The Appendageal Wainscot- Dermoid Cyst

Epidermoid and dermoid cystsare developmental cysts which ensue from displacement ofembryologic tissue or sites of fusion of embryonic elementsand weredescribed by Roser in 1859.Congenital dermoid cysts are described as a dys-embryogeniclesions arising from entrapped ectodermal tissueduringgestational midlinefusionoffirst or secondbranchial arch. Acquireddermoid cysts were designated as “Implantation cysts” in 1895by Sutton and can be engendered bysurgical procedures, as a variant of thyroglossal duct cyst oras traumatic manifestationdisplaying entrapped surface epithelium and implanted epithelial cells of deep connective tissue with subsequent differentiation and configuration of a cyst. Dermoid cysts are commonly asymptomatic and secondary infection ensures the emergence of clinical symptoms. Dermoid cysts are soft, nodular, sessile lesions with an absent pedicle and are discerned on commonly enunciated onfacial regions such as the upper lip, gingiva, palate, uvula or as intra-oral lesions, although no site is exempt.

Misdiagnosing absent pedicle of cervical spine in the acute trauma setting

Congenital absence of cervical spine pedicle can be easily misdiagnosed as facet dislocation on plain radiographs especially in the acute trauma setting. Additional imaging, including computed tomography (CT)-scan with careful interpretation is required in order to not misdiagnose cervical posterior arch malformation with subsequent inappropriate management. A 39-year-old patient presented to the emergency unit of our university hospital after being trampled by a cow over her back and head followed by loss of consciousness, retrograde amnesia and neck pain. Her initial cervical CT-scan showed possible C5-C6 dislocation, then, it became clear that her problem was a misdiagnosed congenital cervical abnormality. Patient was treated symptomatically without consequences. The congenital absence of a cervical pedicle is a very unusual condition that is easily misdiagnosed. Diagnosis can be accurately confirmed with a CT-scan of the cervical spine. Symptomatic conservative treatment will result in resolution of the symptoms.