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INTRODUCTION:: The incidence of midline frontonasal dermoids cysts is 1 in 20000-40000. These lesions may have intracranial extension correlating with the anatomy and embryology of nasofrontal development. Skin involvement may be extensive, with puncta and hair-bearing sinus tracks in the skin of the dorsum of the nose. Incomplete excision frequently leads to recurrence.We report our experience and pathway for management of midline dermoids.METHODS:: Databases were searched to identify patients who had undergone surgery for removal of a dermoid cyst. Preoperative imaging and indications for surgery were reviewed. Cases were grouped according to surgical approach, and outcomes and complications identified.RESULTS:: Fifty-five patients with were treated. MRI or CT was used to delineate the anatomy, and surgical excision expedited if there was a history of infection, or hairs were present at the sinus opening (especially if imaging suggested intracranial extension). 12 were treated endoscopically (one converted to open). 11 required transcranial approaches for intracranial extension (20%). Of these, one lesion breached the dura. The remaining 32 patients had dermoids excised with an open approach, which was either direct, bi-coronal or rhinoplasty.There were no recurrences in the open group; one in the transcranial group. This was treated by re-excision.Another patient was readmitted for treatment of an infection with intravenous antibiotics.CONCLUSION:: Midline dermoid cysts are relatively uncommon. However, knowledge of the pathogenesis of these lesions together with our experience over 15 years has allowed us to develop a protocol-driven approach, with a low incidence of complications.The management of midline frontonasal dermoids. A review of 55 cases at a tertiary referral centre and a protocol for treatment. ©2014American Society of Plastic Surgeons Source


Green B.,Craniofacial Unit | Green B.,Kings College London | Cobb A.R.M.,South West Cleft Unit | Brennan P.A.,Queen Alexandra Hospital | Hopper C.,University College London
British Journal of Oral and Maxillofacial Surgery | Year: 2014

Optical biopsy systems are a potential adjunct to the histopathological assessment of tissue specimens; they are not invasive and can give an immediate result. We review the most common optical biopsy techniques used to detect lesions of the head and neck: elastic scattering spectroscopy, microendoscopy, narrow band imaging, fluorescence, and optical coherence tomography, and discuss their clinical use. © 2014 The British Association of Oral and Maxillofacial Surgeons. Source


Green B.,Craniofacial Unit | Godden D.,Gloucestershire Royal Hospital | Brennan P.A.,Queen Alexandra Hospital
British Journal of Oral and Maxillofacial Surgery | Year: 2015

Adnexal tumours form a heterogeneous group of relatively rare neoplasms. Many of them have a poor prognosis and treatment can sometimes be difficult and controversial. We summarise the latest publications relating to malignant cutaneous adnexal tumours of the head and neck, and give an update on their management. We discuss Merkel cell carcinoma and other rare malignant adnexal tumours including dermatofibrosarcoma protuberans and atypical fibroxanthoma. © 2015 The British Association of Oral and Maxillofacial Surgeons. Source


Bast F.,Craniofacial Unit | Frank A.,Clinic for Otorhinolaryngology | Schrom T.,Clinic for Otorhinolaryngology
ORL | Year: 2014

Objectives: The Eustachian tube is responsible for ventilation, protection and drainage of the middle ear. Dysfunction of the Eustachian tube can lead to impairments ranging from inadequate pressure equalisation in the middle ear and pneumatised mastoid process to cholesteatoma. Conventional surgical interventions for chronic tube dysfunction have not brought resounding clinical success. However, the 'Bielefelder Balloon dilatation' constitutes a new and, judging from early results, very effective treatment for chronic tube dysfunction. Proof of the efficacy of the surgical procedures is provided by objective clinical factors, but for quality assurance, the assessment of the subjective quality of life of patients must also be taken into account. To measure health-related quality of life, standardised questionnaires are used which have been tested for reliability, validity and sensitivity. Methods: A total of 30 patients were included in the study. The patient survey was conducted retrospectively, and validation of patient satisfaction was carried out with the Glasgow Benefit Inventory (GBI). Results: GBI analysis revealed significant improvements in the total score as well as in general and physical health. Conclusions: The Bielefelder Balloon dilatation is a new and safe treatment for chronic tube dysfunction, which had a significant positive influence on the postoperative quality of life of our patient cohort. © 2014 S. Karger AG, Basel. Source


Hachach-Haram N.,Craniofacial Unit | Kirkpatrick W.N.A.,Craniofacial Unit
Facial Plastic Surgery | Year: 2013

The youthful face is often defined by malar and lateral cheek fullness with associated submalar concavity, giving a smooth contour between the different subunits coupled with an aesthetically pleasing convex lower eyelid-cheek continuum. This article reviews the key anatomical concepts of midfacial aging, the evolution of midface-lifting techniques, and indications and contraindications for their use. Copyright © 2013 by Thieme Medical Publishers, Inc. Source

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