Craniofacial Epidermoid and Dermoid Cysts.

BACKGROUND: Epidermoid and dermoid cysts are benign developmental anomalies that can form anywhere in the body. Despite the rarity of incidence in the head and neck, they can arise at a variety of craniofacial locations. The purpose of this study was to analyze the clinical features of epidermoid and dermoid cysts arising in the craniofacial region with a literature review. METHODS: A retrospective study was designed, and clinical features and surgical considerations were investigated from a literature review. Cases of epidermoid cysts in the scalp, temporal area, glabellar area, mouth floor, and buccal mucosa were described. RESULTS: Dermoid cysts in more lateral regions of the scalp are rarely associated with intracranial extension. Because temporal dermoid cysts have a high rate of intracranial extension, radiological evaluation of the lesions in the temporal area is imperative. Epidermoid cysts in the glabellar area are usually superficial. Consideration of the surgical approach for an epidermoid cyst of the mouth floor is important. Because epidermoid cysts in the buccal mucosa are extremely rare, differential diagnosis was emphasized. Epidermoid cysts in the scalp, in the temporal intradiploic area, on the glabellar area in the periorbital region, in the mouth floor, and in the buccal mucosa were surgically excised considering the depth and location. Ten cases of epidermoid cysts in the buccal mucosa were retrieved from the literature review. CONCLUSIONS: Consideration of the anatomic locations of epidermoid and dermoid cysts in the craniofacial region might help facilitate accurate diagnosis and treatment.

Uvular Dermoid Cyst: More Than Just a Lump in the Throat-Management of Resultant Velopharyngeal Insufficiency.

To seal the passage between the nasal and oral cavities during speech and swallowing, velopharyngeal closure is required. However, in velopharyngeal dysfunction, uncoupling of the nasal and oral cavities can be impaired, resulting in hypernasality, nasal air emission, and decreased vocal intensity. Velopharyngeal dysfunction can develop following velopharyngeal mislearning, oral surgery, or a congenital palatal malformation. Rare dermoid cysts of the palate may interrupt normal palatal development, resulting in velopharyngeal insufficiency (VPI). While speech therapy is the standard treatment, some cases may necessitate surgical correction of structural insufficiencies. In this report, we present the case of a 7-year-old female with a past surgical history of a uvular dermoid cyst removal at 14 months of age with VPI that was treated with Furlow Z-palatoplasty. To the author's knowledge, this is one of but a few cases of a uvular dermoid cyst with VPI.

Epidermoid and Dermoid Cysts of the Head and Neck.

ABSTRACT: Epidermoid and dermoid cysts (ECs and DCs) are congenital anomalies occurring in areas of embryonic fusion. Their incidence in the head and neck region is low and ranges from 1.6% to 7%. The aim of this study is to report on the clinical characteristics, treatment, and outcome of 22 patients from a single-institution experience. A retrospective analysis of patients treated for ECs and DCs of the head and neck over a 12-year period was performed. The present study included 22 patients (male/female ratio 1:1). The mean age of presentation was 11.68 years. The lesions were distributed in the orbital regions in 7 (31.82%) patients, auricular regions in 6 (27.27%), neck regions in 5 (22.73%), floor of the mouth in 3 (13.64%), and nose in 1 (4.55%). Complete surgical excision was performed as a definitive treatment method in 21 patients (95.45%). The mean size of the excised lesions was 21.36 mm at the widest length (range: 10-70 mm). On the basis of histopathological examinations, 15 (71.43%) lesions were classified as ECs and 6 (28.57%) as DCs. Post-operative complications were noted in 3 (14.29%) patients--2 (9.52%) with recurrences and 1 (4.76%) with hypertrophic scarring. All of these patients were successfully cured after a second surgery. The ECs and DCs of the head and neck present an interesting diagnostic and therapeutic challenge. Successful management depends on a thorough knowledge of their clinical and radiological features.

Transoral Marsupialization of a Large Dermoid Cyst.

True dermoid cysts are rare congenital entities with a predilection for periorbital, floor-of-mouth, and submental areas in the head and neck region. They are usually asymptomatic unless they substantially enlarge, causing pain or difficulty in swallowing, breathing, speech, or vision, depending on their location. Conventionally, complete excision is the treatment of choice. The authors describe a transoral approach to marsupialize a large dermoid cyst, with a successful outcome and minimal complications. Using this technique, it is hoped that surgeons can minimize the risk of damaging vital structures, shorten operating time, and provide an esthetically better result with a comparable outcome.

Atypical MRI and Histopathological Findings in Dermoid Cyst.

