Six surgical principles for safe excision of superotemporal dermolipoma

Abstract

Purpose The aim of this study was to describe six surgical principles that were applied for safe excision of superotemporal dermolipomas. Patients and methods This retrospective interventional clinical study included 32 dermolipomas (in 29 patients) that presented to the Orbit Clinic of Assiut University Hospital, Assiut, Egypt and were subjected to surgical excision. The six surgical principles applied for safe dermolipoma excision were: conjunctival incision at the junction between normal and abnormal conjunctiva sparing as much bulbar conjunctiva as possible, hooking the lateral rectus muscle and dissecting the lesion free from the muscle and the covering Tenon’s capsule, eversion of the upper lid using Descemar’s retractor, incision at the upper bulbar conjunctiva, and dissection of the superior surface of the lesion away from the levator muscle, dissection of the lateral surface of the lesion from its attachment to the lateral canthus sparing a stump of the conjunctiva, dissection of the deep part of the lesion from the underlying normal orbital tissue, and suturing the bulbar conjunctiva to the preserved conjunctival stump at the lateral canthus. The follow up ranged from 3 to 35 months (mean=21±3.2 months) during which the patients were assessed for improvement in the presenting manifestations as well as for the presence of complications such as ptosis, dry eye, strabismus, limitation of ocular motility, or symblepharon. Results The surgery was successful in all patients without permanent dry eye, blepharoptosis, or permanent strabismus. Temporary limitation of adduction was observed in two patients that resolved spontaneously within 1 month. Conclusion Adherence to the six surgical principles outlined in the study allowed the authors to safely excise the dermolipomas without damaging the lateral rectus, levator complex, and lacrimal gland ductules. Thus, postoperative squint, ptosis, and dry eye were avoided. In addition, preserving the forniceal conjunctiva and suturing the bulbar conjunctiva prevented symblepharon formation and restricted mobility.