Temporal dermoids: Three cases and a modified treatment algorithm

Congenital orbitofacial dermoids can be segregated into frontotemporal, orbital, and nasoglabellar regions. Although 10% to 45% of nasoglabellar dermoids present with sinus tracts and occasional intracranial extension, it is rare for frontotemporal dermoids to do so. Frontotemporal dermoids typically manifest as superficial, slow-growing masses that are treated by simple excision. In this retrospective review of 24 patients with congenital orbitofacial dermoids, the authors noted three cases of temporal dermoids with sinus tracts and bony involvement. All three patients were female, with an average presenting age of 4.2 years. Two lesions appeared on the left and one on the right. Each lesion involved the sphenotemporal suture, requiring debridement of the outer cranial table to prevent recurrence. In light of their experience, the authors offer an amendment to the current treatment algorithm for congenital orbitofacial dermoids. A congenital frontotemporal dermoid with a sinus tract should have preoperative radiological evaluation with computed tomography or magnetic resonance imaging to define the pathological anatomy. If bony invasion exists, aggressive exposure and resection of at least the outer cranial table is necessary to prevent recurrence. Temporal dermoids may represent a distinct entity that requires a separation classification from frontotemporal dermoids.