Excision of lateral dermoid cyst
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:50
This video demonstrates the excision of a lateral dermoid cyst. As noted in other videos, I believe that almost every periorbital dermoid cyst can be reached from an eyelid crease incision. The lid crease has been marked with a marking pen. A 15 blade is then used to make an incision through the skin and orbicularis muscle. Dissection is then carried out between the orbicularis muscle and orbital septum towards the superior lateral orbital rim. The dermoid cyst should be located in the septum/periosteum. Palpation of the area allows the dermoid cyst to be prolapsed forward. Westcott scissors are then used to dissect through the orbital septum to identify the surface of the dermoid cyst. Dissection is then carried out along the surface of the dermoid cyst with Westcott scissors. A cryoprobe is then used to fixate the cyst. This is very useful in fixation of the cyst without rupturing it. Westcott scissors are then used to proceed with dissection along the surface of the dermoid cyst. In general, dissection will proceed until it is difficult and then move to a different spot. Toothed forceps can be used to grasp the cyst if there is material left on the surface of the cyst without rupturing it. Again dissection is carried out around the cyst until difficult and then moved to a different portion of the cyst. Often there is an attachment of the cyst to the periosteum. There is a small rupture in the cyst wall likely secondary to an area that was grasped with the toothed forceps. The cyst is removed completely. The area is irrigated with saline. The lid crease incision can be closed with interrupted 5–0 fast absorbing sutures. I would not use permanent sutures in this patient due to the young age, which could make office removal of the sutures difficult.
