Objective: to highlight the essential points in diagnosis and management of head and neck epidermoid/dermoid cysts.
Design: A retrospective design was followed for the study.
Methods: The study included all patients with epidermoid/dermoid cysts presented to the ENT Department over a 7 year's period. Diagnosis was based on history taking, full clinical examination, ultrasonographic examination of the lesion. All cases were treated with surgical excision through external or trans-oral sublingual approach. Gross and histopathological examinations of the removed cysts were done to confirm the diagnosis.
Results: Twelve cases of head and neck epidermoid/dermoid cysts were recorded over a 7 year's period, in the periauricular (6 cases), submental (3 cases) and submandibular (3 cases) areas. Clinical examination demonstrated a non-tender, well-defined, cystic swelling with no palpable cervical lymph nodes. Ultrasonography revealed a well-circumscribed hypo-echoic lesion with small echogenic debris inside. Complete surgical excision was done through external approach, except one removed via a trans-oral sublingual approach. In two cases, scattered hair could be seen in the keratinous contents and lining wall, with histopathological confirmation of dermoid cyst. In the remaining 10 cases, the cyst wall was lined with stratified squamous epithelium with intacystic lamellated keratin confirming the diagnosis of epidermoid cyst.
Conclusions: Epidermoid/dermoid cysts occur most commonly in the periauricular area and in relation to the mandible. Ultrasonographic picture is characteristic with no need for more expensive investigations. External surgical approach with sharp dissection is the standard surgical procedure. Gross examination provides a clue with histopathological confirmation of diagnosis.