Sub-Brow Incision for Dermoid Cyst Excision

A sub-brow incision is uncommonly used by me for dermoid cyst excision.  However, in this case of an older patient, the dermoid cyst is quite large.  As in all dermoid cyst excisions, the goal is to remove the cyst without rupture.

This is Richard Allen at oculosurg.com.  This video demonstrates the use of a sub-brow incision to approach a dermoid cyst.  My preference is usually to employ a lid crease incision in excision of dermoid cysts.  However, in this case, the patient is older and the cyst is somewhat large, and I thought it would be challenging to approach this through a lid crease incision as it extended laterally.   A 15 blade is used to make an incision along the sub-brow marking.  Dissection is carried out through the orbicularis muscle to the underlying orbital septum.  Westcott scissors are then used to dissect through the orbital septum where the cyst is then encountered.  My goal in excising dermoid cysts is to remove the cyst intact.  Dissection is then carried out along the surface of the cyst.  This is performed until it is challenging, and then one should address a different area of the cyst.  By doing this, one can slowly dissect around the entire cyst, approaching it from different directions until it is difficult.   I usually leave a cuff of subcutaneous tissue attached to the cyst so that I can fixate the cyst at that point and not risk rupturing the cyst.  The cyst can then be prolapsed through the wound and excision can be completed.  This cyst measured approximately 3 cm in diameter.  Hemostasis is assured with cautery.  The incision is then closed with deep interrupted 5-0 Vicryl sutures placed in a buried fashion.  Superficial sutures are then placed with 5-0 fast absorbing sutures placed in an interrupted fashion.  Antibiotic ointment is placed over the incision and the patient will return for follow up in approximately one week.