Orbital dermoid cysts are not monolithic lesions. Functional and aesthetic outcomes can benefit from considering the anatomic pattern of cyst wall expansion and other factors in their surgical management.
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Affiliation(s)
- Jasmina Bajric
- Department of Ophthalmology, University of South Florida , Tampa, USA.,Department of Ophthalmology, Medical College of Wisconsin , Milwaukee, USA
| | - Gerald J Harris
- Department of Ophthalmology, University of South Florida , Tampa, USA
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19
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Bajric J, Griepentrog GJ, Mohney BG. Pediatric Periocular Dermoid Cysts: Incidence, Clinical Characteristics, and Surgical Outcomes. Ophthalmic Epidemiol 2019; 26:117-120. [PMID: 30260262 PMCID: PMC6839760 DOI: 10.1080/09286586.2018.1525412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To report the incidence, clinical findings, and surgical outcomes of periocular dermoid cysts diagnosed among children over a 20-year period. METHODS All patients ≤5 years of age, who were diagnosed with a periocular dermoid cyst in Olmsted County, Minnesota from 1986 to 2005 were reviewed to determine the population incidence, clinical presentation, and management outcomes. RESULTS A total of 54 children were diagnosed with a periocular dermoid cyst during the 20-year period, yielding a birth incidence of 1 in 638 live births. The mean age at diagnosis was 12 months (range, 1 month-60 months) and 29 (53.7%) were female. A total of 44 cysts (81.5%) occurred in the superotemporal orbital rim, 6 (11.1%) in the superonasal orbital rim, 3 (5.6%) in other periocular areas, and one (1.9%) within the orbit. A total of 34 (63%) children had an ophthalmic exam, all without amblyopia or other ocular sequelae. A total of 48 (88.9%) patients underwent surgical excision with 5 (10.4%) having documented intra-operative cyst rupture, none of whom had post-operative complications. Two (4.2%) other patients were, however, noted to have lesion recurrence following surgical intervention. CONCLUSIONS Periocular dermoid cysts occur in approximately 1 in 650 live births and most commonly occur in the superotemporal region of children aged 1 year or less. Ocular sequelae are rare and surgical excision often yields excellent results.
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Affiliation(s)
- Jasmina Bajric
- Department of Ophthalmology, Mayo Clinic, Rochester,
MN
- Department of Ophthalmology, Medical College of Wisconsin,
Milwaukee, WI
- Department of Ophthalmology, University of South Florida,
Tampa, FL
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20
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Villalón ML, Leal MDLÁ, Chávez JR, Santillán EM, Lares-Asseff I, Loera V, Valencia L, Camacho B, Alvarado B, Cervantes V, Patrón L, Almanza H. Recurrent epibulbar dermoid cyst treated with amniotic membrane implant a case report. BMC Surg 2018; 18:98. [PMID: 30428870 PMCID: PMC6236942 DOI: 10.1186/s12893-018-0426-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The dermoid cyst considered a cystic teratoma derived from embryonic germinal epithelium is a slow-growing benign tumour. Dermoid cysts may occur in the orbital and periorbital region in paediatric patients and are often recurrent. The surgical approach depends upon the site of the lesion, superficial or deep. To our knowledge, this is the first described case of a patient with resection of dermoid cyst treated with human amniotic membrane implant and topical application of 0.02% mitomycin C. CASE PRESENTATION We present a case of a 12-year-old male with a tumour in the superotemporal region of the right eye (RE). Symptoms included decreased visual acuity (VA), burning eye, foreign body sensation, and photophobia of the affected eye. A physical examination detected blepharospasm. Ophthalmic examination of his RE, fingers count from a 1-2 m distance, showed no improvement with pinhole. Visual acuity was 20/20 on the left eye (LE). The bio-microscopic examination confirmed the presence of a tumour mass (15 mm × 12 mm) on the surface of the RE, invading the superotemporal sector. The tumour had a lobulated appearance, a shiny and vascularized surface covered by conjunctiva, a pearlescent-pink colour, a medium consistency, was renitent and painless. An ultrasound scan revealed atrophy of the pigmented retinal epithelium with scleral indentation of the RE. A computed tomography (CT) scan revealed a recurrent lesion consistent with an epibulbar dermoid cyst. Surgical excision of the lesion was performed and a human amniotic membrane (HAM) graft and topical 0.02% mitomycin C (MMC) were applied. Histopathological analysis confirmed the diagnosis of recurrent dermoid cyst. CONCLUSION In this case report, we describe a case of recurrent epibulbar dermoid cyst treated with complete resection; topical MMC and HAM implant with good clinical outcome of the lesion and implant adhesion. Resection of a cyst of the ocular surface is not recommended when a large epibulbar dermoid tissue needs to be resected and no HAM graft is available.
