Excision of superior-temporal dermoid cyst
Richard C. Allen, MD, PhD
Additional Notes: Length 02:14
Posted March 20, 2017
This is Richard Allen at the University of Iowa. This video demonstrates excision of a superior temporal dermoid cyst. The dermoid is relatively high and is located superior to the brow. I believe that almost any periocular dermoid can be approached through an upper eyelid crease incision. A 15 blade is used to make an incision along the eyelid crease. The needle tip cautery is then used to dissect between the orbicularis muscle and the orbital septum towards the superior orbital rim. The dermoid is usually in the layer of the septum or periosteum. A 4-0 silk suture is placed through the upper lid at the level of the tarsus to provide traction during the case. Dissection is then carried out superiorly in the area of the dermoid. Usually it is easy to palpate the dermoid with your finger. Westcott scissors are used to dissect in the area where the septum attaches to the periosteum near the frontozygomatic suture. The cyst is then identified. A Desmarres retractor is used to help in exposure. Westcott scissors are used to dissect along the surface of the dermoid cyst. The dermoid can be pushed forward with your finger. Some tissue on the surface of the dermoid has been left so that one can fixate it with forceps. The dermoid can then be detached from the periosteum. The upper eyelid crease incision can then be closed with interrupted 5-0 fast-absorbing sutures. At the conclusion of the case, erythromycin ophthalmic ointment will be placed over the incision. The patient will return in approximately one week for reevaluation.
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