On images, a dermoid cyst is often described as resembling a "sack of marbles" or "marbles in a bag". Typically, it comprises an inhomogeneity filled with multiple nodules in a fluid matrix on both computed tomography and magnetic resonance imaging (MRI). How it appears, however, will vary depending on its histological contents, which may cause confusion in arriving at a diagnosis. This report describes a dermoid cyst in the floor of the mouth of a 55 year-old woman that showed an atypical internal appearance on MRI. Most of the lesion showed homogeneous high signal intensity on T1 - and T2-weighted images, suggesting that it was derived from fat. A small area within the mass, however, showed moderate signal intensity almost equal to that of muscle on T1-weighted images and high signal intensity on fat-suppressed T2-weighted images. Given the location of the lesion, a dermoid cyst was one possible diagnosis. A lipoma or lipoma variants were also considered, however, based on signal intensity. Histopathological section of the excised specimen revealed a dermoid cyst with sebaceous glands in its walls and keratin in its cavity. Dermoid cysts show variation in their internal structures and contents. Since MRI can reflect such histological variation, signal intensity requires careful interpretation.

Venous vascular malformation of the floor of mouth masquerading as a dermoid tumor.

Venous vascular malformations (VVMs) are described as abnormal post-capillary lesions which exhibit low flow. These are typically malleable and may grow with endocrine fluctuations. A VVM that mimics the classic appearance of dermoid tumor on imaging has never been reported. We encountered a 43-year-old woman with intermittent dysphagia relating to a firm submandibular mass. Physical exam and cross-sectional imaging revealed features consistent with variant dermoid cyst. However, catheter angiography eventually demonstrated a VVM which possessed vessels of variable size and partial thrombosis. We report the case and propose that catheter angiography remains important in cases where vascular malformation is considered.

HDLive ultrasound images of ovarian dermoid cysts: diagnostic accuracy.

OBJECTIVE: To demonstrate that the use of 3D/4D HDLive increases the image quality in the diagnosis of benign cystic ovarian teratomas. MATERIALS AND METHODS: 3D/HDLive ultrasound (US) was used in 31 cases of suspected ovarian cystic teratoma using vaginal 2D US. The following pathognomonic images of mature cystic teratomas were considered for diagnosis: 1) a cystic, unilocular lesion with a densely echogenic tubercle (Rokitansky nodule); 2) a diffuse or partially echogenic mass usually demonstrating sound attenuation; 3) fluid-fluid/fat-fluid levels; 4) dermoid mesh with hyperechogenic calcifications indicating the presence of bone, teeth, or other ectodermally-derived structure; 5) multiple mobile spherical structures (fat globules). RESULTS: Dermoids present a wide spectrum of images depending on the predominant tissue type. In the vast majority of cases there are dense echogenic structures that correspond to complex masses of fatty tissue, sebum, hair, epithelial remnants, along with cartilage or bone. If we catalogue all the images together, the pathognomonic of dermoid are: 1) cystic or solid cystic lesions with a Rokitansky nodule, with bone, teeth or cartilage (six cases, 22.2%); 2) a solid mass with or without attenuation that corresponds with pure sebum (five cases, 18.5%); 3) a diffuse mass with fine bands that correspond with hair inside sebum (four cases, 12.9%) and that may form meshes or plugs corresponding with a mixture of fat, sebum, and hair (three cases, 11.5%). CONCLUSIONS: HDLive U.S. provides some images of exceptional quality that enhance the definition of the structures of these tumors (fat, hair, cartilage, bone, etc.) compared to 2D/3D/4D.

A Pediatric Lateral Submental Mass: A Rare Presentation of Dermoid Cyst.

Dermoid cysts are benign cutaneous neoplasms that contain germ cells from the ectoderm and mesoderm. Approximately 70% are diagnosed during childhood before the age of 5. Although they can present throughout the body, the prevalence is 7% for those arising from the head and neck. These lesions present primarily as midline masses and are classified as sublingual, submental, or overlapping depending on their relationship with the muscles of the floor of mouth. A 10-year-old female presented with a 2-week history of right submental swelling. She denied pain, dysphagia, odynophagia, or respiratory distress. Physical examination showed nontender fullness of the submental region without erythema or induration and no palpable cervical lymphadenopathy. Ultrasound showed an oval-shaped cystic mass measuring 4.8 × 4.0 × 2.6 cm. After a course of clindamycin, a computed tomography was obtained which showed a right 4.5 × 4.0 × 2.6 cm fluid filled lesion, within the right lateral floor of mouth. Intraoral resection was performed and the mass was freed from the geniohyoid and mylohyoid. Histopathology was consistent with a dermoid cyst. Submental masses have a broad differential, but rarely are they dermoid cysts if they arise lateral to the midline. With appropriate diagnosis and total surgical excision, patients and their families can be reassured in similar cases.

Differentiation of sublingual thyroglossal duct cyst from midline dermoid cyst with diffusion weighted imaging.

