Dermoid Excision Research Articles

Corneal Fine Needle Diathermy With Adjuvant Bevacizumab to Treat Corneal Neovascularization in Children.

To report the outcomes of corneal fine needle diathermy (FND) with adjuvant intrastromal and subconjunctival bevacizumab injection for corneal neovascularization (CN) in children. Medical records of all children who had undergone FND with adjuvant bevacizumab injection were reviewed retrospectively. Treatment efficacy was evaluated by changes in visual acuity, regression of CN, and clearing of lipid deposits with the aid of slit-lamp color images that were taken before surgical intervention and at last follow-up visit. Postoperative complications were recorded and served to assess the safety of the procedure. Nine eyes of 9 patients were included in the study. The mean age of the patients was 8.4 ± 4.2 years (4-15 years) and the mean follow-up time was 18.7 ± 12.2 months (5-35 months). Three eyes had a history of herpes simplex keratitis (HSK), 3 eyes had complete corneal anesthesia, 2 eyes had CN following suture tract infection after corneal transplant for HSK scar and limbal dermoid excision, and 1 eye had blepharokeratoconjunctivitis. After treatment, 8 eyes had complete CN resolution, and 1 eye with corneal anesthesia following brain tumor resection had partial regression in vessel distribution and size. Lipid deposition clearance lagged behind CN resolution. Mean duration of CN before treatment was 15.3 ± 14.0 months (1-37 months). Mean corrected distance visual acuity before and after surgery was 0.66 ± 0.31 and 0.50 ± 0.37 logMAR, respectively (P = 0.02). Corneal FND with adjuvant bevacizumab injection is effective at treating sectorial corneal vessels in children.

Surgeon point-of-view recording: Using a high-definition head-mounted video camera in the operating room.

Objective:To study the utility of a commercially available small, portable ultra-high definition (HD) camera (GoPro Hero 4) for intraoperative recording.Methods:A head mount was used to fix the camera on the operating surgeon's head. Due care was taken to protect the patient's identity. The recorded video was subsequently edited and used as a teaching tool. This retrospective, noncomparative study was conducted at three tertiary eye care centers. The surgeries recorded were ptosis correction, ectropion correction, dacryocystorhinostomy, angular dermoid excision, enucleation, blepharoplasty and lid tear repair surgery (one each). The recorded videos were reviewed, edited, and checked for clarity, resolution, and reproducibility.Results:The recorded videos were found to be high quality, which allowed for zooming and visualization of the surgical anatomy clearly. Minimal distortion is a drawback that can be effectively addressed during postproduction. The camera, owing to its lightweight and small size, can be mounted on the surgeon's head, thus offering a unique surgeon point-of-view. In our experience, the results were of good quality and reproducible.Conclusions:A head-mounted ultra-HD video recording system is a cheap, high quality, and unobtrusive technique to record surgery and can be a useful teaching tool in external facial and ophthalmic plastic surgery.

Limbal Stem Cell Transplantation for Limbal Dermoid in a Case of Goldenhar Syndrome

Goldenhar Syndrome (known as Oculoauriculovertebral Syndrome (OAVS) or facioauriculovertebral dysplasia) is a rare congenital defect classically involving eye anomalies with or without anomalous development of the ear, nose, lips, soft palate, mandible and vertebra. It is a morphogenetic anomaly associated with the 1st and 2nd branchial arches. We report a case of 9 months old male child presented with ocular abnormalities. On evaluation, he had the classical signs of this syndrome like limbal dermoids, eyelid coloboma, preauricular skin tags and hemi facial microsomia. This patient was first seen in January 2010 and has been followed and treated for the same. The patient underwent a surgery for right eye limbal dermoid at the age of 4 years. The initial presentation with course of the disease and Post-Surgical outcome is described here. The Authors performed dermoid excision with autologous conjunctiva along with limbal stem cells transplantation and achieved a satisfactory surgical outcome.

Limbal Stem Cell Transplantation for Limbal Dermoid in a Case of Goldenhar Syndrome

Goldenhar Syndrome (known as Oculoauriculovertebral Syndrome (OAVS) or facioauriculovertebral dysplasia) is a rare congenital defect classically involving eye anomalies with or without anomalous development of the ear, nose, lips, soft palate, mandible and vertebra. It is a morphogenetic anomaly associated with the 1st and 2nd branchial arches. We report a case of 9 months old male child presented with ocular abnormalities. On evaluation, he had the classical signs of this syndrome like limbal dermoids, eyelid coloboma, preauricular skin tags and hemi facial microsomia. This patient was first seen in January 2010 and has been followed and treated for the same. The patient underwent a surgery for right eye limbal dermoid at the age of 4 years. The initial presentation with course of the disease and Post-Surgical outcome is described here. The Authors performed dermoid excision with autologous conjunctiva along with limbal stem cells transplantation and achieved a satisfactory surgical outcome.

