Subcutaneoscopic Excision of External Angular Dermoid Cysts: Our Covert Scar Approach in 11 Cases

Abstract

Introduction External angular dermoid cysts, or epidermoid inclusion cysts, are a common subcutaneous tumor of the head and neck. For the majority of these lesions, excision is relatively simple and performed through an incision immediately overlying the mass. Facial lesions in pediatric patients present a unique challenge in that a direct approach carries the potential for visible scar formation.

Objective This article aims to detail our experience with subcutaneoscopic excision of external angular dermoid cysts in pediatric patients using endoscopic instrumentation.

Materials and Methods Retrospectively, we reviewed 11 cases, between the ages of 4 months and 3 years with external angular dermoid cysts. An incision is made on the scalp above the hairline, then a tunneled working space is created underneath the skin. 3 mm laparoscopy instruments were then used for providing excellent visualization and precise subcutaneoscopic dissection.

Results There were no complications apparent in any of the 11 cases (except cyst rupture in one case), with mean procedure duration at 61 minutes. Final results at follow-up revealed aesthetically pleasing and well-healed skin incisions, hidden from view behind the hairline.

Conclusion The subcutaneoscopic technique utilizing endoscopic instrumentation has the advantage of improved visualization of the cyst, greater precision of dissection, and excellent cosmesis. One disadvantage of this procedure is that this involves learning a new technique while the majority of surgeons are already comfortable with the open approach. Given the safety and efficacy observed for this subcutaneoscopic procedure, this technique can have tremendous possibilities.

Keywords

covert scar - laparoscopy - endoscopy - subcutaneoscopy - dermoid cyst

• References

• 1 Fisher O, Zamboni WA. Endoscopic brow-lift in the male patient. Arch Facial Plast Surg 2010; 12 (01) 56-59
• 2 Dutta S, Slater B, Butler M, Albanese CT. “Stealth surgery”: transaxillary subcutaneous endoscopic excision of benign neck lesions. J Pediatr Surg 2008; 43 (11) 2070-2074
• 3 Pimpalwar A, Johny C. Transaxillary subcutaneouscopic sternocleidomastoid tumor division for treatment of persistent torticollis in children: our technique. Pediatr Surg Int 2011; 27 (05) 541-543
• 4 Cozzi DA, Mele E, d'Ambrosio G, Totonelli G, Frediani S, Spagnol L. The eyelid crease approach to angular dermoid cysts in pediatric general surgery. J Pediatr Surg 2008; 43 (08) 1502-1506
• 5 Pryor SG, Lewis JE, Weaver AL, Orvidas LJ. Pediatric dermoid cysts of the head and neck. Otolaryngol Head Neck Surg 2005; 132 (06) 938-942
• 6 Steele MH, Suskind DL, Moses M, Kluka E, Liu DC. Orbitofacial masses in children: an endoscopic approach. Arch Otolaryngol Head Neck Surg 2002; 128 (04) 409-413
• 7 Huang MHS, Cohen SR, Burstein FD, Simms CA. Endoscopic pediatric plastic surgery. Ann Plast Surg 1997; 38 (01) 1-8
• 8 Gonzalez M, Pimpalwar A. Transaxillary subcutaneoscopic excision of fibroadenoma of the breast in children: the covert scar approach. J Laparoendosc Adv Surg Tech A 2016; 26 (02) 157-160
• 9 Agrawal V, Acharya H, Agarwal P, Sekhon V, Sharma D. Subcutaneoscopic excision of external angular dermoid cyst in children without conspicuous scarring. Asian J Endosc Surg 2013; 6 (03) 241-244