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Orbital Dermoid Cyst: Classification and its Impact on Surgical Management
Mohammed Ashraf Eldesouky1, Molham Abdelhafez Elbakary1
1a Ophthalmology Department, Faculty of Medicine , Tanta University , Tanta , Egypt.
Purpose:
Analysis of different clinical types of orbital dermoid cyst, and studying the impact of preoperative classification on the proposed surgical procedure.
Methods:
A retrospective study of orbital dermoid cyst cases. The clinical and imaging data were reviewed. The different types of dermoid were recorded as superficial or deep, lateral or medial, exophytic or endophytic. The deep dermoids were classified according to their site and continuity of the cyst wall. The operative approach, intraoperative, and/or postoperative complications were recorded.
Results:
The study included 153 cases of orbital dermoid. The superficial lesions represented 68.6%, of which 74.3% were lateral and 61.0% were endophytic. Intraoperative cyst perforation was recorded in 56.3% of exophytic cases approached through crease incision, and recurrence occurred in 6.3%. Defective cyst wall was found in 31.25% of deep orbital dermoid. Surgery was complicated by cyst rupture when excision was attempted, and recurrence was recorded in one case. Exposure, intended evacuation, and dissection of the cyst wall were better surgical approaches for these cases without reported complications.
Conclusion:
Preoperative classification of orbital dermoid had an important effect on the surgical procedure. Endophytic superficial lesions were approached through crease incision without complications, while exophytic lesions were better approached through infrabrow incision. Deep orbital lesions with defective wall were better approached through exposure, intended evacuation, dissection, and excision of the remaining cyst wall.