The “Stepped Caudal Exposure” Technique for Excision of Nasal Dermoids With Intracranial Extension

Nasal dermoid sinus cysts (NDSCs) are rare congenital malformations derived from ectodermal and mesodermal tissues. There are numerous reports on surgical approaches for extirpation of NDSCs with intracranial extension. Here we describe the "stepped caudal exposure" approach, a technique that minimizes the risk for bacterial infection of the central nervous system from the nasal space. This procedure involves a stepwise osteotomy of the frontal and nasal bones that permits sufficient exposure to allow complete extirpation of NDSCs; it was used successfully to treat a 20-month-old boy with NDSC extending into the intracranial space and an infectious abscess. After NDSC extirpation and debridement of the abscess, the anterior skull base was reconstructed with bone grafts placed on both the intracranial and intranasal sides of the widened foramen cecum. Thereafter, each graft was covered by frontal pericranial flaps for blood supply. These modified surgical techniques may enhance the safety of surgical removal of NDSC, particularly in cases accompanied by infectious lesions such as abscesses.

Anesthetic management of a child with Bardet-Biedl syndrome undergoing post-auricular dermoid excision

Anesthetic management of a child with Bardet-Biedl syndrome undergoing post-auricular dermoid excision

Oculoplastic surgery of interest to the pediatric ophthalmologist

Purpose/RelevanceManagement of oculoplastic disorders encountered in the pediatric population.Target AudienceFor the pediatric ophthalmologist.Current PracticeSurgical management of congenital ptosis, masses in the lid and brow, coloboma of the eyelids, epiblepharon, and blow-out fractures in children falls in the grey zone between the subspecialty training of pediatric ophthalmologists and the purview of oculoplastic surgeons. Many pediatric ophthalmologists do not feel equipped to manage these disorders following fellowship training. In some locations, oculoplastic surgeons are not readily available, or would prefer to defer to the pediatric subspecialist for care of infants and children.Best PracticePediatric ophthalmologists should have in depth knowledge of the surgical considerations and approach relevant to each condition, in order to manage or co-manage these conditions.Expected OutcomesThis workshop will provide attendees already performing these procedures with enhanced technical knowledge. Those not currently performing relevant procedures will have the opportunity to review anatomical considerations, surgical approaches and optimal care of each condition. Surgical procedures performed will be described in depth, fostering skill acquisition by all attendees.FormatDidactic lectures emphasizing case presentations.SummaryWorkshop will include surgical treatment of congenital ptosis, third nerve palsy, Horner’s syndrome or ptosis in association with craniosynostosis. Surgical management of eyelid coloboma, epiblepharon and blepharophimosis will be addressed. Excision of orbital dermoids or other masses through the natural lid crease will be demonstrated. Finally, surgical management of the child with orbital blow-out fracture will be included. Purpose/RelevanceManagement of oculoplastic disorders encountered in the pediatric population. Management of oculoplastic disorders encountered in the pediatric population. Target AudienceFor the pediatric ophthalmologist. For the pediatric ophthalmologist. Current PracticeSurgical management of congenital ptosis, masses in the lid and brow, coloboma of the eyelids, epiblepharon, and blow-out fractures in children falls in the grey zone between the subspecialty training of pediatric ophthalmologists and the purview of oculoplastic surgeons. Many pediatric ophthalmologists do not feel equipped to manage these disorders following fellowship training. In some locations, oculoplastic surgeons are not readily available, or would prefer to defer to the pediatric subspecialist for care of infants and children. Surgical management of congenital ptosis, masses in the lid and brow, coloboma of the eyelids, epiblepharon, and blow-out fractures in children falls in the grey zone between the subspecialty training of pediatric ophthalmologists and the purview of oculoplastic surgeons. Many pediatric ophthalmologists do not feel equipped to manage these disorders following fellowship training. In some locations, oculoplastic surgeons are not readily available, or would prefer to defer to the pediatric subspecialist for care of infants and children. Best PracticePediatric ophthalmologists should have in depth knowledge of the surgical considerations and approach relevant to each condition, in order to manage or co-manage these conditions. Pediatric ophthalmologists should have in depth knowledge of the surgical considerations and approach relevant to each condition, in order to manage or co-manage these conditions. Expected OutcomesThis workshop will provide attendees already performing these procedures with enhanced technical knowledge. Those not currently performing relevant procedures will have the opportunity to review anatomical considerations, surgical approaches and optimal care of each condition. Surgical procedures performed will be described in depth, fostering skill acquisition by all attendees. This workshop will provide attendees already performing these procedures with enhanced technical knowledge. Those not currently performing relevant procedures will have the opportunity to review anatomical considerations, surgical approaches and optimal care of each condition. Surgical procedures performed will be described in depth, fostering skill acquisition by all attendees. FormatDidactic lectures emphasizing case presentations. Didactic lectures emphasizing case presentations. SummaryWorkshop will include surgical treatment of congenital ptosis, third nerve palsy, Horner’s syndrome or ptosis in association with craniosynostosis. Surgical management of eyelid coloboma, epiblepharon and blepharophimosis will be addressed. Excision of orbital dermoids or other masses through the natural lid crease will be demonstrated. Finally, surgical management of the child with orbital blow-out fracture will be included. Workshop will include surgical treatment of congenital ptosis, third nerve palsy, Horner’s syndrome or ptosis in association with craniosynostosis. Surgical management of eyelid coloboma, epiblepharon and blepharophimosis will be addressed. Excision of orbital dermoids or other masses through the natural lid crease will be demonstrated. Finally, surgical management of the child with orbital blow-out fracture will be included.

