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[Clinical manifestations, diagnosis and management of recurrent orbital dermoid cysts].

OBJECTIVE
To evaluate the clinical features, diagnostic methods and treatment of recurrent orbital dermoid cysts.


METHODS
In a retrospective study, the records of 30 consecutive cases with recurrent orbital dermoid cyst confirmed by pathologic examination were analyzed with special attention to the case histories, recurrent factors, clinical manifestations, imaging findings, treatment and prognosis.


RESULTS
In the present series, the interval from first appearance in our institute to the operation ranged from 1 month to 36 years, with a median of 2.5 years. Once, twice and three times of operation history were noted in 20 cases, 9 cases and 1 case, respectively. The clinical characteristics included: periorbital masses with red swelling and tenderness in 16 cases, cutaneous fistulas in 4 cases, ectropion and adherence of upper lid in 4 cases. The risk factors for the recurrence included the incomplete excision the cyst or residual of the cyst wall in the bone sutures in 16 cases, misdiagnosis as subcutaneous mass leading to inappropriate operations in 11 cases, operation without imaging examinations in 8 cases, etc. CT scan was performed in all cases, which showed dermoid cysts with hypodensity or isodensity. The common imaging signs included dumbbell dermoid cysts located near the zygomaticofrontal suture in 8 cases, slender and circuitous tunnel within the orbital wall in 6 cases, and extensive and wavy impression of the bony walls in 6 cases. Surgical excision was performed in 28 cases and conservation therapy was used in 2 cases. Cystic content and wall were removed thoroughly during the operation. Follow-up ranged from 1 to 9 years and no recurrence or serious complications were noted.


CONCLUSIONS
The recurrence of orbital dermoid cysts is correlated with various factors. The importance of recognition of clinical features and imaging findings of this tumor should be emphasized. With the guide of imaging examinations and the combination of various surgical skills, the recurrence of dermoid cysts could be prevented efficiently.