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Dr. Nikesh M Gosrani PG RESIDENT, IGGMC, NAGPUR

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

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

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

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

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

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

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

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 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

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

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

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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 )

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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

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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

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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