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Endoscopic-guided Excision of a Midline Forehead Dermoid
Chapter 1 of 5 · Case-Based Learning
Case presentation
Case presentation and imaging findings
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Due to the conspicuous location of the mass and the patient's dark complexion, endoscopic removal was considered appropriate.
Endoscopic excision of benign forehead masses in children aims to avoid conspicuous scarring and disfigurement.
The infant presented at 10 months of age with a firm non-mobile mass in the mid forehead.
The patient was entirely asymptomatic.
CT scan with bone windows showed a 1 centimeter mass located in an intraosseous pocket in the mid forehead.
The mass appeared to be encased by thick periosteum on CT imaging.
A pediatric general surgeon and a head and neck surgeon with extensive experience in facial plastics collaborated to perform the procedure.
The procedure was performed at 18 months of age.
A short vertical incision is made in the midline, approximately 2 centimeters above the hairline.
Cautery is used to deepen the incision through subcutaneous tissue, galea, and periosteum to the level of the bone.
A periosteal elevator is used to strip the periosteum off the bone, approximately 1 centimeter in all directions.
A curved elevator is used to create a subperiosteal tunnel in the midline starting at the incision and advancing towards the lesion.
The dermoid is hidden by a layer of severely adherent, thickened sclerotic periosteum.
Significant force is required to elevate the adherent calcified periosteum and expose the dermoid.
A sharp curved curette is used to initiate excision of the dermoid.
A blunt, right angled curette is used to reach deeper into the crater.
The wall of the dermoid is excised and removed using a 5 millimeter Maryland grasper.
The edges of the bone crater are rasped to obtain a smooth contour.
Bone wax is applied to the crater to aid hemostasis and fill the bony defect.
The deep tissues are not approximated.
The skin is closed with 3 interrupted sutures of 4-0 chromic.
The child's parents were highly satisfied with the result at 3 days postoperatively.