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Grand Rounds
Brooke LW Nesmith, M.D.University of Louisville School of MedicineDepartment of Ophthalmology & Visual
Sciences1/16/2015
Presentation
CC: Enlargement of right upper eyelid mass x 2 months
HPI: 10mo male referred to oculoplastics clinic for evaluation of right upper eyelid mass. Patient has had fullness of right upper lid laterally since approx 2 months of age, has become progressively larger in the past 2 months.
Presentation
PMHx: Full term with uncomplicated delivery; Asthma
Meds:Albuterol, Zyrtec
Allergies: Cephalexin
Exam
Visual acuity: Central steady and maintained OUPupils: 4mm OU, no RAPD Motility: Full OUGlobes soft to palpation OU
External Exam: Soft firm mobile mass at superior aspect of right lateral orbital rim. No edema or erythema. No tenderness to palpation. No globe displacement.
Anterior Segment Exam: WNL OU
Assessment 10 month old male with congenital right
superolateral orbital mass of the upper eyelid with recent enlargement.
congenital cyst– dermoid– epidermal
Right anterior orbitotomy to excise lesion
Plan
Surgical Course
1 x 0.5cm tan-white to tan-yellow cyst was successfully excised near the right zygomaticofrontal suture line without rupture
Pathology
Pathology
Orbital Cysts of Childhood surface epithelium
dermoid- (epidermal and conjunctival)
simple epithelial (epidermal, conjunctival, respiratory, apocrine gland)
teratomatous neural (associated with ocular maldevelopment) secondary (mucocele) inflammatory (parastic) noncystic lesions with a cystic component
– adenoid cystic carcinoma, rhabdomyoscarcoma
Shields J, Shields C. Orbital cysts of childhood-classification, clinical features, and management. Surv Ophthalmol 2004;49:281-299
Orbital Cysts of Childhood
Shields J, Shields C. Orbital cysts of childhood-classification, clinical features, and management. Surv Ophthalmol 2004;49:281-299
Dermoid Cyst
Most common– 40% of all orbital lesions of childhood– 89% of all orbital cystic lesions of childhood that
come to biopsy or surgical removal
Congenital choristomas– embryonic epithelial nests – entrapped during
embryogenesis– along suture lines
Shields J, Shields C. Orbital cysts of childhood-classification, clinical features, and management. Surv Ophthalmol 2004;49:281-299
Dermoid Cyst Anterior lesions
– generally becomes apparent during 1st decade of life
– most common location – superolateral aspect of orbit at frontozygomatic suture
Shields J, Shields C. Orbital cysts of childhood-classification, clinical features, and management. Surv Ophthalmol 2004;49:281-299
Dermoid Cyst Deeper lesions
– may remain clinically occult until adulthood – present with painless, progressive proptosis, motility deficits, or diplopia
Shields J, Shields C. Orbital cysts of childhood-classification, clinical features, and management. Surv Ophthalmol 2004;49:281-299
Dermoid Cyst Dumbbell-shaped
– cyst in orbit and temporal fossa – connected by defect in bone
– pulsating proptosis with mastication
Missotten G, Van Santbrink-Bakker H., de Keizer R. Dumbbell-shaped dermoid cysts. Acta Ophthalmologica 2010;doi:10.111/j.1755-3768.2008.01409.
Dermoid Cyst Workup and Imaging
– classic dermoid cysts at frontozygomatic suture may be diagnosed clinically without imaging
– imaging required for medial lesions (rule out encephalocele or mucocele) and deep lesions
Treatment– surgical excision – remove with cyst wall intact
without causing iatrogenic rupture
Missotten G, Van Santbrink-Bakker H., de Keizer R. Dumbbell-shaped dermoid cysts. Acta Ophthalmologica 2010;doi:10.111/j.1755-3768.2008.01409.
Thank you.