Osteotomy-Free Management of Dumbbell-Shaped Orbital Dermoid Cysts

To report the clinical characteristics and surgical outcomes of patients with dumbbell-shaped orbital dermoid cysts that were managed without osteotomy.

Retrospective review of patients with histologically confirmed dumbbell-shaped orbital dermoid cysts (characterized as bilobed cysts with intra and extraorbital components, connected through an osseous cleft) that, between 1997 and 2024, were excised without lateral osteotomy.

Eighteen patients (11 female; 61%) presented at a mean age of 25 years (median 28; range 2-45 years), the main features being eyelid swelling (83%), orbital discomfort (61%), and proptosis (39%). All cysts involved the superotemporal quadrant and extended through the frontozygomatic or zygomaticosphenoidal sutures into the temporalis fossa. Seventeen patients (94%) were managed with an upper eyelid crease incision, and 2/17 (12%) of them had removal of tough fibrous tissues that were closing a rim-cleft; the lesion in 1 other patient was managed through a lateral canthotomy incision. Significant spillage of contents occurred in 6/18 (33%) cases, and this was managed with copious saline irrigation. Histology confirmed a chronic granulomatous inflammation in all specimens. Transient postoperative complications occurred in 3 patients (17%), and no persistent inflammation was observed at a mean follow-up of 21 months (median 6; range 2-197 months).

Most dumbbell-shaped orbital dermoid cysts can be excised through an upper-lid skin-crease incision without lateral osteotomy. Meticulous dissection, curettage, or fulguration of the intraosseous tract, and careful management of spilled cyst contents reduce complications. This minimally invasive strategy offers excellent outcomes with low morbidity and fast recovery.