Anaesthesia and airway management of occulo auricular vertebral dysplasia: A rare case report

A 12 year old girl child from the department of Ophthalmology posted for right eye limbal dermoid excision. Opthlamic examination and history revealed bilateral restricted eye movements, limbal dermoids, and decreased vision since birth. Fundus examination showed pathological myopia. There were multiple preauricular appendages in front of both ears. The lateral X-ray of cervical spine showed fused second and third cervical vertebra with loss of intervertebral disc space. Chest X-ray showed scoliosis of Cervico-Thorasic vertebra with convexity to right. Clinical examination of the airway revealed restricted head and neck movements with Mallampatti class II which indicates difficult intubation. The history, clinical examination and radiological findings confirmed her to be a case of Goldenhar syndrome. Difficult airway continues to be a major cause of anaesthesia related complications. Therefore fibre optic intubation under regional nerve block and sedation was planned for the surgery. Lack of associated cardiac and neurological anomalies encouraged us to present the advantage of fibre optic intubation. The larynx was adequately relaxed because of regional nerve block which helped us by decreasing the number of attempt of scopy and vocal cords injury. The intraoperative and postoperative period was uneventful.

A comparative study of two techniques for excision of midline nasal dermoids: how we do it

A comparative study of two techniques for excision of midline nasal dermoids: how we do it

A Novel Technique: Eccentric Lamellar Keratolimbal Allografting Using a Femtosecond Laser

To report on a patient who received an eccentrically designed lamellar keratolimbal allograft prepared using a femtosecond (FS) laser to preserve peripheral curvature. A 19-year-old woman, with a pseudopterygium on the left eye resulting from dermoid excision about 11 years earlier, received an eccentric lamellar keratolimbal allograft in a procedure involving FS laser use. Corneal flaps of depths 280 and 400 mum and diameters 6.5 and 6.6 mm were eccentrically created by FS laser treatment of the recipient and donor eyes, respectively, after removal of the pseudopterygium. After amniotic membrane transplantation, the eccentrically designed corneal flap was secured with 10-0 nylon sutures. Corneal flap creation was uneventful. Only minimal suturing was required for lamellar keratoplasty, and no complications occurred. Twelve months after surgery, a stable corneal surface was observed, with minimal scar formation at the graft margin and relatively good graft interface clarity. Eccentric lamellar keratolimbal allografting using an FS laser is an effective and time-saving surgical method to treat peripheral corneal abnormalities featuring corneal opacity.

Repair of Limbal Dermoid With Excision and Placement of a Circumlimbal Pericardial Graft

To report the treatment of a limbal dermoid tumor with excision of the lesion combined with the placement of a processed pericardial graft. A case report of a new approach to treat large limbal dermoids after excision of the lesion from the cornea and limbus. The surgical result was very reasonable from a cosmetic result, and the patient recovered quite well. The use of processed pericardium on the scleral side of the lesion has not been reported previously with limbal dermoid excision. Intraoperatively, the abnormal tissue blended with the sclera and excision of perilimbal tissue was necessary to obtain a clear margin. One might want to consider the method described here for the treatment of large limbal dermoid lesions when the pathology seems indistinct at the conjunctival-corneal border during surgery.

