Monday, April 9, 2012

Doc, My Child has this Swelling Since Birth !

In the previous blog, the patient presented with an inflammed orbital cyst in adulthood. However, most cases are brought to the attention of ophthalmologists because of parental concern.
Below was a typical case in a 3 year-old boy. The cyst presented as a slow-growing, painless, subcutaneous mass. Intense inflammation may occur if the cyst ruptures spontaneously or because of trauma. Excision resulted in complete resolution.

Swellling of the left upper eyelid below the eyebrow.
Feature typical of an orbital dermoid.

Marking was done below the eyebrow to hide
the scar.

Incision was made below the eyebrow.

The dermoid was exposed via blunt dissection.

The cyst was removed intact to avoid leaving behind
any remnants which may cause inflammation.

The cyst measured 1.5cm in diameter.

Cheesy content inside the cyst.

The wound was closed with 6/0 vicryl.

Appearance at 6 days post-operative, the scar will fade
with time and become inconspicuous as it is hidden
by the eyebrow.

Monday, April 2, 2012

Doc, I Got a Big Lump in My Upper Lid !

This young man who had had a small lump in the right upper eyelid since young. Recently, the lump suddenly ballooned with pain. The location of the lump was classical for dermoid cyst and the sudden increase in size meant the cyst has become inflammed possibly due to trauma or spontaneous ruptured of the cyst.

Dermoid cyst is a developmental abnormality in which a bit of skin has been pinched off from the surface and comes to lie in areas where they are not usually found. The most common site for dermoid cyst on the face is below the lateral side of the eyebrow. This cyst can continue to grow because of secretion from the component. It is advisable to remove the dermoid cyst when the patient is young to prevent its continous growth or inflammation as a result of trauma.
The cyst in this patient showed transillumination indicating the cyst is filled with fluid.

About 4 ml of yellowish-green fluid was aspirated from the cyst. The aspiration was done to reduce the pain from distension and also help with surgery so that the wound created does not have to be too big.

To make the scar less conspicuous, the incision was made below the eyebrow.

The whole lump was removed completely so that there is no remnant to cause future inflammation or reaccumulation of the fluid.

The flaccid cyst measured 1.5cm across.

The cyst has thickened wall and contained some cheesy materials secreted by the inner surface of the cyst.

The wound was closed with 6/0 nylon suture and he had no recurrence at 6 months follow-up.