Endoscopic excision of a forehead mass

Endoscopic Excision of Forehead and Eyebrow Benign Tumors in Children

OBJECTIVE

Direct excision of dermoid cysts of the eyebrow and forehead may lead to a prominent facial scar. Endoscopic techniques have greatly reduced the morbidity of excising benign orbitofacial masses. Access, visualization, and dissection of these masses are comparable to open approaches without the use of large or conspicuous incisions. This study evaluates the efficacy of the endoscopic approach in the treatment of dermoid cysts of the eyebrow and defines the place of this approach as an alternative to open surgery.

MATERIALS AND METHODS

Between July 2008 and April 2015, a total of 23 pediatric patients (13 females and 10 males) with dermoid cysts of the brow underwent excision by endoscopy. The mean age was 11.9 months (2-32 months). The lesion was located on the lateral brow in 17 cases and on the hairless forehead in 6 cases. To assess osseous involvement, sonography and magnetic resonance imaging study were performed in 22 and 1 case, respectively. Medical photos documentation was done systematically. For those children having an excision of cyst by endoscopy, the operative time, hystopathological examination, specimen size, and hospital stay were evaluated. In addition, parents of these patients were contacted to determine satisfaction with the procedure.

RESULTS

All procedures were successfully performed endoscopically. The mean operative time was 41 minutes (range 17-120 minutes). There was no intraoperative complication. The mean specimen size was 12 mm. In postoperative period, 1 patient presented edema on the forehead with uneventful course. All procedures were performed on the day-surgery. The hystopathological examinations were dermoid cysts in 21 cases, hemangioma in 1 case, and dermatofibroma in 1 case. The mean follow-up was 45.5 months (4-84 months). There was no residual mass or recurrence after long follow-up. Cosmetic results were excellent and all families were pleased with the outcome.

CONCLUSIONS

Endoscopic excision of forehead masses and dermoid cysts of the eyebrow is safe and it has proven to be an effective and minimally invasive alternative to the conventional approach. The main advantage of this procedure is the minimization of scar visibility compared with open surgery.

Endoscopic forehead approach for minimally invasive benign tumor excisions

IMPORTANCE

Direct transcutaneous resection has been a widely accepted standard for the removal of benign forehead lesions. In recent years, the endoscopic approach has become more prevalent because of its noninvasiveness. To date, only a few studies with limited case numbers have reported on this technique. We report our findings from one of the largest cohorts of patients undergoing tumor resection of the forehead via the endoscopic approach.

OBJECTIVES

To evaluate results of the endoscopic forehead approach for benign tumor excisions, to give a more nuanced insight into this procedure, and to discuss technical pearls and potential pitfalls from our experience.

DESIGN, SETTING, AND PARTICIPANTS

Multicenter, retrospective case study at 2 university centers and 1 private practice among 36 patients aged 18 to 72 years (mean age, 44 years) who underwent the endoscopic forehead approach for benign tumor resections.

MAIN OUTCOMES AND MEASURES

Symptoms at presentation, surgical procedure and duration, type of lesions, intraoperative and postoperative complications, recurrences, and patient satisfaction.

RESULTS

In total, 34 patients had an asymptomatic forehead mass, while 2 patients reported discomfort and headache. Among all patients, complete tumor excision was achieved endoscopically. The mean operative time was 36 minutes. Histopathological examination revealed 18 lipomas, 13 osteomas, 2 dermoid cysts, and 1 bone fragment after previous rhinoplasty. In 2 patients, no specimen was submitted. No hematomas, infections, scalp numbness, contour irregularities, temporal branch paralysis, or tumor recurrences occurred. One patient had a prolonged area of alopecia, which resolved on its own. All patients attested to a high satisfaction rate.

CONCLUSIONS AND RELEVANCE

The endoscopic approach offers excellent aesthetic results and allows for safe tumor removal. It has proven to be an effective and minimally invasive alternative to the conventional open approach.

LEVEL OF EVIDENCE

4.

Case report: endoscopic excision of a nasoglabellar dermoid

Endoscopic techniques have greatly reduced the morbidity of excising benign orbitofacial masses. Access, visualization, and dissection of these masses are comparable to open approaches without the use of large or conspicuous incisions. Existing reports focus on treatment of dermoids and other benign masses in the forehead, brow, and temple. We describe the successful endoscopic excision of a nasoglabellar dermoid, which is much less common.

Endoscopic approach for the resection of forehead masses

Over the past several years, surgery aided by the endoscope has come into favor for a number of reasons. Because it is minimally invasive surgery, it has less morbidity, thus, reduced postoperative pain and complications. It results in earlier mobilization and shorter hospitalization, and most importantly, it contributes to an improved cosmetic appearance as a result of a shortened incision line concealed within the hairline in most cases. We have proposed an alternative approach to the surgical resection of forehead masses by means of the endoscope, which has proven to be useful not only for diagnosis but also as a therapeutic tool for the removal of forehead lesions. This report described the clinical experience with the removal of forehead masses in four patients. The cases illustrated the feasibility and ease of resecting a variety of forehead masses with excellent cosmetic results. We hope that more plastic surgeons will use the proposed technique and will continue to explore the safe limits of endoscopic plastic surgery.

Extended applications for endoscopic forehead surgery

Endoscopic equipment and specially designed elevators and dissecting instruments provide access to the forehead and scalp region through minimal incisions. This technique is now widely accepted for aesthetic forehead and browlifts. To our knowledge, however, it has not previously been used in reconstructive forehead and scalp surgery. We carried out a retrospective review of 5 cases involving patients who underwent reconstructive scalp and frontal bone defect surgery: 2 patients had frontal defects that were contoured with expanded polytetrafluoroethylene (Gore-Tex; WL Gore & Assoc, Phoenix, Ariz) inserted endoscopically; 2 patients had scalp soft tissue defects that were treated with wide subgaleal undermining and endoscopically guided galeotomies that resulted in primary closure; and 1 patient was treated for facial paralysis to improve the aesthetic result. We conclude that aesthetic endoscopic surgical techniques and equipment can be used in reconstructive therapy for patients with bony and soft tissue defects of the scalp and forehead.