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Affiliation(s)
- Ma Luisa Villalón
- The Californias' Children Hospital Ophthalmology Service, Av. Alejandro Von Humboldt 11431, Garita de Otay, 22509, Tijuana, BC, Mexico
| | - Ma De Los Ángeles Leal
- School of Health Sciences, Valle de Las Palmas, Autonomous University of Baja California, Blvd Universitario 1000, Valle de Las Palmas, 22260, Tijuana, BC, Mexico
| | - José R Chávez
- School of Health Sciences, Valle de Las Palmas, Autonomous University of Baja California, Blvd Universitario 1000, Valle de Las Palmas, 22260, Tijuana, BC, Mexico
| | - Eduardo M Santillán
- Fray Junípero Serra Hospital, Security and Social Services Institute for State Workers, Tijuana, Avenida De Las Palmas 1 Col Las Palmas, 22106, Tijuana, BC, Mexico
| | - Ismael Lares-Asseff
- Interdisciplinary Research Center for the Comprehensive Regional Development, Durango Module, Durango, Mexico.,National Polytechnic Institute, Sigma Street #119, Fracc. 20 de Noviembre II, C.P. 34220. Año 2009-2010, Durango Dgo., Mexico
| | - Verónica Loera
- Interdisciplinary Research Center for the Comprehensive Regional Development, Durango Module, Durango, Mexico.,National Polytechnic Institute, Sigma Street #119, Fracc. 20 de Noviembre II, C.P. 34220. Año 2009-2010, Durango Dgo., Mexico
| | - Laura Valencia
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico
| | - Blanca Camacho
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico
| | - Brenda Alvarado
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico
| | - Vilma Cervantes
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico
| | - Leslie Patrón
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico
| | - Horacio Almanza
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico.
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Abstract
To describe a unique case of a non-germinomatous germ cell tumor, a giant orbital dermoid, present in adulthood. A 31-year-old male presented in our clinic with gradual, painless, progressive proptosis in the left eye since 28 years associated with gradual loss of vision. The left eye showed gross proptosis. Ocular structures could not be made out. Computed tomography scan showed a well-circumscribed oval heterogeneous mixed solid and cystic lesion completely filling the left orbit with calcification. The differential diagnosis was that of either teratoma or optic nerve glioma. The patient underwent excision of the lesion. Histopathology revealed a capsulated tumor with multiple cystic components filled with blood and eosinophilic material suggestive of a dermoid cyst. Non-germinomatous germ cell tumors may present atypically in adults and neglected benign dermoid cysts can attain massive size mimicking malignant lesions.
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Affiliation(s)
- Bipasha Mukherjee
- a Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| | - Akruti Desai
- a Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
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Al-Muhaylib A, Alkatan HM, Al-Faky YH, Alsuhaibani AH. Periorbital lesions misdiagnosed as dermoid cysts. J AAPOS 2017; 21:509-511. [PMID: 29107796 DOI: 10.1016/j.jaapos.2017.07.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/11/2017] [Accepted: 07/16/2017] [Indexed: 11/29/2022]
Abstract
Several periorbital lesions can be clinically misdiagnosed as dermoid cyst. We retrospectively reviewed the histopathological findings for 97 biopsied periorbital lesions with a clinical diagnosis of dermoid cyst from January 2006 to July 2016 at a single center and identified 5 cases that were eventually found to have been misdiagnosed. The main presenting symptom was a long-standing mobile painless mass with intact overlying skin below the medial aspect of the brow in 4 patients and below the center of the brow in 1 patient. The tissue diagnoses included vascular lesions (hemangiomas and cavernous venous malformation) in 4 patients and pilomatrixoma in 1 patient. The agreement between the clinical and pathological diagnosis of a periocular dermoid cyst in our series was 94.8%.
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Affiliation(s)
- Ahmed Al-Muhaylib
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; Ophthalmology Department, College of Medicine, Qassim University, Kingdom of Saudi Arabia
| | - Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; Department of Pathology, College of Medicine, King Saud University, Kingdom of Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Adel H Alsuhaibani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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23
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Abstract
Periorbital dermoid cysts occur mainly in children. Sonography is useful for the noninvasive, nonionizing evaluation of soft tissue lesions in infants and children without requiring sedation or anesthesia. We report the sonographic appearance of 25 periorbital dermoid cysts and identified that all are avascular oval lesions located below the aponeurotic plane. Nonaggressive bone remodeling was present in 52% of the cases. These finding in pediatric periorbital lesions are highly suspicious of a periorbital dermoid cyst.
