A series of ruptured dermoid cysts in pediatric patients

Ruptured dermoid cysts can often have atypical presentations and be challenging to manage. We report 3 cases of pediatric patients with ruptured dermoid cysts. Case 1 was a 16-year-old boy with an enlarging left superotemporal orbital mass who presented with 2 days of acute inflammation. Computed tomography revealed a well-circumscribed lesion that was excised. Histopathology confirmed a ruptured dermoid cyst. Case 2 was a 4-year-old girl with a right superotemporal orbital mass that enlarged following trauma. Magnetic resonance imaging revealed a bilobed dermoid, and excision confirmed prior rupture. Case 3 was an 8-month-old girl with a left superotemporal dermoid cyst noted shortly after birth. By age 2 years, it was nonpalpable but later reappeared. Excision confirmed prior rupture. All patients achieved resolution following anterior orbitotomy with complete excision of the cyst wall, with no recurrences observed during follow-up. Given the variability in presentation, spontaneous rupture should remain on the differential diagnosis for periorbital lesions. Surgeons should maintain a high index of suspicion for occult cyst rupture, particularly when atypical lesions are located at the frontozygomatic suture.