Lesion location and surgical outcomes in pediatric frontonasal and orbital dermoid cysts: A systematic review.
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OBJECTIVE: This systematic review aimed to answer the clinically relevant question of whether lesion location (midline versus periorbital) is associated with differences in risk of intracranial extension, operative strategy, and recurrence in pediatric frontonasal and orbital dermoid cysts. DATA SOURCES: MEDLINE, Embase, Cochrane Library, and ScienceDirect were searched for studies published between 2000 and 2025. REVIEW METHODS: Eligible studies included pediatric patients with histopathologically confirmed dermoid cysts involving the frontonasal or periorbital regions. Data on demographics, lesion location, intracranial extension, surgical approach, and recurrence were extracted and synthesized. RESULTS: 39 studies encompassing 766 pediatric patients were included. Patients were divided into three groups: Type I (37.9%) - lateral dermoids (eyebrow/orbital); Type II (42%) - midline superficial dermoids without a sinus tract; and Type III (20.1%) - midline dermoids with a sinus tract, with or without intracranial extension. Intracranial extension was identified in 68 of 766 patients. Almost all cases occurred in children with midline lesions; only two patients with orbital dermoid cysts had intracranial extension. Recurrence occurred in 29 of 763 evaluable patients. CONCLUSIONS: This systematic review demonstrates that lesion location is the key determinant of clinical behavior in pediatric frontonasal and orbital dermoid cysts. Lateral periorbital lesions are typically superficial and associated with a low risk of complications, whereas midline lesions carry a significantly higher risk of sinus tract formation, intracranial extension, and postoperative recurrence. The choice of surgical approach should be individualized based on lesion location, depth, and extension, balancing adequate exposure with optimal cosmetic and functional outcomes.