Neuroimaging findings in a child with dumbbell-shaped frontosphenoidal dermoid cyst presenting as preseptal cellulitis

Is pre-operative imaging of external angular dermoid cysts in children necessary?

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.

Dermoid Cyst of Nasal Tip and Nasal Septum

ABSTRACT

Dermoid cyst is a congenital and benign disease with most occur on the head and neck. It is rarely that occur on the nasal tip and nasal septum at same time and rarely repair of using nasal septum mucosa. The authors treated a child with dermoid cyst in the nasal tip and septum. Only the dermoid cyst at the tip of the nose caused the change of appearance. Dermoid cyst of nasal septum did not cause any clinical symptoms. She underwent excision of the dermoid cyst at the tip of the nose and endoscopic surgery for the dermoid cyst in the nasal septum and used the nasal septum mucosa for repair at the same time. After 6 months of recovery, the appearance of the nasal tip recovered well without obvious scar, the nasal septum area recovered well, and the local stoma was unobstructed without recurrence. The authors found that this kind of nasal septal cyst with no clinical symptoms can achieve good therapeutic effect through endoscopic surgery and repair of using nasal septum mucosa, with less damage, rapid recovery, and good prognosis.

Orbital dermoid cyst presenting as chronic osteomyelitis

A dermoid cyst is a choristoma that arises from the displacement of ectoderm to a subcutaneous location along embryonic closure lines. Rarely dermoids have a deep intraorbital component that is connected to a superficial component through a defect in bone, also known as dumbbell dermoid. We report the case of a young boy who was misdiagnosed having chronic osteomyelitis of the zygoma, based on the clinical and radiological features. On surgical exploration he was found to have a dumbbell-shaped dermoid with a bony defect. Histopathological features were consistent with a diagnosis of dermoid cyst with chronic inflammation.

Infected Nasal Dermoid Cyst/Sinus Tract Presenting With Bilateral Subperiosteal Supraorbital Abscesses: The Midline Nasal Tuft of Hair, an Overlooked Finding

This case is, to the authors' knowledge, the first reported case in the literature of bilateral orbital abscesses as result of an infected nasal dermoid. The baby presented with what proved to be bilateral supraorbital subperiosteal abscesses with associated frontal osteitis/osteomyelitis and soft tissue infection of the glabella. Methicillin-sensitive staphylococcus aureus infection was found in the setting of a midline nasal dermoid with tuft of hair and infected sinus tract that was at least initially missed on diagnosis.