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Is pre-operative imaging of external angular dermoid cysts in children necessary?
Jessica Mead1, Joshua Kirkpatrick2, Jean Murdoch3
1Department of Paediatric Surgery, Wellington Hospital, Wellington, New Zealand.
Insights
Pre-operative imaging for external angular dermoid cysts in children is rarely needed and does not typically alter management. Routine imaging is unnecessary unless specific clinical signs suggest deeper involvement.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Medical Imaging
Background:
- External angular dermoid cysts are congenital tumors found near the eye.
- Accurate diagnosis and management are crucial for pediatric patients.
Purpose of the Study:
- To determine the frequency and types of pre-operative imaging used for pediatric external angular dermoid cysts.
- To assess if pre-operative imaging influences the management of these cysts.
Main Methods:
- Retrospective analysis of 61 children under 16 years old.
- Data collected on presentation, investigation, treatment, and outcomes for external angular dermoid cyst excision between 2008 and 2021.
Main Results:
- Pre-operative imaging was performed in 31% of patients (radiographs, ultrasound, CT, MRI).
- No imaging revealed intracranial or orbital extension, nor did it change management.
- All cysts were successfully excised, with low rates of complications and recurrence.
Conclusions:
- External angular dermoid cysts rarely extend intracranially or orbitally.
- Routine pre-operative imaging is generally not required unless specific clinical indicators are present.
Aim:
To investigate the frequency and modality of pre-operative imaging in children with an external angular dermoid cyst and whether this influenced subsequent management.
Methods:
A retrospective study was undertaken to assess the presentation, investigation, treatment and outcomes in children aged less than 16 years with an external angular dermoid cyst. All children who underwent external angular dermoid cyst excision between January 2008 and April 2021 at a regional children's hospital were analysed.
Results:
Sixty-one patients (32 boys) were identified. Fifty-four were managed by paediatric surgeons and seven by ophthalmic surgeons. Pre-operative imaging was performed in 19 (31%) patients, including plain radiographs (3), ultrasound scan (14), computerised tomography scan (1), and magnetic resonance imaging scan (2). None of these investigations showed evidence of an intracranial or orbital extension of the cyst or changed management. All cysts were excised under day-case general anaesthesia. There was one minor postoperative complication and two recurrences.
Conclusions:
External angular dermoid cysts rarely communicate through the bone with the orbit or anterior cranial fossa. Routine pre-operative imaging is unnecessary unless there are clinical features such as an atypical location (e.g. temporal), eye signs (e.g. strabismus, proptosis and globe displacement) or a draining sinus.
