Post-traumatic and congenital respiratory epithelial cysts in the orbit are rare lesions with only five and nine published cases respectively. We describe fourteen new cases, ten occurring after trauma and four congenital cases.
We reviewed the clinical, imaging and pathological features of all cases of respiratory epithelial cysts diagnosed at our institution over the last 20 years. Patients with definite paranasal sinus mucocoeles were excluded.
Ten cases of post-traumatic respiratory epithelial cyst (7 males, age range 23 – 70 at presentation) presented an average of 18 years after their original trauma. 8 patients had sustained blow-out fractures of the orbital floor with repair, then later developed a cyst surrounding the implant. 3 presented with features of acute infection in a long established cyst.
Four congenital cases (3 females, age range 17 – 38 at presentation) had lesions in the anterior inferomedial orbit (3 cases) or superotemporal orbit (1 case).
All cases underwent surgical excision of the cyst and its lining, along with any surgical implant within the cyst. One patient developed a recurrent post-traumatic cyst 8 years after surgical removal of a floor implant and the cyst. One congenital case was recurrent after earlier incomplete excision elsewhere.
Respiratory epithelial orbital cysts may be post-traumatic or congenital. They are probably commoner than the paucity of published reports would suggest. Post-traumatic cysts often present many years after trauma, and may become secondarily infected. Complete surgical removal is required to prevent future recurrence.