Subcutaneoscopic Excision of External Angular Dermoid Cyst in Children: Avoiding a Scar On the Face.

Julius Carillo, MD, Bethany Slater, MD, Ashwin Pimpalwar, MD. Division of Pediatric surgery, Michael E Debakey Department of surgery, Baylor college of medicine and Texas Children’s Hospital, Houston, Texas.


Background: External angular dermoid cysts/ epidermoid inclusion cysts are a common subcutaneous tumor of the face. For the majority of these lesions, excision is relatively simple and performed through an incision immediately overlying the mass. Facial lesions in pediatric patients present a unique challenge in that a direct approach carries the potential for visible scar formation. We describe a subcutaneoscopic videoscopic technique that provides excellent visualization and avoids scars on the face.

Objective: To describe a subcutaneoscopic technique for the removal of a epidermal inclusion cyst on the face.

Study Design: This is a technical report on a pediatric patient who underwent excision of an epidermal inclusion cyst using the subcutaneoscopic method.

Methods/Technique: A 2 year old child presented with a right sided external angular dermoid cyst (epidermoid inclusion cyst) of the face. The child was taken to the OR for subcutaneoscopic excision of this cyst. A 1.5cm incision was made on the scalp above the hairline. Space was then created subcutaneously using Kittner’s dissectors and Foley’s balloon catheter up to the cyst. After creating a tunneled working space underneath the skin, a 3mm telescope was inserted through the incision. The skin was retracted up with retractors and the dissection was completed with 3 mm laparoscopy instruments. The visualization provided was excellent and precise dissection was possible without much difficulty. The mass was sent to pathology and the wound was closed.

Results: The mass was successfully removed with no adverse complications.

Conclusion: The subcutaneoscopic technique has the advantage of improved visualization of the cyst, greater precision of dissection, and excellent cosmesis. One disadvantage is that this involves learning a new technique while the majority of surgeons are already comfortable with the open approach. However, it should be noted that basic laparoscopic skills translate well to this technique and competence can easily be achieved after only a few cases.

Session Number: Poster – Poster Presentations
Program Number: P549
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