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

Background: Orbital teratoma is a relatively rare disease, often present at birth or detected within six months of life. As children are in the growth and development stage, giant orbital masses can affect orbital volumes, and conventional treatment may not be as effective as expected, with relatively many complications. Case presentation: A 2-year-old female child with proptosis, inwards, and upward eyeball displacement. Enhancing magnetic resonance imaging (MRI) revealed a well-circumscribed mass without significant improvement, which was hypointense signals on T1 weighted images(T1WI) and hyperintense signals on T2 weighted images(T2WI). A transconjunctival approach via the inferior fornix with canthotomy and cantholysis was performed. One month after surgery, the patient had enophthalmos, conjunctival hyperemia, and keratitis on ocular examination. A second operation was performed, with the implantation of an allogeneic sclera into the orbit to increase the orbital volume, improve the pitting of the fossa, and restore keratitis to normal. Histopathological examination showed that the fibrous capsule wall was covered with squamous and glandular epithelium, with visible brain tissue and cartilage-like matrix consistent with orbital teratoma. Conclusions Giant orbital teratomas in children are less common. This clinical case suggests that larger orbital masses occurring in childhood may result in markedly increased orbital volume and the possibility of postoperative enophthalmos and keratitis and that we need to increase the orbital volume and reduce the incidence of complications by timely implantation in orbit after excising the mass and defining its nature.