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Orbitofacial masses in children: an endoscopic approach
Matthew H Steele1, Dana L Suskind, Michael Moses
1Division of Otolaryngology, University of Chicago, 5841 S Maryland Ave, MC1035, Chicago, IL 60637, USA.
Insights
Endoscopic surgery safely removes pediatric orbitofacial masses, offering excellent results with minimal scarring. While nerve injury risks exist, careful technique ensures a favorable outcome for children.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Ophthalmology
Background:
- Orbitofacial masses in children present unique surgical challenges.
- Minimally invasive techniques are increasingly preferred for pediatric surgical procedures.
- Traditional open approaches can lead to significant facial scarring.
Purpose of the Study:
- To evaluate the safety and efficacy of an endoscopic approach for pediatric orbitofacial mass excision.
- To describe the surgical technique and outcomes of endoscopic resection in children.
- To highlight the cosmetic benefits of endoscopic surgery in pediatric patients.
Main Methods:
- Retrospective chart review of pediatric patients undergoing endoscopic orbitofacial mass excision.
- Utilized a single-port endoscopic approach with subgaleal dissection.
- Assessed for successful mass resection and incidence of complications, including nerve injury.
Main Results:
- All pediatric orbitofacial masses were successfully resected endoscopically.
- The mean operative time was 50.5 minutes.
- Complications included transient nerve palsies and hypoesthesia, with no other adverse events reported.
Conclusions:
- Endoscopic excision of pediatric orbitofacial masses is a safe and effective surgical option.
- Careful anatomical knowledge and dissection are crucial to minimize nerve injury risks.
- The primary advantage is the avoidance of facial scarring in pediatric patients.
Objective:
To describe an endoscopic approach for pediatric orbitofacial masses.
Design:
A retrospective medical chart review.
Setting:
Tertiary-care children's hospital.
Participants:
Patients (4 boys, 7 girls) ranged in age from 6 months to 11 years. All children underwent endoscopic excision of an orbitofacial mass.
Intervention:
A single port approach was used in all but the initial case. The scalp incision was placed approximately 2.0 cm behind the frontal hairline. A subgaleal dissection was performed to minimize risk of nerve injury. Under endoscopic visualization, the mass was resected.
Main Outcome Measures:
Ability to successfully excise the mass endoscopically, and the incidence of complication.
Results:
All lesions were successfully resected endoscopically. The surgical time varied from 30 to 105 minutes (mean, 50.5 minutes). Pathologic examination revealed 10 dermoid cysts and 1 neurofibroma. Two children had transient frontalis branch palsies that resolved spontaneously. There was 1 unilateral frontal hypoesthesia in the patient with the neurofibroma (an expected result). There were no other complications.
Conclusions:
An endoscopic approach to pediatric orbitofacial tumors is safe and effective. Although the risk of nerve injury may be higher, a thorough knowledge of frontotemporal anatomy and careful dissection will minimize this risk. The distinct advantage of an endoscopic approach is the absence of any facial scar in these young patients.