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Lucas T Lenci, Meredith Baker, Richard C Allen, ; Dermoid Cysts: Imaging in the prevention of complications.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4754.
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Dermoid Cysts are common lesions in the periocular region. They account for approximately 5% of all orbital lesions (1). The majority arise in children in the superotemporal region from the frontozygomatic suture (2). To our knowledge, there has been no study evaluating decisions about when/if to image patients with presumed dermoid cysts. The purpose of this study is to determine clinical characteristics which may guide imaging decisions in the management of presumed dermoid cysts.
A retrospective chart review was performed on our dermoid cyst patient database at the university of Iowa over the last 5 years. Clinical, pathologic and imaging data were obtained. We analyzed whether the imaging data obtained changed the patients course. We defined a change in management if an alternate diagnosis, significant intraorbital or intracranial extension, or significant bony erosion was found.
57 patients charts met our criteria. The mean age was 6.4 years with 21 females and 36 males. 40/57 (70%) were located superotemporally and 10 (18%) superomedially. 27/57 (47%) patients obtained imaging mostly in the form of CT or MRI. 42/57 (74%) patients had comments about mobility. 12 (21%) lesions were immobile. 8 (14%) cases of gross rupture during surgery were found. 3 were located medially (21% chance of rupture), 5 laterally (12%). Imaging changed management in 3/27 (11%) cases that had imaging and only 3/57 (5%) total cases. Each of these cases had other significant clinical findings including new onset strabismus, proptosis, and recurrence. The average age was 28.8 for these complicated lesions, which also had no mobility on exam.
There is little to no guidance on when dermoids should be imaged. Management was altered by imaging in only 3/57 (5%) total patients, while 47% of patients underwent imaging. Location of the dermoid doesn’t seem to have an impact on management, however medial lesions tend to have an increased risk of intraoperative rupture (21%). Orbital findings such as proptosis, strabismus, or significant mass effect are reasons to obtain imaging as well as recurrence and older age. Lack of mobility was seen in all of our complicated dermoids. Medial canthal lesions have not been associated with intracranial extension or misdiagnosis in our case series, which is similar to other studies (3,4). Thus, imaging is likely not necessary for periocular dermoid lesions without other clinical findings.
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