Excision of superior-lateral dermoid cyst

This is Richard Allen at the University of Iowa. This video demonstrates the use of an upper eyelid crease incision for removal of a superior lateral presumed dermoid cyst. A monopolar cautery is used to make an incision along the upper eyelid crease. Dissection is then performed through the orbicularis muscle to expose the orbital septum. Dissection is then carried out between the orbicularis muscle and the orbital septum superiorly toward the superior orbital rim. Dermoid cysts in this area usually are centered on the fronto-zygomatic suture. Additional dissection is performed within the orbital septum until the lesion is identified. Gentle dissection is then carried out along the surface of the cyst. This is performed inferiorly first. These lesions will usually have an attachment to the underlying periosteum. Dissection is then performed superiorly around the cyst. In general, my goal in approaching dermoid cysts is to dissect in an area until it is difficult, and then move to a different area and continue this until dissection is performed around the entire cyst. It is important to try not to rupture the cyst during the excision. Sometimes a cryo probe is useful in helping retract the cyst. Once the connection to the periosteum is identified, a freer periosteal elevator can be used to complete dissection from the periosteum or include some periosteum in the removal of the cyst, if necessary. As you can see here, this is a relatively large cyst in an older patient that was neglected. Completion of the excision is performed without rupture. Hemostatis is assured. The lid crease incision is then closed with interrupted 6-0 prolene sutures. The patient returns in approximately one week.