Epidermoid cysts in head and neck: our experiences, with review of literature

Abstract

Epidermoid cysts are benign lesions, characterized by cystic spaces lined by simple squamous epithelium (epidermoid cyst), containing skin adnexa ("true" dermoid cyst) or tissues of all three germ layers (teratoid cyst). Head and neck constitute ~7% of all cases of epidermoid and dermoid cysts. There is often a diagnostic dilemma with the more common cystic lesions of this region. A retrospective case-series study of histologically proved epidermoid cysts in the head-neck region, from February 2008 to January 2011, in the Department of Otorhinolaryngology and Head-Neck Surgery of a tertiary Government teaching hospital in eastern India. The diagnosis was reached by fine needle aspiration cytology FNAC and subsequent histopathology where feasible. Necessary imaging was done for evaluation and management. A total of 28 cases were analyzed. 5 were female, with a male: female ratio of 4.6. Age range was from 2 to 60 years (mean = 30). Excision was the preferred treatment in 20 cases (71.4%). Various sites like the submandibular region (5), pinna (5), sublingual region (1), periorbital (6), suprasternal (6), along the anterior border of sternocleidomastoid (1) and glabella (3) were involved, along with an iatrogenic implantation epidermoid cyst in a tracheostomy scar. Some of the interesting cases presenting with clinical dilemma have been emphasized. Epidermoid cysts are relatively less common in the head-neck region, hence are liable to be misdiagnosed. In this case-series, few cases presenting with enough elements of confusion and dilemma are discussed with overall analysis and review of the related literature.

Keywords: Dermoid cyst; Epidermoid cyst; Head and neck.

Fig. 1

In this 2-year-old child, the suprasternal epidermoid cyst (white arrow) is associated with bilateral 2nd branchial arch fistulas (black arrows) and a left-sided pre-auricular sinus (red arrow)

Fig. 2

An epidermoid cyst in the pinna

Fig. 3

a This huge disfiguring mass (white closed arrow) in the floor of the mouth of a 23-year-old woman pushes her tongue (black arrow) against the palate, and extends inferiorly to be palpable under the chin. There are also the typical “double chin” and “second tongue” appearances. b The mass is being removed via external approach. c Histopathological examination (hematoxylin and eosin, ×100) reveals squamous epithelial lining of the cyst wall with keratin layers and debris

Fig. 4

The cystic mass is seen to occupy the left submandibular region (a) and intra-orally the left side of the floor of the mouth (b). The epidermoid cyst is being taken out into-to via intra-oral approach (c)

Fig. 5

The epidermoid cyst along with the tract excised from the tracheostomy scar

Fig. 6

a This 44-year-old woman presented with a mass between her right upper eyelid and eyebrow, resulting in cosmetic deformity and restricted upward vision. A scar is also visible over the right eyebrow. b CT scan (coronal section) shows the mass almost isointense with the orbital fat, and dehiscent frontal sinus floor with lipping towards the orbital cavity

Fig. 7

This 23-year-old woman presented with a 3 × 3 cm firm swelling in the lateral aspect of her neck, at the junction of upper and middle third of the anterior border of sternocleidomastoid