Orbitofacial masses in children: an endoscopic approach.

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.