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24
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Abstract
BACKGROUND Progress in medical branches that has taken place since the first child with Goldenhare syndrome (GS) had been described in 1952 by Maurice Goldenhar, facilitated better understanding of this congenital defect. It also gave new perspectives and the opportunity to achieve satisfactory treatment results, mainly due to development of surgical techniques. DATA SOURCES Based on the literature and own experience, we discussed the phenotype of presentation of GS, ethiopathogenesis, genetic counselling and treatment with particular emphasis on surgery correction of hemifacial microsomia. RESULTS The spectrum of GS abnormalities ranges from mild to severe ones and include patients with barely noticeable facial asymmetry to very pronounced facial defect with more or less severe abnormalities of internal organs and/or skeleton. It is characterized most commonly by impaired development of eyes, ears, lips, tongue, palate, mandible, maxilla, zygomatic and orbital structures and deformations of the teeth structures. Ethiopathogenesis is multifactorial and dependent on genetic and environmental factors but there are still many unknowns about the syndrome which should be revealed. CONCLUSIONS Patients with GS due to a large variety of abnormalities and different severity of symptoms pose a challenge for clinicians. All of this necessitate an individual approach to each single patient and involvement a team of specialists in treatment planning. It is a complex, long-lasting, multidisciplinary process and should be divided into stages, according to patient's age, as well as the extent and severity of observed abnormalities. Neonatologists and pediatricians are involved in care of these patients from the onset.
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25
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Lenci LT, Shams P, Shriver EM, Allen RC. Dermoid cysts: clinical predictors of complex lesions and surgical complications. J AAPOS 2017; 21:44-47. [PMID: 28089745 DOI: 10.1016/j.jaapos.2016.09.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the clinical characteristics and role of imaging in the evaluation of dermoid cysts and to determine predictors of cyst rupture during surgical excision of dermoid cysts. METHODS In this single-center, consecutive, nonrandomized comparative case series, the records of consecutive patients with suspected dermoid cysts who underwent surgery between January 1, 2000, and December 31, 2014, were reviewed retrospectively for demographic information, clinical findings, preoperative imaging, surgical details, and pathology reports. RESULTS A total of 100 patients were included. Cyst volume was similar between superomedial and superotemporal lesions (P = 0.61) but greater in patients >10 years of age (P < 0.001). Immobility of the cyst was present in all complex dermoids (4/4), but there was no difference in the mobility of superotemporal or superomedial cysts (P = 0.69). Forty-two patients underwent imaging; superomedial lesions were more likely to be imaged than superotemporal lesions (P = 0.073). All 4 patients with complex dermoids presented with orbital signs and underwent preoperative imaging. None of the remaining 38 patients who underwent imaging had orbital signs, and the results of imaging had no effect on surgical planning. Intraoperative cyst rupture occurred in 18 patients. There was no significant difference in cyst rupture between superotemporal and superomedial cysts (P = 0.452). Smaller cyst volume was associated more often with intraoperative cyst rupture (P < 0.001). CONCLUSIONS Preoperative imaging of superomedial and superolateral dermoid cysts is likely unnecessary unless associated with orbital signs. Intraoperative cyst rupture is not influenced by cyst location but does appear to be more likely in smaller cysts.
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Affiliation(s)
- Lucas T Lenci
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Pari Shams
- Moorfields Eye Hospital, London, United Kingdom
| | - Erin M Shriver
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Richard C Allen
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
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26
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Abstract
Dermoid cyst is an example of choristoma (i.e., tumors that originate from aberrant primordial tissue which result in normal appearing tissue in an abnormal location). This particular type of cyst is formed at the site where 2 suture lines of the skull close during embryonic development, and during this time, dermal or epidermal elements are pinched off which later convert to form cysts. Approximately, 50% of these tumors that involve the head are found in or adjacent to the orbit. This article presents a similar case of the orbital dermoid cyst with its management and also a review on other varieties of dermoid cysts of the head and neck region.
