New ‘ZISIS’ (Zigzag Incision–Suction–Irrigation System) Technique for Endoscopic-Assisted Forehead Tumour Excision

  • Sunil ChoudharyEmail author
  • Soumya Khanna
  • Raghav Mantri
  • Prateek Arora
  • Rohit Jain
Original Article



Endoscopic-assisted excision of forehead tumours like osteomas and lipomas is well established, but the conventional techniques suffer from many limitations like inadequate access, fogging of the endoscope and unclear vision due to collection of blood and debris.


Three simple modifications of the conventional endoscopic forehead technique for benign tumour excisions are described by the acronym ‘ZISIS’.
  1. 1.

    ZI Zigzag scalp incision increases the surface area of the opening permitting easy insertion of multiple instruments along with the endoscope.

  2. 2.

    S Suction tubing made from a disposable suction catheter tube is taped along the endoscope sheath for continuous suctioning and good vision.

  3. 3.

    IS Irrigation system of warm saline made with an infant feeding tube is also taped along the endoscope just opening in the front of the suction tube.



A total of 12 consecutive patients underwent endoscopic excision of forehead benign tumours in 2 years. This included 2 lipomas and 10 osteomas cases. All patients achieved excellent hidden scars in the scalp. All patients rated their results as excellent with respect to the hidden scar and aesthetic result. No early or late complications were reported with follow-up ranging from 6 months to 2 years.


A new simple modification called ‘ZISIS’ endoscopic forehead excision technique is described for benign forehead tumours excision making it easier, efficient and ergonomic.

Level of Evidence IV

Evidence obtained from multiple time series with or without the intervention, such as case studies.


Forehead osteoma Forehead lipoma Endoscopic excision ZISIS Zigzag incision Suction irrigation system 



Authors have no financial disclosures to make.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

Video 1

Video gives brief overview and advantages of the new ‘ZISIS’ technique for endoscopic-assisted forehead tumour excisions. It also shows its application in two cases of multiple forehead osteomas and a forehead lipoma, respectively (MOV 84627 kb)


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Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2019

Authors and Affiliations

  • Sunil Choudhary
    • 1
    Email author
  • Soumya Khanna
    • 1
  • Raghav Mantri
    • 1
  • Prateek Arora
    • 1
  • Rohit Jain
    • 1
  1. 1.Max Institute of Reconstructive, Aesthetic, Cleft and Craniofacial Surgery (MIRACLES)Max Super Specialty HospitalNew DelhiIndia

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