PURPOSE: to differentiate sublingual thyroglossal duct cyst (TGDC) from midline dermoid cyst (DC) with diffusion weighted imaging (DWI). MATERIALS AND METHODS: Retrospective analysis of 22 consecutive patients (11 male and 11 female aged 5-15 years) with midline cystic lesion at floor of mouth. They underwent DWI of floor of mouth. Apparent diffusion coefficient (ADC) of the cystic lesions was calculated and correlated with surgical findings. RESULTS: The mean ADC value of TGDC of 1st observer was (2.20 ±â€¯0.28 × 10-3 mm2/s) and of 2nd observer was (2.28 ±â€¯0.27 × 10-3 mm2/s) was significantly higher than that of DC (P = 0.001) whose ADC of 1st observer was (1.55 ±â€¯0.15 × 10-3 mm2/s) and of 2nd observer was (1.53 ±â€¯0.11 × 10-3 mm2/s). There was excellent inter-observer agreement of both readings (r = 92%, P = 0.001). When ADC of 1.76 and 1.62 × 10-3 mm2/s was used as a threshold value for differentiating TGDC from DC, the best results were obtained with area under the curve of 0.94 and 0.96, accuracy of 90% and 86%, sensitivity of 91% and 91%%, specificity of 90% and 80%, negative predictive value of 90% and 88% and positive predictive value of 92% and 84% of both reviewers respectively. CONCLUSION: DWI is reliable and reproducible imaging modality for differentiation sublingual TGDC from DC.

Dermoid cyst with cerebellar meningoencephalocele at different locations accompanied by posterior fossa abnormalities: case report.

CONTEXT: Dermoid cysts are well-defined cysts containing sebaceous glands and dermal structures. In the literature, dermoid cysts and associated closure defects have been described in the same locations. CASE REPORT: In this case, a dermoid cyst was found at the base of the mouth with a coexisting closure defect in the occipital calvarium. Additional abnormalities were also observed, including posterior myeloschisis, right cerebellar dysgenesis, vermian hypogenesis and posterior fusion of the second and third vertebrae. The finding of a dermoid cyst located at the base of the mouth is discussed here, with additional imaging findings. CONCLUSION: Dermoid cysts in the head and neck region may be accompanied by posterior fossa abnormalities.

Acute presentation of an intraoral dermoid cyst causing airway compromise in a young child.

A 4-month-old boy presented with a cystic swelling at the floor of the mouth causing acute airway compromise. The only previous history of note, was a tongue tie release at 3 days old. CT scan suggested a dermoid cyst with extensive floor of mouth abscess. He had an excision of the cyst and drainage of the superimposed abscess and made a good recovery. The histology report revealed a dermoid cyst which is a rare diagnosis in a child, particularly within the oral cavity. Early treatment is required to remove these lesions especially when they cause airway compromise or swallowing difficulties. This is the first case to our knowledge which suggests tongue tie release procedures causes a predisposition to the development of dermoid cysts in the oral cavity.

Occurrence of dermoid cyst in the floor of the mouth: the importance of differential diagnosis in pediatric patients.

Lesions in the floor of the mouth can be a challenging diagnosis due to the variety of pathological conditions that might be found in this area. Within a broad range of lesions, attention has to be addressed to those that require specific management, such as a dermoid cyst (DC) and a ranula. Especially in pediatric patients, in whom the failure of diagnosis can postpone the correct treatment and cause sequelae later in life. DC, a developmental anomaly, is managed primarily by surgical resection. On the other hand, ranula is a pseudocyst that may be treated by marsupialization. This article reports a large and painful lesion in the floor of the mouth in a pediatric patient. With a diagnostic hypothesis of ranula, two surgical interventions were performed, but there were recurrences of the lesion. Subsequently, the patient was referred to the Oral and Maxillofacial Surgery Unit for re-evaluation. Computed tomography showed a semi-transparent image suggesting a cystic formation. Another surgical procedure was performed where the lesion was completely removed. Anatomopathological analysis confirmed the diagnosis of DC. The five-year follow-up showed no signs of recurrence. This article indicates that although DC in the floor of the mouth is rare, it should be considered in the differential diagnosis of other diseases in this area. This precaution may be particularly important in the following circumstances: 1) Similar lesions that have different therapeutic approaches and, 2) To prevent future sequelae in pediatric patients.

[Intralingual dermoid cyst: imaging features of a giant cyst]. / Kyste dermoïde de la langue: aspects en imagerie d'un kyste géant.

Dermoid cysts of the oral cavity are rare and most commonly involve the floor of mouth. Intralingual dermoid cysts are extremely rare and usually large at the time of diagnosis in adult patients. We report the case of 6 year old girl with macroglossia and swallowing and respiratory difficulties due to a giant intralingual dermoid cyst. Ultrasonography showed a large cystic intralingual lesion. MRI allowed accurate evaluation of the size, the extension and the relationship of the cystic mass with adjacent structures, the fat component of the cystic mass confirmed the dermoid origin. This case illustrates the diagnostic contribution of US and MRI in this disease.

