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.

Considerations in the management of congenital cranial dermoid cysts

OBJECTIVECongenital dermoid cysts (CDCs) develop from the entrapment of the surface ectoderm along the lines of embryonic fusion and have a capacity to grow. Given this capacity for continual expansion, the timing of removal and anticipation of possible epidural extension is important.METHODSThe authors retrospectively reviewed records of patients with the diagnosis of dermoid cyst presenting over a period of 10 years. Baseline characteristics, histological reports, and surgical records were collected and analyzed. Only those patients with histological confirmation of dermoid cyst were included in the study.RESULTSOne hundred fifty-nine (64 male and 95 female) patients were studied. The average age at the time of surgery ranged from 1 month to 63 years (mean 3.55 ± 9.58 years, median 11 months). Eighteen (11.3%) CDCs were in the midline anterior fontanelle, 52 (32.7%) were frontozygomatic, 14 (8.8%) occurred along the coronal sutures, and 75 (47.2%) occurred along the lambdoid sutures. In 74 (46.5%) cases the cysts were found to insignificantly erode the cranium, 30 (18.9%) eroded through a partial thickness of the cranium, 47 (29.6%) eroded through the full thickness of the cranium, and 8 (5.0%) eroded through the full thickness of the cranium and demonstrated epidural extension. The study population showed female predominance (n = 95, 59.7%). Although cyst location and patient sex were not found to vary significantly with cranial involvement (p = 0.196 and p = 0.066, respectively), delay in time to surgery did vary significantly (p < 0.00001).CONCLUSIONSCongenital cranial dermoid cysts found in infants and children are best removed early.

Congenital dermoid inclusion cyst over the anterior fontanelle: report of two cases

Congenital dermoid inclusion cyst over the anterior fontanelle (CDIC) is an uncommon cystic lesion. It is a benign and curative lesion. In these two cases a soft, cystic mass located over the anterior fontanelle. The cyst had no intracranial extension and was easily excised intact. The clinical and image findings of the cysts were described and compared with the usual dermoids. Many different types of lesions over the children's skull exist and some are commonly diagnosed in daily practice. Congenital dermoid inclusion cyst over the anterior fontanelle (CDIC) is a rare and benign lesion.Pulse Vol.7 January-December 2014 p.42-45