Experience in the treatment of giant orbital intraconal teratoma: A case report

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Rationale: Orbital teratoma is a relatively rare disease in infancy. In the pediatric population undergoing significant growth and development, the presence of giant orbital masses can significantly affect orbital volumes and impair the visual function. Traditional treatments may not yield anticipated effectiveness, often leading to numerous complications. This report aims to present a rare case involving a giant orbital intraconal teratoma. The objective is to analyze the treatment course comprehensively, distill valuable experiences and lessons learned, enhance treatment strategies, and ultimately reduce the incidence of complications associated with these formidable pediatric tumors. Patient concerns: A 2-year-old female child was presented exhibiting proptosis and inward and upward eyeball displacement. Enhanced magnetic resonance imaging revealed a well-circumscribed mass, persisting with hypointense signals on T1-weighted images (T1WI) and hyperintense signals on T2-weighted images (T2WI). Diagnoses: The diagnosis of teratoma was confirmed finally through histological and immunohistochemical exams. Interventions: A transconjunctival approach via the inferior fornix, coupled with canthotomy and cantholysis, was performed. However, a month postsurgery, the patient developed enophthalmos, conjunctival hyperemia, and keratitis upon ocular examination. A second operation involved the implantation of allogeneic sclera into the orbit to increase orbital volume, improve the pitting of the fossa, and restore keratitis to normal. Outcomes: No recurrence and other complications were noted during the 1-year follow-up. Lessons: Giant orbital teratomas in children are infrequent and pose significant challenges in the field of therapy. The potential consequences of larger orbital masses in childhood, including increased orbital volume and the risk of postoperative enophthalmos and keratitis. The findings emphasize the importance of timely implantation into the orbital after mass excision to enhance orbital volume and reduce the incidence of complications.