Closed rhinoplasty approach for excision of nasal dermoids

To assess the efficacy of excision of nasal dermoids through a closed rhinoplasty incision. This is the first description of the use of this approach for excision of superficial nasal dermoids. Three boys aged five, nine and 12 years presented with midline nasal dermoids with minimal cutaneous involvement. Magnetic resonance imaging demonstrated distinct, cystic, superficial nasal masses. The cysts were excised through a closed rhinoplasty approach. In each case, completeness of extirpation was judged by histopathological examination of the excised specimen. Aesthetic outcome was recorded photographically. All three patients' cysts were completely excised, with excellent cosmetic results. The closed rhinoplasty incision is another approach in the surgeon's armamentarium for excision of small, superficial nasal dermoid cysts. In well selected cases, this approach gives optimal cosmetic results, provides adequate exposure with minimal dissection, and allows total extirpation.

Canine amniotic membrane transplantation for corneal reconstruction after the excision of dermoids in dogs

Transplantation of canine amniotic membrane (AM) in conjunction with a third eyelid flap was performed after the removal of large dermoids by keratectomy and conjunctivectomy on 7 eyes of 7 dogs. Corneal epithelialization was completed within 2 weeks after the transplantation. Five eyes attained normal transparency of the cornea within 5 weeks. Slight pigmentation of the bulbar conjunctiva at the limbus was observed in 1 dog that had pre-existing pigmentary keratitis. Neovascularization and scarring of the cornea and impaired vision were not found in any dogs at 8 weeks after the transplantation. In conclusion, transplantation of canine AM can promote corneal healing after the excision of large dermoids in dogs.

Excision of nasal dermoids with intracranial extension—Anterior small window craniotomy approach

Dermoid cysts are the most common midline congenital nasal masses and may extend intracranially. They commonly become infected, may distort nasal growth, and are cosmetically unacceptable. The treatment of nasal dermoids is complete surgical excision. Removal of any intracranial extension traditionally required a bicoronal incision and frontal craniotomy, with significant associated morbidity. This retrospective study describes a new minimally invasive approach for excision of the intracranial component of the dermoid. We present three cases where a brow incision was used. The intracranial part was removed by cutting a small window in the frontal bone directly over the dermoid, minimizing complications of formal craniotomy. Good access allowing complete excision of the dermoid and very low morbidity was achieved in all patients. The dura was breached in one patient at operation but this was easily repaired with a periosteal patch. All patients recovered quickly and hospital stay was short. The resultant scar was cosmetically acceptable. The use of a brow incision and small window craniotomy is a successful low morbidity technique for excision of nasal dermoids with intracranial extension.

Two Cases of Cosmetic Treatment of Limbal Dermoid

Purpose: To report two cases of cosmetic treatment of limbal dermoid, which consist of local excision of the limbal dermoid, corneal tattooing, and amniotic membrane transplantation. Methods: Dermoid excision, corneal tattooing, and amniotic membrane transplantation were carried out in both a girl and a woman who each had a limbal dermoid in their left eyes. Postoperatively, they were followed up for more than six months. Results: No specific complications occurred. The patients were satisfied with the surgical results. After a few months the conjunctiva was found to grow into the tattooed cornea. Conclusions: In the treatment of limbal dermoid, local excision combined with corneal tattooing and amniotic membrane transplantation can be a cosmetically successful alternative choice.

Nasal dermoids

Midline congenital nasal lesions are rare, occurring in one out of every 20,000-40,000 births. Of these midline lesions, nasal dermoids are the most common. This review centers on diagnosis of nasal dermoids, the role of imaging in diagnosis and surgical planning and the various approaches to surgical management of these lesions. Multiplanar, high-resolution thin section magnetic resonance imaging allows for excellent soft tissue detail, particularly when intracranial extension is expected. Open rhinoplasty is favored by many authors for excision of dermoids. Transnasal endoscopic excision of nasal dermoids has been reported but is not recommended for dermoids extending into or beyond the falx cerebri. Imaging of the midface and brain is essential for accurate diagnosis, assessment for any intracranial extension and appropriate surgical planning. Any surgical approach for removal of nasal dermoid cysts should permit adequate access, allow repair of the skull base and cerebrospinal fluid leak, facilitate nasal reconstruction and result in acceptable cosmesis. The head and neck surgeon should be able to consider various surgical approaches to manage these lesions.

