Surgical Removal of Epidermoid Cyst of Forehead... Limitless Borders for Maxillofacial Surgeons-a Case Report
Department of Oral and Maxillofacial Surgery, K.D. Dental College & Hospital, Mathura, UP India
ABSTRACT
An epidermoid cyst or epidermal inclusion cyst is a benign cyst usually found on the skin. The slow growing benign cysts develop out of ectodermal tissue. Epidermoid cyst may have no symptoms, or it may be painful when touched and release macerated keratin. The treatment of epidermoid cyst is surgical removal with entire removal of capsule to minimize the recurrence or minimize the chance of malignant transformation. Here we report a case of a 64 year male old patient with epidermoid cyst in forehead, total surgical resection of the cyst was done in department of Oral and Maxillofacial Surgery in K.D.Dental College and Hospital with optimal exposure to avoid recurrence.
KEYWORD-- Epidermoid cyst, total surgical resection.
INTRODUCTION
Epidermoid cyst is considered a benign lesion and usually affect the scalp regions, face, neck back or torso.1 The slow growing benign cysts develop out of ectodermal tissue. Epidermoid cyst may have no symptoms, or it may be painful when touched. Epidermoid cysts commonly result from implantation of epidermis into the dermis, as in trauma or surgery. They can also be caused by a blocked pore adjacent to a body piercing. Epidermoid cysts have prevalence for males and are seen in Gardner's syndrome and Nevoid basal-cell carcinoma syndrome.
Surgical resection is the only effective treatment, but the debate is still open regarding the advantages of a total resection versus a decompression procedure with subtotal resection.2
CASE REPORT
A 64 year old male patient reported to the department of Oral and Maxillofacial Surgery, K.D.Dental College and Hospital, Mathura with painless ovoid gradually progressive and persistent swelling on mid forehead region since 10 years. On clinical examination swelling was found about 3cm in diameter, well defined and firm on palpation. Patient had decided to seek expert help mainly for esthetic purpose. Computed tomographic scan and FNAC were performed. CT scan revealed 28x26x10mm large encapsulated homogenous extracranial mass in mid-forehead region. FNAC cytology revealed pultaceous material with presence of fat and no malignancy criteria.
Surgical debulking with capsule was planned, though it was a great challenge as esthetic was main concern of patient, also care had to be taken as cyst spillage may cause secondary infection (into intracranial space may cause meningitis) or limited resection causes higher risks of recurrence or chance of malignant transformation.
Horizontal skin incision was given parallel to hairline. After dissecting subcutaneous tissue, encapsulated cyst was removed very gently and sent for histological examination. Anterior table of frontal bone was curette very cautiously to remove any residue. Gelfoam was placed in dead space and subcutaneous suture was placed along the skin crease.
Histopathological examination showed cystic lumen lined by orthokeratinized stratified squamous epithelial cell suggestive of epidermoid cyst.
Figure 1: Pre-operative view
Figure 2: Cyst 3cm in diameter
Figure 3: Horizontal skin incision parallel to skin crease and dissecting subcutaneous tissue
Figure 4: Surgical debulking with capsule
Figure 5: Post Operative View after 1 month
DISCUSSION
Development of epidermoid cyst is multifactorial, but inclusion of ectodermal tissue into the skull during embryogenesis is one main hypothesis.3 It may arise secondary to trauma and may undergo malignant transformation.4 In our case we were not sure the actual cause of cyst, as there was no history of trauma it might be a possible congenital variety. There were no clinical signs of infection or malignant condition. Thorough physical examination and FNAC, helped us to rule out this with other pathological conditions like lipoma, salivary vascular lesion etc.
In consideration of the higher morbidity of recurrent epidermoid cyst, the latest studies take the view that total resection is associated with improved function and low mortality and should be recommended as the ideal goal of treatment.5,6
CONCLUSION
In the surgical point total debulking of epidermoid cyst with capsule is a challenging specially when patient is more anxious for esthetic though it dramatically reduces the risk of recurrence and malignant transformation.
DECLARATION OF PATIENT CONSENT
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
CONFLICTS OF INTEREST: There are no conflicts of interest
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How to cite this article
Dr. Soumendu Karak, Dr. Shishir Mohan Devki. Surgical Removal of Epidermoid Cyst of Forehead... Limitless Borders for Maxillofacial Surgeons-a Case Report. Guident. 2020 Oct;13(11). Available from: https://guident.in/articles/oral-surgery/surgical-removal-of-epidermoid-cyst-of-forehead-limitless-borders-for-maxillofacial-surgeons-a-case-report.html
