Sunday, September 18, 2016

How to excise an epithelial inclusion cyst over cheek in a young modelling girl?

Epithelial Inclusion cyst of the cheek -two in number

Dr. Arjun Das

Make direct incision on the lesion skin deep. Remove the lesion in toto. Fine suturing. Facial nerve is deep.

Dr. Ajay Jain

Sir, thank you for answering.  she do modelling and do not want any scar on her face.   I was thinking of Bailey incision

Dr. Athira Ramakrishnan

I was having a parallel discussion with a plastic surgeon, small direct incision with immediate post op silastic sheet application was suggested

Dr. Ajay Jain

Hi how does silastic Sheet help here

Dr. Athira Ramakrishnan

It is supposed to hydrate the scar and reduces marks, apparently that is quite the thing to avoid scarring or keloid, it comes in trade name Lysil, think should consider it especially for patient of her profile. It should be applied after suture removal, everyday for a month or so.

Dr. Madhusudan G

*Vertical incision... Just over the lesions, just enough to remove..
*Please make sure you infiltrate xylo+ adr so that the field is bloodless... So that avoid cautery which might touch the skin edges
*Liberal undermining if you plan to excise an ellipse of skin to avoid tension along suture line
*closure- PDS/vicryl rapid/monofilament absorbable interrupted with knot inside followed by 8/0 ethylon for skin with half mattress closure
*scar support with STERISTRIPS for first 5-7 days till the wound heals
*suture removal in 3-4 days followed by continuation of STERISTRIPS.
*scar treatment from 2nd week either by silicone gel sheet/ chin strap at nights/ silicone creams whichever is suitable for the patient for long term usage for at least 3 months with sun exposure avoidance and sunscreens....
Each and every step is crucial for the best final scarring..
Though it looks very lengthy... It is the successful formula for best scar...
At last, the patient commitment for the scar treatment holds the key..
* for subcutaneous closure use PDS/ vicryl rapid 5/0 or less.
*Post op care - regular massage with scar repair creams available in the market- CONTRACTUBEX / HEXILAK / scar repairex anything is fine, but massaging with good pressure is must.

Dr. Satyawati Mohindra

Any body having experience ?Is there no way to go trans buccaly so that you do not touch the skin at all ?Very informative indeed. Thanks adhira and madhu.

Dr. Hitesh

Mam I removed lipoma transoral in same region. Incision on buccal mucosa and blunt dissection will protect facial nerve.

Dr. Ajay Jain

Lipoma is more deeper.  So may be suitable for intraoral approach.  Epithelial inclusion cyst is just underneath the skin and that too two in number and on cheek.   You need head on to separate it well from skin.  Bailey incision could be a suitable alternative.   Any comment on that.

Dr. Satyawati Mohindra

Basically we are tempted to think about trans buccal route for the same reason.You are right ajay but whatever you do there is going to be a scar. The skin is thinned out already. The lesion looks bluish . Are you sure it is epidermal inclusion. Not some hemangioma or something else.[9:10 AM, 9/18/2016] Satyawati Mohindra: Another thing ajay.[9:09 AM, 9/18/2016] Satyawati Mohindra: Bailey incision is also unlikely to help because the cyst is very close to skin. It looks you are likey to have a button hole once to try to separate from skin.        

Dr. Athira Ramakrishnan

Excision entirely knife dissection will help reduce soft tissue manipulation and scarring 

Dr. Mohnish Grover

Wow. Nice discussion on this topic.. lipomas and epidermal inclusion cyst are very dffrnt esp in this area.. as dr ajay said lipoma is much deeper so amenable to intraoral excision. Epidermal inclusion cyst is very superficial, bound to hv a button hole if we do intraoral. A controlled scar here is better than that. Also epidermoids can have that bluish tinge. Its not uncommon. It actually indicates that cyst is superifical.           

Dr. Anandabrata Bose

Excellent discussion. I would go by direct approach and use the facial lines to minimise scars. Even with baileys lot of mobilisation is reqd with a possible button hole close to the cyst. Thay would be bad scarring. Secondly with baileys going to neck produces a scar and with limited exppsure traction and working under a tunnel is uncomfortable unless using robotics!!  I have no experience with silastic gel. How do you use it please?

Dr. Athira Ramakrishnan

Sir, a small portion of that sheet has to be cut and the adhesive surface has to be kept on the scar, entirely covering it, it flattens and hydrates the scar

Dr. Anandabrata Bose

Thanks i will try it.

Dr. Prahalad NB

It up folks. Quite an education for us.  great discussion. Keep it up

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