|Year : 1978 | Volume
| Issue : 1 | Page : 27-28
Nasal orbital dermoid
Shashi Kapoor, GC Sood, Manorma S Kapoor
Department of Ophthalmology, J.I.P.M.E.R., Pondicherry-6, India
Department of Ophthalmology, J.I.P.M.E.R., Pondicherry-6
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kapoor S, Sood G C, Kapoor MS. Nasal orbital dermoid. Indian J Ophthalmol 1978;26:27-8
Dermoids are the congenital lesions originating from the nests of primitive ectoderm at closure sites of foetal clefts. These can be seen at the limbus, or as swellings under the lid at the upper and outer angle. They contain oily material derived from the sebaceous glands in their walls and sometimes have teeth, hair and other dermal appendages as their components.
Dermoids are usually well circumscribed swellings but on occasions they have extensions in the form of diverticulae or fistulous openings around the orbit which act as a source of recurrence if not removed completely,,.
We describe a case of a dermoid located in the nasal part of the orbit, where its extensions were traced by injecting a radiopaque dye into the lumen of the cyst.
| Case Report|| |
A 40-year-old man presented with forward protrusion and lateral deviation of the left eye ball. A noniransilluminant cystic mass was palpable in the medial part of the left orbit; the posterior part of the mass was not felt [Figure - 1]. There was slight depigmentation of the overlying skin. The signs of active or healed inflammation were absent. The adduction movement of the left eye ball was restricted. The fundus examination was not possible because of the exposure keratitis.
The systemic examination was of no significance. Radiological examination of the orbit showed thickening of the upper and nasal wall of the orbit. The contents of the cyst were aspirated and Dianosil, a radiopaque dye was injected into its lumen. The dye outlined a cystic mass, 4 cm. in diameter, with a diverticulum in its upper nasal part [Figure - 2]. Another tract was originating from the lower temporal aspect of the cyst and was passing backward, downward and medially along the floor of the orbit [Figure - 3]. The examination of the aspirated fluid had cholesterol crystals in it.
| Discussion|| |
The commonest site for the occurrence of dermoids in body is the genital and sacral area; about 7% of all dermoids are seen in the head and neck region. A dermoid in the medial part of the orbit has been reported only once. The dermoids are known to have diverticulae and sinuses which are responsible for the failure of surgery. Szaley and Bledose reported a fistula of the nose. Dayal and Hameed recorded a case with fistula on the tip of the nose. Barley reported a fistula in the lower conjunctival sac.
Its extensions or communications to the cranial cavity and lateral orbital wall have been recorded by Mortada, Mehra and Samuel,,,. The exact localization of these pouches can be helped by injecting radiopaque dyes into the lumen of the cyst. The origin of the cyst or its extensions into the cranial cavity, paranasal sinuses, orbital walls or other sites can thus be easily established.
| Summary|| |
An unusual case of nasal orbital dermoid is reported where the diverticulae were traced by injection of Dianosil into the cyst. It is recommended that an injection of a radiopaque dye should always be made into the cyst to trace abnormal pouches which if left can be responsible for the recurrences after excision of the cyst.
| References|| |
Barley, W.E., 1939, Amer. J. Ophthal. 22,
Daval, Y. and Hameed, S., 1962, Amer. J. Ophthal., 53,
Gifford, H., 1929, Arch. Ophthal., 2,
Mehra, N.S. and Bannerji, C., 1965, Amer. J. Ophthal., 60,
Mortada, A., 1970, Brit. J. Ophthal., 54,
New, G.B. and Erich, J.B., 1937, J. Surg. Obst. Gynecol., 65,
Samuels, B., 1936 Amer. J. Ophthal., Soc.
Szaley, G. and Bledose, R., 1972, Amer. J. Dis. Child. 3,
[Figure - 1], [Figure - 2], [Figure - 3]