Head and Neck #20

Description:

• Well-defined cystic lesion in subcutaneous plane of lateral margins of orbit on left

• Underlying bone and adjacent lacrimal gland are unremarkable

Description:

Possible differential considerations include:

• Orbital dermoid cyst – TRUE

• Orbital teratoma – TRUE

• Orbital dermolipoma – TRUE

• Orbital hemangioma – TRUE

• Orbital rhabdomyosarcoma – FALSE

Dermoid cysts

• They are thought to occur as a developmental anomaly in which embryonic ectoderm and mesoderm are trapped in the closing neural tube between the 5th and 6th weeks of gestation

• These lesions are usually extraconal, non-enhancing masses with smooth margins, cystic, and/or solid components

• They are typically heterogeneous with soft tissue, fluid, and fatty (sebum) components; occasionally calcifications may be present

• They are most commonly located superotemporally, arising from the zygomaticofrontal suture, followed by superonasally, arising from the frontoethmoidal or frontolacrimal sutures

• Ruptured dermoids may show adjacent inflammatory changes

• Superficial lesions barely require cosmetic excision, while a deeper lesions may require more invasive methods involving micro-dissection and orbitotomy

References:

• Kudo K, Tsutsumi S, Suga Y et al. Orbital dermoid cyst with intratumoral inflammatory hemorrhage: case report. Neurol. Med. Chir. (Tokyo). 2008;48 (8): 359-62. Pubmed citation

• Ahmed RA, Eltanamly RM. Orbital epidermoid cysts: a diagnosis to consider. J Ophthalmol. 08;2014: 508425. doi:10.1155/2014/508425 – Free text at pubmed – Pubmed citation

• Chaudhry IA. Management of deep orbital dermoid cysts. Middle East Afr J Ophthalmol. 2008;15 (1): 43-5. doi:10.4103/0974-9233.53376 – Free text at pubmed – Pubmed citation