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ISSN (Online) : 2456-2688
Facial Medial Dermoid Cyst – A Case Report
Sajad Ahmad Salati*
Department of Surgery, Unaizah College of Medicine, Qassim University, KSA
Email: docsajad@gmail.com
Keywords: Choristoma, Medial Dermoid Cyst Congenital, Nasal Dermoid, Proptosis
Abstract
An anterior facial medial dermoid cyst at the frontonasal suture in a 7-year-old male child is presented along with the
images of computed tomography (CT) study. The CT scan images show clear nasal bone indentation with no erosion.
Dermoid cysts are a subtype of benign heterotopic lesions termed choristomas and contain cutaneous elements which
include squamous epithelium and dermal appendages such as hair, sebaceous glands, and sweat glands. Of all the pediatric
head and neck dermoid cysts, periorbital cysts account for up to 9–10%. The periorbital dermoid may occur in two variants
1. Introduction
Dermoid cysts are a subset of benign heterotopic
neoplastic lesions termed as choristomas. ey arise
from the epidermal rest cells that get pinched during
embryogenesis by the underlying developing bony
structures. In the pediatric population, the cysts in the
periorbital region account for about 10% of head and
neck dermoid cysts and generally occur in proximity
of frontonasal or frontozygomatic suture. e overall
prognosis of these lesions is good but they can rupture
and lead to severe inammation in the surrounding
tissues1,2. is report presents a case of an anterior facial
medial dermoid cyst in a 7-year-old male child.
2. Case Report
A 7-year-old male child, rst in the birth order, was
brought with a swelling at the bridge of the nose
(Figure1a-c). e parents had noted a fullness in the area
at the age of 9months and stated that the swelling had
progressively enlarged to become clearly noticeable. e
patient was born at full term by normal vaginal delivery
and had attained all the developmental milestones
normally. ere was no other signicant antenatal or
postnatal history. On examination, there was a single,
ovoid, non-tender, smooth, non-pulsatile, mobile, cystic,
subcutaneous lump about 2 cm × 1.5 cm located over the
right side of root of the nose, inferior to head of right
eyebrow, and superior to medial canthus. e lump
had minimal surface erythema and absent impulse on
coughing. Computed tomography (CT) scan imaging
shows a well-dened smooth margin fat-containing
extraconal mass located at the right side of root of the nose
with no intracranial extension. Bone window revealed
a clear indentation of right nasal bone but without any
bony erosion and the orbital anatomy was maintained.
ere were neither perilesional inammatory changes
nor any calcications.
e clinical presentation and imaging of the lesion
were most consistent with a medial dermoid cyst.
Excision of the cyst under general anesthesia was
planned and informed consent was secured from the
parents. e patient underwent an uneventful excision
of the cyst through a 2 cm long, transverse skin incision.
Histopathological study of the lesion demonstrated
a cystic structure lined with stratied squamous
keratinizing epithelium with skin adnexal structure
elements, consistent with a dermoid cyst. ere were no
postoperative complications. No recurrence was recorded
at 6 years follow-up and the parents were satised with
the outcome.
Journal of Health Science Research, Vol 6(1), 2021, 24-26
*Author for correspondence
How to cite this article: Salati SA. Facial Medial Dermoid Cyst – A Case Report. Journal of Health Science Research, 2021;6(1):24-26.
DOI: https://doi.org/10.7324/jhsr.2021.614
Facial Medial Dermoid Cyst – A Case Report
Vol 6 (1) | 2021 | https://jhsronline.com/index.php/jhsr Journal of Health Science Research
25
3. Discussion
Periorbital dermoid cysts are congenital and belong to a
subset of benign heterotopic neoplastic lesions termed
as choristomas1. ey are common in the pediatric
age-group and develop adjacent to the suture lines and
progressively enlarge as the child matures.
ese lesions are believed to evolve from the dermal
and the epidermal rest cells trapped during embryogenesis
in the cranial fusion lines as the closure of the neural tube
takes place2. Histologically, they have a lining of stratied
squamous epithelium with dermal adnexa such as hair
follicles, sebaceous, and sweat glands. e cyst contents
include keratin, hair, smooth muscle, and lipid debris3.
Dermoid cysts can be classied into (a) supercial or
anterior, and (b) deep varieties4.
Supercial dermoids, like the case presented in this
report, classically present as painless, rm, somewhat
mobile subcutaneous lumps. e lesions are usually
discovered by the parents/guardians in the 1st year
of their child’s life. With the growth of the child, the
periorbital facial fat normally decreases and this factor
results in making the cysts more prominent. Rarely the
supercial dermoid may rupture due to direct trauma,
extruding keratin and thence presenting with acute
inammatory features such as periocular erythema,
tenderness, and edema. Deeper orbital dermoids are
rare and grow indolently, presenting in the teenage or
even late adulthood with the gradual onset of globe
dystopia or proptosis and adjacent bony changes or
erosion5.
Anterior dermoid cysts most commonly occur at the
superolateral aspect of the orbit near the frontozygomatic
suture and less frequently are encountered as medial
lesions at the frontonasal suture as in case presented in
this report. Due to the anterior location, these lesions
usually do not result in globe displacement, but if proper
surgical attention is not sought and the lesion allowed
Figure 1. (a) External photograph (lateral view) demonstrates a mass on the right side of root of the nose, under the head of
the brow. (b) External photograph (anterior view) demonstrates a mass on right side of root of the nose, under the head of the
brow. (c) Immediate post-excision image with a sutured transverse incision. (d) Well-dened smooth margin low attenuating,
fat-density extraconal mass located on right side of root of the nose. (e) CT scan (bone window) showing clear indentation of
right nasal bone without any erosion.
d
c
b
a
e
Sajad Ahmad Salati
Vol 6 (1) | 2021 | https://jhsronline.com/index.php/jhsr Journal of Health Science Research 26
to grow to a large enough size, they have thesignicant
potential to cause visually signicant ptosis.
Imaging studies such as CT or magnetic resonance
imaging play an important role in determining the true
extent of the facial dermoid cysts and hence in planning
their appropriate management. Images should be obtained
for all the lesions not located in the superolateral quadrant
of the orbit and clinically suspected of being dermoid,
due to their tendency to grow stealthily deep into the
adjacent structures, creating a dumbbell shape. Imaging
is also indicated if the dermoid is nonmobile or presents
with features of inammation or stulization, and in the
presence of proptosis, globe dystopia, temporalis fossa
swelling, or optic neuropathy6.
e standard of care is complete surgical excision
without rupture of the cyst wall. e procedure is usually
straightforward for anterior cysts but deep orbital cysts may
present a surgical challenge requiring a dicult approach.
4. Conclusion
Periorbital dermoid cysts are congenital choristomas
that develop adjacent to the suture lines . Management
comprises of imaging studies to determine their extent
followed by complete surgical excision .
5. Acknowledgments
e author thanks the parents of the patient for sharing the
images and allowing their usage for academic purposes.
6. Authors’ Contributions
All the article has been draed by the author.
7. Financial Support and
Sponsorship
None.
8. Conicts of Interest
None.
9. Ethics Approval and Consent
to Participate
Not applicable.
10. Consent for Publication
Yes.
11. References
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Paliwal A. Orbital oor dermoid: An unusual presentation.
Indian J Ophthalmol 2009;57(1):51-2. https://doi.
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PMC2661519.
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comparison. Yale J Biol Med 2014;87(3):349-57. PMid:
25191150; PMCid: PMC4144289.
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