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Table of Contents
CLINICAL NOTE
Year : 2001  |  Volume : 3  |  Issue : 1  |  Page : 16-18

Recurrent infection of dermoid cyst in the neck: A case report


1 Department of Otrhinolaryngology, Ohud Hospital, Al Madina, Saudi Arabia
2 Department of Histopathology, King Fahad Hospital, Al Madina, Saudi Arabia
3 Department of Otorhinolaryngology, Security Forces Hospital, Riyadh, Saudi Arabia

Date of Web Publication9-Jul-2020

Correspondence Address:
FRCS Adel A Banjar
ENT Department, Ohud Hospital, P.O. Box 779 A1 Madina
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.289353

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  Abstract 


Dermoid cysts are uncommon in the neck and the clinical diagnosis is confused with other neck masses. We present a case of dermoid cyst in the submandibular area in a 7 year old boy. The recurrent infections and radiological picture resemble lymphadenitis with abscess formation.
The distinction between dermoid cyst and other similar neck masses is important for the correct diagnosis and proper selection of surgical procedure which can save the patient much anxiety and trauma.

Keywords: Submandibular, dermoid, Lymphadenitis, diagnosis


How to cite this article:
Banjar AA, Hussain SA, Pottachilakath AS, Asiri SM. Recurrent infection of dermoid cyst in the neck: A case report. Saudi J Otorhinolaryngol Head Neck Surg 2001;3:16-8

How to cite this URL:
Banjar AA, Hussain SA, Pottachilakath AS, Asiri SM. Recurrent infection of dermoid cyst in the neck: A case report. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2001 [cited 2021 May 5];3:16-8. Available from: https://www.sjohns.org/text.asp?2001/3/1/16/289353




  Introduction Top


The differential diagnosis of a neck mass covers a broad spectrum of diseases and carries implications for treatment as varied as any areas of medicine. Paediatric patients generally exhibit inflammatory neck masses more frequently than congenital neck masses .[1] All possible causes of neck masses should be considered in the differential diagnosis.


  Case Report: Top


A 7 year old boy from Pakistan presented with history of recurrent painful neck swelling of three years duration. The last attack started two weeks before the presentation and did not respond to antibiotic as previous attacks. There was no history of constitutional symptoms or systemic diseases. There was no difficulty with speech, mastication, swallowing or respiration. There was no family history of similar lesion or tuberculosis. The parents wefe not sure about the history of the vaccination to tuberculosis.

Clinically, there was a round-shape, tender and firm 2x3cm swelling with normal skin in the left submandibular area. No other mass was palpated and the patient was diagnosed as cervical lymphadenitis and antibiotic was prescribed. Two weeks later, the tenderness was disappearing and the swelling became daugh in consistency [Figure 1]. Dental examination was normal and no intraoral lesion was detected. Blood test and serological investigation for Brucellosis and CMV were within normal limit. Tuberculin test was negative and no abnormalities were detected in X-rays of the chest and the neck and fine needle aspiration was not informative. CT- Scan of the neck showed a rim-enhanced cystic swelling at left submandibular region suggestive of an abscess [Figure 2]. The mass was excised and dissected in toto through submandibular incision. No tract was found during the dissection. Examination of the cyst revealed a cheese-like material and histopathological report was consistent with dermoid cyst.[Figure 3].
Figure 1: Left submandibular swelling (arrows)

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Figure 2: Axial contrast enhanced CT-Scan of the Neck shows an oval well-defined swelling located in submandibular region (large arrow) in contact with the geniohyoid muscle(small arrow)

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Figure 3: Photo micrograph showing cyst wall lined by keratinized stratified squamous epithelium. A sebaceous gland seen subepithelially(H&E10ˣ10)

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The patient had uneventful postoperative course and there was no recurrence of the swelling during two years follow-up.