Corneal Keloid Mimicking a Recurrent Limbal Dermoid

We report a 12-year-old boy who presented with the clinical appearance of a limbal dermoid recurrence. Histologic study of the lesion revealed it to be a corneal keloid. In the event of a recurrent mass following dermoid excision, keloid should be considered in the differential diagnosis.

Imaging and surgical approach of nasal dermoids

Objective: Determine the most accurate and cost effective radiographic evaluation for nasal dermoids. Determine the best surgical approach for excision of nasal dermoids. Design: Retrospective chart review. Setting: Division of Pediatric Otolaryngology, Children's Hospital and Health Center, San Diego, California. Participants: All patients with nasal dermoids evaluated and treated from 1990 to 2000. Intervention: Preoperative radiographic evaluation and surgical excision. Outcome measures: Accuracy of CT and MRI correlated with surgical findings and results. Results: Ten patients were identified with the diagnosis of nasal dermoid. The age at diagnosis ranged from 0 to 24 months, with a mean of 3 months. Six children presented with masses located at the glabella, three patients presented with masses located at the nasal dorsum and one presented with a mass at the nasal tip. Six children underwent a computed tomogram with contrast of the head. Seven children underwent a MRI study of the head. Three children underwent an initial CT followed by MRI. Twenty percent of children were found to have intracranial extension. CT scan accurately diagnosed intracranial extension in one case, was indeterminate in a second case and falsely positive in a third case. MRI correctly diagnosed intracranial extension in two cases and had no false positive or false negative results. No children were found to have associated intracranial anomalies. In the early years of the review, a simple excision was made over the mass with blunt and sharp dissection for removal. (An external rhinoplasty incision is now used with better exposure and improved cosmetic results.) In cases with intracranial communication, a combined approach of external rhinoplasty and craniotomy was used. Conclusions: MRI alone is the most cost effective and accurate means of evaluating nasal dermoids and is essential for preoperative planning. The surgical approach of choice is external rhinoplasty for both cosmetic reasons and exposure of nasal dermoids with and without intracranial extension.

Endoscopic pediatric plastic surgery.

Although the advent of endoscopic technology is expanding the fields of reconstructive and aesthetic surgery in adults, there have been to date no reports of its use in the pediatric population. Because of its minimally invasive nature, yet wide range of exposure, endoscopic techniques have much appeal in this age group. Herein we present our initial experience with endoscopic pediatric plastic surgery. From February 1995 to December 1995, 41 patients were treated utilizing 5-mm and 10-mm endoscopes at Scottish Rite Children's Medical Center, Atlanta, GA. There were 19 males and 22 females. The mean age at surgery was 5.6 years (range, 7 months-15 years). The most common types of procedures performed were insertion of tissue expanders (N = 19), excision of facial dermoids (N = 7), torticollis release (N = 5), and excision of vascular lesions (N = 4). The remaining 6 patients underwent a variety of reconstructive procedures. The complication rate in the tissue expander group was 3 out of 39 expanders inserted (9.5%), and consisted of infection (N = 2) and rupture (N = 1). In the dermoid group, complications consisted of wound infection requiring reoperation (N = 1), and transient frontal paresis (N = 1). One patient in the hemangioma group had an incomplete resection necessitating open excision. The remaining patients all had satisfactory outcomes with no complications. The majority of the procedures were done on an outpatient basis. These results suggest that endoscopic techniques are eminently applicable in the pediatric population, providing the benefits of small and remote incisional wounds with complication rates that are comparable to those of conventional surgical treatment.

Excision of Limbal Dermoids

We reviewed the clinical files of 10 patients who had undergone excision of unilateral epibulbar limbal dermoids. Preoperatively, all of the affected eyes had worse visual acuity (P less than .02) and more astigmatism (P less than .01) than the contralateral eyes. Postoperatively, every patient was cosmetically improved. Of the eight patients for whom both preoperative and postoperative visual acuity measurements had been obtained, in six it had changed minimally (less than or equal to 1 line), and in two it had improved (less than or equal to 2 lines). Surgical complications included persistent epithelial defects (40%) and peripheral corneal vascularization and opacity (70%). These complications do not outweigh the cosmetic and visual benefits of dermoid excision in selected patients.