parotid dermoid a rare case

1. Dr. Nikesh M Gosrani
PG RESIDENT,
IGGMC, NAGPUR

2. HISTORY
 19 yr old male
 c/o swelling on
right parotid region
since 9 years
 Increasing gradually

3. HISTORY
 Past history - not significant
 Family history - not significant
 Personal history - chronic gutka chewer

4. GENERAL EXAMINATION
 GC- mod
 Afebrile
 P-74/min
 BP- 120/80 mmHg
 No pallor/clubbing/cyanosis/icterus/edema
 No significant cervical lymphadenopathy

5. Systemic Examination
 Respiratory system -NAD
 Cardiovascular system - NAD
 Gastrointestinal system - NAD
 Central Nervous System - NAD

6. LOCAL EXAMINATION
 Swelling in rt parotid
 size 4x3cm
 Soft ,cystic ,mobile non
 Fluctuant
 No s/o inflamation
 Overlying skin
normal

7. LOCAL EXAMINATION
 Facial nerve normal examination b/l
 Oral cavity -NAD
 Nose -NAD
 Ear -NAD

8. INVESTIGATIONS
 Hb - 12.9 gm%
 TLC - 8800/mm
N-56%,L-38%,E-3%,M-3%
 Bld. Urea - 16 mg%
 Urine – N.

9.  FNAC - inconclusive
 USG LOCAL- mild heterogenous lesion
in right parotid
size 4x3x4 cm on superficial lobe
? Pleomorhic adenoma
 Differential Diagnosis :
Rt parotid pleomorphic adenoma
Warthins tumor
Dermoid
Branchial cleft cyst
Branchial pouch cyst
 Advice operation :superficial parotidectomy

10.  Intraoperational findings :
 Mass 4x3x4
 Unilocular cyst
 Opaque grey white
 Dense fibrous wall

11.  Histopathology report :
 Cyst wall - stratified squamous
 Underlying sebaceous glands
 With hair follicles
 s/o d=Dermoid

12. Discussion
 Also called Epidermal cyst.
 Dermoid cyst of head & neck rare (6.9% of all dermoid cyst)
Orbit 49.5%,
nose 12.6%,
submental & submaxillary region 23.3 %
remainder 14.6%
 Initially Based on pathogenesis & microscopic appearance
 Congenital dermoid - teratoma type(ovaries & testes)
 Acquired dermoid cyst (hands & other exposed parts)
 Congenital inclusion dermoid (head & neck).
a.nasooptic groove
b.nose (frontonasal plate)
c.submental & submaxillary region
d.miscellaneous group(midventral or middorsal line )

13. Discussion
 Now 4 types of Dermoid – Sequestration dermoid
Implantation dermoid
Tubulo dermoid
Teratomatous dermoid
 Sequestration – inclusion of epithelium burried at line of
embryonic fusion eg; near head & neck
 Implantation dermoid- indriven epithelium beneath skin due
to puncture injury eg ; exposed part of body
 Tubulodermoid – cyst from unobliterated portion of
congenital ectodermal duct or tube eg;thyroglossal
cyst,post anal cyst,ependymal cyst in brain
 Teratomatoid dermoid – from totipotent cells eg; ovary,testis

14. Discussion
 Parotid dermoid – rare entity
 Clinicallydifficult to make diagnosis
 Physical examnation – no characterstic findings
 Isolated mass, near surface or within gland
 Histologically –keratization of squamous epithelium,
a/w skin appendages – hair follicles,sweat glands,
sebaceous gland
 Parotid dermoid relatively well encapsulated
 Simple excision may recur so superficial
parotidectomy is advisable

15. Conclusion
 Parotid extremely rare
 Due to rarity & absence of pathognomonic findings ,
difficult to diagnose preoperatively
 Must be differentiated from malignant tumors & other
cystic lesion
 Recur after simple excision so superficial
parotidectomy is advisable