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An Endoscopic Approach

Matthew H. Steele, MD; Dana L. Suskind, MD; Michael Moses, MD; Evelyn Kluka, MD; Donald C. Liu, MD, PhD

Arch Otolaryngol Head Neck Surg. 2002;128:409-413.

Objective  To describe an endoscopic approach for pediatric orbitofacial masses.

Design  A retrospective medical chart review.

Setting  Tertiary-care children's hospital.

Participants  Patients (4 boys, 7 girls) ranged in age from 6 months to 11 years. All children underwent endoscopic excision of an orbitofacial mass.

Intervention  A single port approach was used in all but the initial case. The scalp incision was placed approximately 2.0 cm behind the frontal hairline. A subgaleal dissection was performed to minimize risk of nerve injury. Under endoscopic visualization, the mass was resected.

Main Outcome Measures  Ability to successfully excise the mass endoscopically, and the incidence of complication.

Results  All lesions were successfully resected endoscopically. The surgical time varied from 30 to 105 minutes (mean, 50.5 minutes). Pathologic examination revealed 10 dermoid cysts and 1 neurofibroma. Two children had transient frontalis branch palsies that resolved spontaneously. There was 1 unilateral frontal hypoesthesia in the patient with the neurofibroma (an expected result). There were no other complications.

Conclusions  An endoscopic approach to pediatric orbitofacial tumors is safe and effective. Although the risk of nerve injury may be higher, a thorough knowledge of frontotemporal anatomy and careful dissection will minimize this risk. The distinct advantage of an endoscopic approach is the absence of any facial scar in these young patients.

From the Departments of Otolaryngology (Drs Steele, Suskind, and Kluka) and Surgery (Dr Liu) and the Division of Plastic Surgery (Dr Moses), Louisiana State University Health Science Center, and The Children's Hospital of New Orleans (Drs Suskind, Moses, Kluka, and Liu), New Orleans. Dr Suskind is now with the Division of Otolaryngology, University of Chicago, Chicago, Ill.

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