The Great Orbital Mimic: Navigating Surgical Intervention for Infant Teratoma Through Case-Based Insights and Literature Review

Introduction: Craniofacial teratoma is a rare congenital tumor in an infant. The diagnositic challeges no. This case underscores the challenges in managing facial teratomas due to their anatomical complexity and potential for recurrence or residual deformity. Methods: A rare case of a mature teratoma involving the left temporal region, mid-cheek, lateral canthus, and upper eyelid is presented. The lesion exhibited components such as venous malformations, calcifications, and overgrowth of bone, muscle, and fat, consistent with PIK3CA-related overgrowth syndrome (PROS). Initial management with oral propranolol and sirolimus therapy failed to reduce lesion size. Surgical debulking was performed for diagnostic confirmation and therapeutic purposes. Results: Postoperative outcomes showed well-healed scars without ectropion; however, bony erosion necessitated reconstruction. Histopathology confirmed complete excision of the mature teratoma. This case highlights the importance of a multidisciplinary approach in managing complex facial lesions. While initial medical therapy failed, surgical intervention provided both diagnostic clarity and therapeutic resolution. The absence of ectropion postoperatively highlights the importance of meticulous surgical planning. Future management will involve reconstructive efforts to address bony defects caused by mass effect. Conclusions: A multidisciplinary approach is critical in managing complex facial lesions such as mature teratomas. Surgical intervention remains pivotal when medical therapies fail. Long-term follow-up is essential to monitor for recurrence and address residual deformities.