J Korean Ophthalmol Soc.  2017 Feb;58(2):208-212. 10.3341/jkos.2017.58.2.208.

Frontotemporal Dermoid Cyst with Sinus Tract in a Child

• Kwon JM
• Lee JW
• Ahn JH

• KMID: 2369470
• DOI: http://doi.org/10.3341/jkos.2017.58.2.208

Abstract

PURPOSE
To report the treatment results of a frontotemporal dermoid cyst with a cutaneous fistula and sinus tract that caused recurrent periorbital cellulitis in a child.
CASE SUMMARY
A 4-year-old girl who presented with left orbital swelling and tenderness visited our hospital. She had a cutaneous fistula with a small amount of purulent discharge at the left frontotemporal area. Orbital computed tomography scans showed a well-defined low density lesion in the fronto-zygomatic suture, and there was a bony defect in the left greater wing of the sphenoid bone of the orbit. Orbital magnetic resonance imaging showed a cutaneous fistula and sinus tract that extended into the middle cranial fossa. The patient was treated with intravenous antibiotics until the inflammation was resolved. Surgery was performed to remove the dermoid cyst with sinus tract. After surgery, there was no evidence of recurrence, and complications included neurologic and ophthalmic symptoms.
CONCLUSIONS
Orbitofacial lesions, particularly frontotemporal cutaneous fistulas that present with recurrent discharge, should be regarded with suspicion in cases of deep extended dermoid cysts with sinus tract. Additionally, imaging tests should be carefully conducted before surgery.

Keyword

Dermoid cyst; Fistula; Periorbital cellulitis; Sinus tract

MeSH Terms

Anti-Bacterial Agents
Cellulitis
Child*
Child, Preschool
Cranial Fossa, Middle
Cutaneous Fistula
Dermoid Cyst*
Female
Fistula
Humans
Inflammation
Magnetic Resonance Imaging
Orbit
Recurrence
Sphenoid Bone
Sutures
Anti-Bacterial Agents

Figure

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  Figure 1. Clinical photographs of the patient. (A) Cutaneous fistula with purulent discharge at left frontotemporal area. (B) Lateral view.

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  Figure 2. Computed tomography (CT) scan of patient. (A) Axial CT scan (bone window) show bony defect in the left greater wing of sphenoid which is interconnected with the temporal fossa. (B) Coronal CT scan showing well defined low density lesion in fron-to-zygomatic suture.

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  Figure 3. Magnetic resonance (MR) images of the patient. (A) Axial T2-weighted MR image showing cutaneous fistula and sinus tract extended into the middle cranial fossa in the left lateral orbital area. (B) Coronal T2-weighted MR image showing sinus tract that is well defined and in high signal lesion.

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  Figure 4. The photographs of histopathological findings. (A) A dermal cyst which is lined by squamous epithelium is seen (hematoxylin-eosin stain, original magnification ×20). (B) The wall of the cyst has associated sebaceous glands and hair follicles (hematoxylin-eosin stain, original magnification ×20).

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  Figure 5. The postoperative photograph of the patient. There was no evidence of recurrences and complications at 1 month after surgery.

Reference

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