  Discussion Top


Dermoid is a general term used for all dysontogenetic cysts, i.e. cyst linked with the development of organ structures and resulting from defective embryogenesis .[2],[3] Dermoid cyst can be of congenital or acquired origin and can be classified into three broad categories based on pathogenesis and microscopic appearance. The first category is congenital dermoid cysts of the teratoma type, which is derived from pinching off a portion of the blas- tomere. They develop mainly in the gonads and may contain skin, hair, nails or teeth depending on the dominant germinal layer. The second category is acquired dermoid cysts. In this type, a portion of the skin is traumatically implanted followed by ectopic formation of a dermal cyst that is lined by squamous epithelium. The third type is a congenital inclusion dermoid cyst which form along the lines of embryological fusion and are thought to result from the inclusion of sequestered epithelial remnants or from ectodermal displacement by ingrowing membranous bone.[4] Congenital inclusion dermoid cyst is the category of special interest to the head and neck surgeon.

They are lined by epidermis-like other epidermal cyst-but in contradistinction to simple epidermal cysts, all elements of the skin are present. [4]

Dermoid cysts in the head and neck region account for about 7% of all dermoids in the body [2],[5] and they were observed more in the head compared to the neck.[6] The periorbital location is by far the most common site for dermoid cysts.[3],[4] Other infrequent locations include: nasal region, oral cavity and the neck. Dermoid cysts in the neck arise from sequestration of the epithelium along the lines of fusion of the first and second branchial arches or at the mid ventral and mid dorsal fusion in the suprasternal, thyroid and suboccipita regions. The cysts may appear in the submental region, floor of the mouth, submandibular, and thyrohyoidal regions .[4] They are easily confused with other congenital, developmental or inflammatory lesions in the neck such as thyroglossal duct cyst, ectopic thyroid, enlarged lymphnodes, enlarged salivary gland, branchial cleft cyst, cystic hygroma and abscess.[3] Dermoid cyst of the floor of the mouth can extend to the neck.

The importance of distinction between different cysts of the neck is demonstrated by Katz.[6] He reviewed the cases of midline dermoid cysts in the neck and midline thyroglossal duct cysts and advised the inspection of the cyst to identify dermoid cyst, which is easily removed without scarifying any structure. Inspection of the content of the cyst may be confusing in some conditions, for example sebaceous material present in dermoid cyst and sebaceous cyst and histopathological examination is conclusive in such case.[4]

In our case, the age of the patient and the absence of trauma to the neck as well as the intraoperative finding suggested the congenital origin of the cyst. The cyst demonstrated in our case with its relatively large size 3x3cm did not give any intraoral signs and the swelling was unrecognized between the attacks as may be displaced between muscles of the floor of the mouth. The CT-Scan findings were similar to the case reported by Lanzieri.[5] These factors were misleading and contribute to the delay of the diagnosis. The surgical excision was curative.


  Conclusion: Top


Dermoid cysts constitute an interesting group of lesions with a diverse embryogenesis, pathology and clinical manifestations. They are rare in the neck and other congenital or inflammatory neck masses can confuse the diagnosis as demonstrated in our case. The clinical distinction between different cysts of neck is difficult but repeated examination and careful inspection of the content of the cyst during the surgery is advisable and may lead to the correct diagnosis and proper design of surgical intervention.



 
  References Top

1.
Frederick Mc Guirt W Differential diagnosis of Neck Masses. In: Otolaryngology Head and Neck Surgery. (Chap. 85) Cummings C.W., Fredrickson J.M., Harper L.A., Krause CJ, Schullar DE (eds). Mosby Year CV Book. Inc. St Louis; 1543- 1565; 1993.  Back to cited text no. 1
    
2.
Voltonen H, Nuutinen J, Karja J, Collan Y. Congenital dermoid cysts of the tongue, J Laryngol Otol 19S6; 100: 965-9.  Back to cited text no. 2
    
3.
Quraishi HA, Ortiz O, Wax MK. Dermoid cysts of the floor of the mouth. Otolaryngol Head & Neck Sure 1997; 118 (4): 562-563.  Back to cited text no. 3
    
4.
Mc Avoy JM, Zuckerbraun L. Dermoid cysts of the head and neck in children. Arch Otolaryngol Head Neck Surgl976: 102:529-31.  Back to cited text no. 4
    
5.
Lanzieri CF. Head and Neck Case of the day. Dermoids of the submandibular spacc. Am J Roentgenol 1997; 169(1): 276-280.  Back to cited text no. 5
    
6.
KatzA. Midline Dermoid Tumors of the Neck Arch Surg 1974; 109: 822-823.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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