Nasal dermoid cysts with intracranial extension: avoiding coronal incision through midline exposure and nasal bone osteotomy

OBJECTIVEUp to 10% of midline nasal dermoid cysts have intracranial extension. Previous techniques of excision include frontal and frontonasal craniotomies via a coronal approach, combined with a direct cutaneous excision of the dermoid cyst. While the coronal incision allows for wide visualization, it carries significant risks of transfusion, blood loss, and scarring. The authors present an alternative technique in which access is gained through a midline extension of the dermoid cyst excision that provides direct access for a keyhole frontal craniotomy.METHODSThe authors utilize a nasal bone osteotomy, pericranial flap, and keyhole-type craniotomy performed through a nasal midline incision for the treatment of nasal dermoid cysts with intracranial extension. They performed a retrospective chart review of all patients with nasal dermoid cysts treated at the Ann & Robert H. Lurie Children’s Hospital of Chicago from 2009 to 2017. Patient demographic data, operative data, and in- and outpatient complication data were collected.RESULTSIn 10 patients with cyst extension near or into the intracranial cavity (7 with true intracranial extension), the nasal osteotomy technique was performed. The mean blood loss was 13 ml, with a 0% transfusion rate. The mean length of inpatient stay was 1 day. A durotomy was made and repaired as part of the dermoid cyst dissection in 3 patients. One patient underwent intraoperative placement of a lumbar drain. The mean operative time was 228 minutes. There were no intraoperative or postoperative complications, including the need for a reoperation. No patients had any long-term complications, and no patients have had dermoid cyst recurrence. The appearance of the scar was acceptable in all cases.CONCLUSIONSThe midline approach to nasal dermoid cysts with intracranial extension is safe and results in limited blood loss, short operative times, and short lengths of inpatient hospital stay. This is a viable technique for the treatment of this challenging pathology.

Direct Brow Lift - An Update of Current Literature

Eyebrow ptosis is the earliest manifestation of the aging forehead. Surgical procedures to lift the ptotic brow were first published in the early 1900s and since the introduction of the direct brow lift technique, there have been numerous minor refinements to this procedure, as well as some major developments in surgical techniques. It was modified to utilize a mid-forehead or a coronal incision, and then superseded by the endoscopic technique of brow lifting. Yet, with the armory of brow lifting techniques that currently exist, there still is a major role for the direct brow lift, herein described in detail.

Ultrasonographic study of subcutaneous penile granuloma secondary to silicone injection

Penile augmentation has been reported in the literature by injecting various materials. This study reports our experience in management of penile augmentation complications associated with selfpenile injection of silicone liquid. After a careful ultrasound study, the penile skin was excised through a circumferential sub-coronal incision and dissected with the silicon mass. Histology was well-compatible with silicone granulomas. The patient was discharged after 24 hours. Ultrasonography has permitted preoperatively to determine if the plane between the indurated inflammatory tissue and the Buck’s fascia was preserved for the complete surgical excision of affected tissue.

Small Supracilliary Incision for the Management of Fracture of Supraorbital Rim and Anterior Wall of Frontal Sinus

With the development of biomedical materials and new techniques in craniofacial sinus surgery, the management of frontal sinus fractures is advanced considerably. We discuss a case of fracture of anterior wall of frontal sinus that was also associated with fracture of the supra-orbital rim and describe supracilliary approach through a small incision (approximately 3 cm) used for the management in this case. With this approach we could successfully expose and reduce the fracture fragments without the need for coronal incision, endoscope or intra-operative imaging.

Aggressive Giant Cell Reparative Granuloma of the Nasal Cavity

Giant cell reparative granuloma (GCRG) is an uncommon and nonneoplastic reactive tumor that involves the maxilla and mandible in the region of the head and neck. It is rare in the nasal cavity, and it might be misdiagnosed. We reported a very aggressive GCRG with intracranial invasion, which was treated surgically via a combined approach of a lateral rhinotomy with a craniotomy by bilateral coronal incision. The pathology was consistent with GCRG. A short literature review about diagnosis, clinical behavior, and treatment of this tumor entity is given.