Occurrence and Characteristics of Head Cysts in Children

Noam Armon, MD; Sivan Shamay, MD; Alexander Maly, MD; Alexander Margulis, MD

Disclosures

ePlasty. 2010;10:e37 

In This Article

Results

Eighty-nine children met the criteria for inclusion. They underwent surgery for 90 cysts (one child had 2 cysts). The cysts were classified into 4 different categories: dermoid cyst, pilomatrixoma, branchial cyst, and epidermal cyst.

Fourteen children (15.5%) had preoperative imaging: 12 patients (13.3%) underwent computed tomography (CT) and 3 patients (3.3%) underwent ultrasonography (US). One patient had both CT and U/S performed prior to the surgery.

Only 1 patient presented with a history of infection (an abscess). The average age for presentation was 16 months for the dermoid cysts and 5.4 years for pilomatrixomas. Children with branchial cysts (5 patients), presented at the average age of 6.85 years.

The treatment was site dependent, with all lesions removed by direct excision and layered closure.

Diagnosis

The preoperative diagnosis was based on the patient's history, physical examination, and radiographic studies. The pathology slides were reviewed by an expert dermatopathologist to determine the final diagnosis.

Of the 90 cysts, 53 (58.88%) were diagnosed as dermoid cysts, 16 (17.77%) were diagnosed as pilomatrixomas, 5 (5.55%) were diagnosed as branchial cysts, and 12 (13.33%) were diagnosed as epidermal cyst.

Location

Of the 53 dermoid cysts, 47 (88.67%) were located at the lateral eyebrow, 2 (3.7%) were located in the medial eyebrow or at the nasal bridge, 2 (3.7%) were located in the midforehead, and 1 (1.8%) was located preauricularly. One cyst (1.8%) was located in the upper forehead above to the coronal suture. Of the dermoid cysts, 94% were located along the coronal suture, as opposed to only 35% of the nondermoid cysts (P <.01).

This difference in location also manifested as a significant predictor of the cyst type by the physician (P <.01).

In 91% of the boys with dermoid cysts, the cyst was located along the coronal suture. Only 33% of girls with dermoid cysts had a location along the coronal suture (P <.01).

Male gender and younger age were significantly associated with correct diagnosis of dermoid cysts (P <.05).

Of the 16 pilomatrixomas, 7 (43.75%) were located in the cheeks, 7 (43.75%) were located in the eyebrows, 1 cyst (6.25%) was located preauricularly, and 1 cyst (6.25%) was located on the nasal dorsum.

Of the 5 branchial cysts, 4 (80%) were located preauricularly and 1 (20%) was located postauricularly.

The 12 epidermal cysts were located as follows: 1 (8.3%) in the scalp, 2 (16.6%) in the cheek, 1 (8.3%) in the midforehead, 1 (8.3%) in the temporal area, 3 (25%) in the eyebrows, 1 (8.3%) preauricularly, and 3 (25%) postauricularly (Table 1).

Correlation between the Clinical and the Pathological Diagnosis

In 78% of the cases, the preoperative diagnosis correlated with the histopathological diagnosis.

Ninety-five percent of the dermoid cysts and 100% of the branchial arch cysts were diagnosed correctly prior to the surgery. On the other hand, only 36% of the pilomatrixomas and none of the epidermal cysts had a correct clinical preoperative diagnosis. Most of the pilomatrixomas were erroneously diagnosed clinically as dermoid cysts (27%), nonspecific cysts (27%), or sebaceous cysts (8%).

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