Quiste dermoide latero cervical / Dermoid cyst of the lateral neck

Resumen Introducción: Los quistes dermoides son lesiones de origen ectodérmico poco frecuentes. Solo un 1,6% de ellos, se presenta en el piso de la boca y de éstos, solo un 6% lateralmente en el espacio submandibular. Objetivo: Reporte de caso y revisión de la literatura. Caso clínico: Se presenta un caso de una paciente de 32 años, con un cuadro de 1 año de evolución caracterizado por una lesión de crecimiento lento pero sostenido. Se le realizó la resección de la lesión junto con una submandibulectomía ipsilateral resultando compatible con un quiste dermoide. Discusión: La localización de esta lesión es muy infrecuente. En el estudio histopatológico son lesiones con epitelio pluriestratificado cornificado y anexos cutáneos. El estudio de imágenes orienta a una lesión quística, siendo la resonancia nuclear hoy en día el mejor examen para caracterizar esta lesión. Es una lesión benigna, sin recidivas reportadas cuando la resección ha sido completa.

Introduction: Dermoid cysts are uncommon lesions from ectodermic origin. Only 1.6% arise in the floor of the mouth, and at this site only 6% arise laterally in the submandibular region. Aim: Case report and review of the literature. Clinical Case: 32 years old patient, with a slow growing lesion during 1 year. Complete resection with an ipisilateral submandibulectomy was performed. The pathologic report showed a dermoid cyst. Discussion: The localization of this lesion is very uncommon. In the pathologic report are lesion with pluri stratified cornified epthitelium with skin attachments. Image studies show a cystic lesion being the magnetic resonance the best study to characterize this lesions. Are benign lesions, without recurrence reported when the lesion has been fully excised.

An unusual presentation of a lingual dermoid cyst.

Dermoid cysts are rare lesions of the head and neck that usually present in children as an asymptomatic, slowly growing mass. We report a case that demonstrates that dermoid cysts can present later in life as a recurrent acute infection. Our patient was a 48-year-old man with a 22-year history of recurrent abscesses of the tongue and floor of the mouth that had required a tracheotomy and multiple hospitalizations. Magnetic resonance imaging performed between acute episodes revealed the presence of a 1.8-cm lesion within the tongue musculature. The patient underwent resection, and pathology was consistent with a lingual dermoid cyst. At 2 years of follow-up, he experienced no recurrence of symptoms.

Intramedullary cystic teratoid tumor of the cervical spinal cord in association with a teratoma of the ovary.

A 15-year-old black female student came to the hospital because of disturbance of her gait. On examination, there was a dermal sinus in the skin overlying the spine of the seventh cervical vertebra, and myelography with computed tomography scan demonstrated a block to the flow of metrizamide contrast material at T-5 with cephalad extension of an intradural cystic lesion to the C-5 level. An x-ray examination of the abdomen at the time demonstrated a tooth-shaped radiodensity in the left hypogastrium. On exploration of the spine via C5-T5 laminectomy an intramedullary cystic teratoid tumor was found which was partially excised. At later exploration of the abdomen, a teratoma of the left ovary was removed. The pathology and natural history of teratomas and teratoid tumors is discussed along with surgical management of these tumors.

Interpretation of the origin of a submandibular mass by CT and MRI imaging.

OBJECTIVE: To clarify the useful findings for determining whether the submandibular mass is intraglandular or extraglandular. STUDY DESIGN: Forty-eight patients with swelling of the submandibular region were reviewed. The relationship between the lesion and the submandibular gland and the displacement of the anterior facial vein were analyzed. RESULTS: The accuracy of the predictions based on the relationship between the lesion and the submandibular gland (SMG) was 87% on contrast-enhanced CT (CECT), 85% on CT sialography (CTS), and 91% on MRI. Although the displacement of the facial vein outside the lesion suggested an intraglandular lesion, and inside the lesion suggested an extraglandular lesion, these were not sufficient to differentiate the lesions in 7 out of 23 CECT cases and 4 out of 11 MRI cases. CONCLUSION: The finding of a relationship between the lesion and the SMG is the most important finding of this study.

A case of large dermoid cyst in the floor of the mouth.

Dermoid cysts in the floor of the mouth are rarely observed. When they develop, they do not appear until they grow large enough or appear through infection. Some operative approaches and management have been performed to large dermoid cysts in the floor of the mouth with some variations. Intra-oral approach is the most useful for cosmetic appearance. We presented a 24-year-old female who underwent expedient surgical excision using finger end serviceable enucleation through the intra-oral approach.