Excision of superior cystic lesion
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This is Richard Allen at the University of Iowa. This video demonstrates excision of a superior cystic lesion in an adult patient. A blepharoplasty marking is made and then incised with the needle tip cautery. A flap of skin and orbicularis muscle is then excised with the needle tip cautery. Dissection is then carried out superiorly between the orbicularis muscle and the orbital septum towards the lesion. Care is taken to follow the surface of the orbital septum. The lesion is then palpated and Westcott scissors are used to dissect along the anterior surface of the lesion. Superiorly, dissection is carried out along the superior surface of the mass. This is followed to the periosteum of the superior orbital rim. Laterally, the attachment of the lesion to the underlying bone is noted. A freer periosteal elevator is then used to incise the periosteum and elevate the periosteum from the underlying bone with the lesion. Further dissection is carried out inferiorly. The periosteal elevator is then used to further dissect the lesion from the underlying bone. Care is taken not to rupture the cyst. Wescott scissors are then used to complete the excision of the lesion. The lesion is sent to the pathologist for evaluation after its removal. Inspection of the lesion shows no evidence of rupture. The underlying bone is inspected and hemostasis is assured. The upper lid crease incision is then closed with interrupted 6–0 Prolene sutures.