Otolaryngology–Head and Neck Surgery (2010) 142, 288-289
CLINICAL PHOTOGRAPH
Postauricular epidermal cyst Fuat Buyuklu, MD, and Evren Hizal, MD, Ankara, Turkey No sponsorships or competing interests have been disclosed for this article.
A
57-year-old male presented to our clinic with an eightyear history of a slowly growing mass behind his right ear. There was no trauma or surgical intervention in his history. Physical examination revealed a 4 cm ⫻ 3 cm, nonfluctuant, mobile mass behind the right auricle (Fig 1). The overlying skin was blue-purple in color. CT scans revealed a mass with a dense content and no contrast enhancement. There was no invasion to the temporal bone or auricular cartilage. The mass was excised under local anesthesia, including the overlying skin. Pathological diagnosis was reported as epidermoid cyst. This paper has been approved by the Baskent University Health and Medical Sciences Institutional Review Board.
Discussion Differential diagnosis of a postauricular swelling include congenital etiologies such as first branchial cleft cysts, sinuses, and torticollis pseudotumor; acquired cysts after ear piercing; inflammatory conditions such as complicated mastoiditis and subperiosteal abscess; reactive, granulomatous or neoplastic/metastatic lymph node enlargements; reactive bone formation, bony fracture segment or calcified hematoma in patients with a history of trauma; cholesteatomas presenting in the postauricular area after erosion of the mastoid cortex; neoplasms involving the mastoid bone, facial nerve, sternocleidomastoid muscle, jugular paraganglia, and the tail of the parotid gland; and benign cutaneous masses such as lipoma, epidermoid/dermoid cysts, pilar cysts, and sebaceous cysts.1-4 Epidermoid cysts result from the proliferation of epidermal cells within the dermis or superficial subcutaneous tissue. As true cysts, epidermoid cysts have an epithelial lining and the origin of the epidermal cells is thought to be the follicular infundibulum of the hair shafts. Epidermoid cysts show a spherical or elliptical growth pattern. The cavity of the cyst generally contains fluid, cellular products, or debris. These cysts may arise
Figure 1 Preoperative photograph of the nonfluctuant, mobile mass behind the right auricle.
either spontaneously or secondary to a trauma in all age groups after puberty and cause mainly cosmetic problems. If they appear rarely before puberty or in large numbers, Gardner’s syndrome should be suspected. Although rare, malign degeneration was reported to develop from epidermal cysts.5 CT and MRI are useful for diagnosis and preoperative planning. Intraoperative electrophysiological nerve monitoring should be considered for lesions that extend toward the course of the facial nerve. The treatment of the epidermoid cysts is surgical excision with careful dissection and removal of the entire cyst wall.
Received August 14, 2009; revised August 23, 2009; accepted October 14, 2009.
0194-5998/$36.00 © 2010 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. doi:10.1016/j.otohns.2009.10.016
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Postauricular epidermal cyst
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Acknowledgment
Disclosures
We would like to thank Ozcan Cakmak, MD, for his valuable contribution to the preparation of this text.
Competing interests: None.
Author Information From the Department of Otorhinolaryngology, Baskent University Faculty of Medicine, Ankara, Turkey. Corresponding author: Evren Hizal, MD, Baskent Universitesi Tip Fakultesi, Kulak Burun Bog˘az Anabilim Dali, 6. Cadde No:72/2, Bahcelievler/ Ankara. E-mail address:
[email protected].
Author Contributions Fuat Buyuklu, surgeon, writer; Evren Hizal, data collection, writer, reviewer.
Sponsorships: None.
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