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Affiliation(s)
- Richa Gupta
- Department of Oral and Maxillofacial Surgery, Jabalpur Hospital and Research Centre, Jabalpur, Madhya Pradesh, India
| | - Rajesh B Dhirawani
- Department of Oral and Maxillofacial Surgery, Jabalpur Hospital and Research Centre, Jabalpur, Madhya Pradesh, India
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27
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Matsuo T. Clinical decision upon resection or observation of ocular surface dermoid lesions with the visual axis unaffected in pediatric patients. SPRINGERPLUS 2015; 4:534. [PMID: 26413440 PMCID: PMC4577497 DOI: 10.1186/s40064-015-1326-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/09/2015] [Indexed: 11/10/2022]
Abstract
Ocular surface or epibulbar dermoid lesions may present as limbal dermoids at the corneal limbus or dermolipomas in the conjunctival fornix. The purpose of this study is to review clinical features of ocular surface dermoids (grade I), with the visual axis unaffected, in pediatric patients, in order to find key features for making clinical decision, either resection or observation. The study involved 13 consecutive patients with limbal dermoids or fornix dermolipomas which did not affect the visual axis, seen in 11 years at a referral-based institution. Eight patients underwent surgical resection at the age, ranging from 1 to 18 (median, 4) years, with concurrent preauricular appendage resection in 3 patients. Limbal dermoids in 6 patients presented dome-shaped elevation from the ocular surface, and extended in inferotemporal quadrant for 1-2 clock hours. The remaining 2 patients showed dermolipomas in the temporal conjunctival fornix. Postoperative astigmatism at the final visit ranged from 0 to 7 (median, 2.9) diopters in 6 patients with limbal dermoids while ranged from 0 to 1 diopters in 2 patients with fornix dermolipomas. All patients with meaningful astigmatism wore glasses before and after the surgery, resulting in no apparent ametropic or anisometropic amblyopia. Observation was chosen in 5 patients with the age at initial visit, ranging from 0 to 2 (median, 1) years, and the age at the final visit, ranging from 2 to 6 (median, 3) years. Flat limbal dermoids, extending for 1-2 clock hours, were noted in 3 patients, a dome-shaped limbal dermoid for 1 clock hour in one, and a fornix dermolipoma in one. Three patients had preauricular appendages. No patient, except for one with a dome-shaped limbal dermoid, showed astigmatism, greater than one diopter. In conclusions, dome-shaped limbal dermoids were excised while flat limbal dermoids observed. The age at surgery varied largely in pediatric patients with limbal dermoids (grade I) or fornix dermolipomas which did not affect the visual axis. The surgical timing was influenced by surgical scheduling for preauricular appendage resection, determined by a plastic surgeon. Surgical decision was made for cosmetic purposes, but not for medical needs to avoid amblyopia.
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Affiliation(s)
- Toshihiko Matsuo
- Department of Ophthalmology, Okayama University Medical School and Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama City, 700-8558 Japan
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29
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Fasina O, Ogun OG. Giant deep orbital dermoid cyst presenting early in infancy in a Nigerian child: a case report and review of the literature. J Med Case Rep 2012; 6:320. [PMID: 23009314 PMCID: PMC3469404 DOI: 10.1186/1752-1947-6-320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 08/20/2012] [Indexed: 11/23/2022] Open
Abstract
Introduction Dermoid cysts are the most common orbital cystic lesions seen in children. While superficial orbital dermoid cysts present early in life, deep dermoid cysts remain clinically occult until adolescence or adulthood. We here present a case of a deep orbital dermoid cyst in a Nigerian child that became symptomatic early in infancy. Case presentation A female Nigerian infant of Yoruba ethnicity presented at three months of age with left non-axial proptosis and a hazy cornea. A superotemporal cystic orbital mass was seen on ultrasonography, and her parents were counseled for simple tumor excision. They however defaulted, only for their child to re-present two years later with gradually progressive proptosis, an enlarged orbit and keratinized ocular surface, necessitating orbital exenteration. Conclusion Deep orbital dermoid cysts may be symptomatic from birth. Late presentation may result in an irreversible loss of vision, as demonstrated in our case. The need for public enlightenment on early presentation and prompt management of such benign lesions is emphasized.
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Affiliation(s)
- Oluyemi Fasina
- Department of Ophthalmology, University College Hospital Ibadan, Ibadan, Nigeria.
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30
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Hou JH, Aakalu VK, Setabutr P. Quantitative characterization of growth rate of an incidental deep dermoid cyst in a child using sequential magnetic resonance imaging. J AAPOS 2012; 16:403-5. [PMID: 22929455 DOI: 10.1016/j.jaapos.2012.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Revised: 04/21/2012] [Accepted: 04/23/2012] [Indexed: 10/27/2022]
Abstract
When orbital lesions are discovered incidentally, some have advocated observation given the slow-growing nature of deep dermoids; however, little has been published regarding the true growth potential of these tumors. We describe a case of an incidental deep orbital dermoid cyst in a 7.5-month-old girl with retinoblastoma. The cyst was monitored with five sequential magnetic resonance imaging studies of the orbit over 23 months with careful documentation of growth. The cyst was surgically removed without complication, and histopathology confirmed the diagnosis of dermoid cyst. This case represents the first published quantitative measurement of dermoid growth potential and highlights the need for close early monitoring in incidentally discovered cases.
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Affiliation(s)
- Joshua H Hou
- Departments of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.
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