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Grand Rounds
Brooke LW Nesmith, M.D.University of Louisville School of MedicineDepartment of Ophthalmology & Visual
Sciences1/16/2015
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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.
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Presentation
PMHx: Full term with uncomplicated delivery; Asthma
Meds:Albuterol, Zyrtec
Allergies: Cephalexin
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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
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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
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Surgical Course
1 x 0.5cm tan-white to tan-yellow cyst was successfully excised near the right zygomaticofrontal suture line without rupture
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Pathology
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Pathology
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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
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Orbital Cysts of Childhood
Shields J, Shields C. Orbital cysts of childhood-classification, clinical features, and management. Surv Ophthalmol 2004;49:281-299
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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
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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
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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
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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.
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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.
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Thank you.