Upper blepharoplasty approach to frontozygomatic dermoid cysts

Dermoid cysts are common periorbital lesions in children. Traditional surgical approaches have included incisions over the mass; above, below, or through the brow; and parallel to the superior orbital rim and the Lynch incision, as well as lateral canthotomy. We aimed to present experience of Alder Hey Children's Hospital on frontozygomatic dermoid removal through a blepharoplasty incision. In this article, we also aimed to review the current literature, describe the operative technique clearly, and offer reasonable explanations for the operative choices made based on our experience of the clinical anatomy and pathology.

Thirty-four children were operated on (19 girls and 15 boys), aged 1 to 11 years, between 2005 and 2008. The lesions were left sided in 14 patients and right sided in 20 patients. Preoperative computed tomographic/magnetic resonance imaging scan was generally not used, except in cases where the cyst was more than 1 cm away from the brow margin.

All cysts were completely excised. At surgery, all cysts were adherent to the periosteum, and 3 were subperiosteal. None extended through the bone into the orbit. The average operating time was 30 minutes. The average follow-up duration was 1 year. The only complications were early mechanical ptosis in 3 children, which completely resolved; the majority had an uneventful postoperative course. There were no recurrences, and in all patients, scar camouflage was described as excellent.

This interesting and extremely effective technique provides excellent scar camouflage with no lid or ocular dysfunction.