A Novel Lid Crease Approach to Supraorbital Mucoceles

Abstract

Objective: 1) Review various approaches to lateral frontal supraorbital mucoceles (endoscopic, open: bicoronal, hemicoronal with osteoplastic flap, subfrontal, and supraciliary approach). 2) Describe a hybrid lid crease approach that allows the direct excision of the mucocele lining and harvest of a pericranial flap through a minimally invasive well-hidden blepharoplasty incision. Method: 1) Literature review of current endoscopic and open approaches for the removal of frontal/supraorbital mucoceles. 2) Description of surgical technique of the lid crease approach, harvest of pericranial flap, and a representative case with radiology, pathology, preoperative photos, intraoperative photos, postoperative photos, and follow-up. Results: Open approaches to the frontal sinus are successful in the removal of lateral frontal/supraorbital mucoceles. However, disadvantages include large scars and increased operative and recovery time. Endoscopic approaches are also successful but can be limited in lateral frontal lesions. We describe a novel approach via a lid crease incision. This approach provides direct access to the frontal sinus with complete removal of the mucocele lining. In addition, a pericranial flap can be harvested to obliterate the frontal sinus. In our case, one month postoperative photos show a well-hidden scar and 9-month follow-up does not show recurrence of disease. Conclusion: The hybrid lid crease approach combines the advantages of direct removal of the mucocele lining in a well-hidden blepharoplasty incision. Although long-term follow-up is required to validate this technique, our preliminary data suggests this technique combines the advantages of both open and endoscopic approaches.