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A Rare Case Of Parotid Dermoid. Dr. Nikesh M Gosrani PG RESIDENT, IGGMC, NAGPUR. HISTORY. 19 yr old male c/o swelling on right parotid region since 9 years Increasing gradually. HISTORY. Past history - not significant Family history - not significant

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a rare case of parotid dermoid

A Rare Case Of Parotid Dermoid

Dr. Nikesh M Gosrani

PG RESIDENT,

IGGMC, NAGPUR

history
HISTORY
  • 19 yr old male
  • c/o swelling on right parotid region since 9 years
  • Increasing gradually
history1
HISTORY
  • Past history - not significant
  • Family history - not significant
  • Personal history - chronic gutka chewer
general examination
GENERAL EXAMINATION
  • GC- mod
  • Afebrile
  • P-74/min
  • BP- 120/80 mmHg
  • No pallor/clubbing/cyanosis/icterus/edema
  • No significant cervical lymphadenopathy
systemic examination
Systemic Examination
  • Respiratory system -NAD
  • Cardiovascular system - NAD
  • Gastrointestinal system - NAD
  • Central Nervous System - NAD
local examination
LOCAL EXAMINATION
  • Swelling in rt parotid
  • size 4x3cm
  • Soft ,cystic ,mobile non
  • Fluctuant
  • No s/o inflamation
  • Overlying skin normal
local examination1
LOCAL EXAMINATION
  • Facial nerve normal examination b/l
  • Oral cavity -NAD
  • Nose -NAD
  • Ear -NAD
investigations
INVESTIGATIONS
  • Hb - 12.9 gm%
  • TLC - 8800/mm

N-56%,L-38%,E-3%,M-3%

  • Bld. Urea - 16 mg%
  • Urine – N.
slide9

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 DermoidBranchial cleft cyst Branchial pouch cyst
  • Advice operation :superficial parotidectomy
slide10

Intraoperational findings :

  • Mass 4x3x4
  • Unilocular cyst
  • Opaque grey white
  • Dense fibrous wall
slide11

Histopathology report :

  • Cyst wall - stratified squamous
  • Underlying sebaceous glands
  • With hair follicles
  • s/o d=Dermoid
discussion
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 )

discussion1
Discussion
  • Now 4 types of Dermoid – Sequestration dermoid Implantation dermoidTubulodermoidTeratomatousdermoid
  • 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;thyroglossalcyst,post anal cyst,ependymal cyst in brain
  • Teratomatoiddermoid – from totipotent cells eg; ovary,testis
discussion2
Discussion
  • Parotid dermoid – rare entity
  • Clinicallydifficultto 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
conclusion
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