A 6-year-old boy presents with a painless, slowly enlarging superonasal orbital mass since infancy. CT shows a well-circumscribed mass abutting the orbital rim with fat density and a focal calcified focus within it. The MOST appropriate management is:

• A External beam radiotherapy
• B Systemic corticosteroids followed by observation
• C Incisional biopsy to confirm histology before any excision
• D Complete surgical excision via an orbitotomy ✓

Explanation

The fat density mass with a calcified focus at the superonasal orbit is a dermoid cyst; the calcification represents residual adnexal tissue such as tooth or bone. Complete excision without rupture is curative, because spillage of keratin contents causes intense granulomatous inflammation. Steroids and radiotherapy play no role, and incisional biopsy risks rupture and seeding of the cyst contents.

Reference: Parsons' Diseases of the Eye, 22nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.