Hydatid cyst of the mandibular condyle extending to the orbit–An unusual presentation

Abstract

Hydatidosis is one of the most well-known zoonotic infections affecting the liver or brain, prevalent worldwide. Dogs are the most well-known intermediate hosts that affect humans. Humans can also contract the disease and become accidental intermediate hosts. While it is rare in the head and neck region, hydatidosis can manifest as either multiloculated or uniloculated lesions. The management of these cases presents significant challenges in maxillofacial surgery. Understanding the diagnosis, treatment options, and prognosis of head and neck hydatidosis is crucial. Even with advancements in medical technology, diagnosis and treating these infections continues to be a complex as these conditions can arise unexpectedly during a clinicians practice. This case report highlights the significance of clinical presentation, thorough history taking, histopathologic examination, and management plans. We present a case of a 17-year-old male who presented to our clinic with orbital proptosis and vertical orbital dystopia and was diagnosed with a hydatid cyst with an aim to help practitioners better understand and diagnose head and neck zoonotic diseases while promoting careful management practices.

Highlights

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Hydatid cysts in the maxillofacial region are quite rare, and their presence can have significant implications. Whether these cysts appear as multilocular or unilocular, it’s important to maintain a suspicion for hydatid cysts in such cases.
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The diagnosis of head and neck hydatid cysts presents challenges and requires comprehensive history-taking, clinical evaluation, and histopathologic examination.
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The choice of treatment depends on various factors, including the size and location of the cyst, the patient’s overall health, and the potential for complications.
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A multidisciplinary approach is often beneficial in managing such cases effectively.

1 Introduction

Hydatid disease is a common echinococcus infection in the Middle East and Mediterranean regions. It most commonly affects the liver, with a prevalence of 65 %. The pathophysiology of this disease is complex. After the parasite eggs are ingested and hatch, the oncospheres penetrate the duodenal walls, where they enter the circulatory system. They subsequently migrate into the liver and become trapped in the sinusoids. The larvae develop into metacestodes and finally form unilocular cysts [ , ].

Hydatidosis can also affect other organ systems. It is considered a zoonotic disease caused by Echinococcus granulosis . Various animals can present as intermediate hosts, most commonly dogs. The infection is transmitted to humans through the consumption of contaminated food, unwashed hands after touching an infected intermediate host, or ingestion of contaminated water. Although rare, hematogenous spread of eggs can occur, reaching head and neck organs such as the parotid gland and orbits [ , ].

The primary diagnosis is made via computed tomography (CT) or magnetic resonance imaging (MRI). The treatment of choice is surgical excision followed by the administration of systemic albendazole [ ]. We report a new case of a condylar hydatid cyst that extended into the orbit of a 17-year-old male patient. The aims of this case report are to 1) increase practitioners’ awareness, 2) facilitate accurate diagnostics, and 3) ensure familiarity with head and neck zoonotic diseases, ultimately promoting careful management of such conditions.

2 Case presentation

A 17-year-old male patient who was not known to have any medical problems nor was on any chronic medications was referred from the ophthalmologic department to our facility for a biopsy of a right extraconal mass. Social history revealed that the patient was the son of a shepherd and was almost always in close contact with sheep and dogs.

The patient suffered from proptosis of the right eye, vertical dystopia, a dilated pupil on the right side, and decreased visual acuity [ Fig. 1 ]. The patient also suffered from horizontal ophthalmoplegia on an outward gaze. The relative afferent pupillary defect (RAPD) was positive in the right eye. Laboratory investigations revealed no abnormalities. The patient’s extraoral examination revealed no trismus or deviation of the mandible upon opening or closing. There was no tenderness over the lateral condylar region and no signs of clicks or crepitations. The overlying skin over the right temporomandibular joint was nonerythematous, and there were no signs of infection.

A computed tomographic (CT) scan was performed [ Fig. 2 ] and revealed a multilocular osteolytic mass of the right mandibular ramus and condyle that perforated the cortex and extended into the infratemporal space and cranial base and perforated the lateral orbital wall. Magnetic resonance imaging (MRI) was performed to rule out intracranial extension or perineural invasion [ Fig. 3 ]. The chest X-ray (CXR) was unremarkable. A Liver ultrasound (US) was performed, and the results did not reveal abnormalities or focal cystic lesions suggestive of hydatidosis.