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139 Paediatric orbital dermoid cyst management: is preoperative imaging always necessary?

Abstract

We describe the role of diagnostic imaging in supporting the clinical diagnosis of paediatric orbital dermoid cysts

Retrospective review of clinical notes of children who underwent orbital dermoid excision from 2019 to 2024.

Eleven eyes of eleven children (72,7% female and 27,3% male) were identified. Mean age at the time of surgery was 4.7 years. In 100% of the cases the onset was noticed before the age of 18 months. The main symptom at presentation was a slowly progressive, painless subcutaneous mass. The localization of the orbital mass was supero-temporal along the zygomatic-frontal suture in all cases. All lesions were mobile and well circumscribed with no clinical evidence of intra-orbital or intra-cranial extension. All patients underwent diagnostic imaging with either Ultrasound (US - 45,45%) or MRI (45,45%). In one case of a growing cyst both diagnostic tools were carried out. None showed deep intra-orbital extension on imaging. All patients underwent uneventful total excision of lesion with no intraoperative evidence of intra-orbital or intracranial extension. Histology confirmed the diagnosis of Dermoid Cyst in all cases.

The suspicious diagnosis of orbital dermoid cyst is made clinically and confirmed by the pathology results after surgical excision biopsy. Imaging plays an important role in case of atypical presentation or evidence of deeper extension.

Preoperative diagnostic imaging may not be necessary in the management of Dermoid Cysts which do not have clinical evidence of intraorbital or intracranial extension. In cases of doubt, US should be the first choice of imaging as it is less invasive.

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