Excision of central dermoid cyst
Richard C. Allen, MD, PhD
Additional Notes: Length 02:27
Posted March 20, 2017
This is Richard Allen at the University of Iowa. This video demonstrates excision of a central dermoid cyst. This is a somewhat unusual location for a dermoid cyst. The lid crease has been marked and an incision is made with the 15 blade through the skin and underlying orbicularis muscle. Dissection is then carried out between the orbicularis muscle and the orbital septum superiorly. Palpation identifies the location of the cyst superiorly. Dissection is then carried out along the surface of the orbital septum towards the superior orbital rim. This dissection is careful so that the cyst is not ruptured. The cyst is identified and Westcott scissors are then used to dissect in the layer of the orbital septum. The cyst should lie in the orbital septum/periosteal attachments. Westcott scissors are then used to dissect along surface of the cyst. A cryoprobe is very useful to use for traction of the cyst. It provides gentle traction without rupture of the cyst. In excising dermoid cysts, it is useful to dissect along the surface of the cyst until the dissection gets difficult. Then it is useful to move to another spot. This is performed 360° around the cyst with Westcott scissors. Usually, a periosteal attachment is identified which is then transected with the Westcott scissors. The periosteal attachment is demonstrated, and the cyst is then excised. The lid crease is then closed with interrupted 5-0 fast absorbing sutures after assuring hemostasis. The patient will follow-up in approximately 1 week for reevaluation.
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