Definition & Overview
A dermoid cyst is a growth of tissue in or on the skin layer. It typically contains hair, fluid, teeth, and even skin glands, depending on its location. It can occur anywhere in the body, though it is usually found in the face, back, nasal sinuses, ovaries, and even in the spinal cord or the brain. In some cases, the dermoid cyst can even contain blood, fat, nails, and thyroid tissue. These cysts arise from germ cells present at birth and develop abnormally after some time, often painless and with no associated symptoms. These cysts, which can affect people of any age from any background, are usually benign though some malignant cases are reported from time to time.
Dermoid cyst excision is an outpatient procedure that removes these cysts.
Who Should Undergo and Expected Results
The procedure is recommended for patients with dermoid cysts:
- On the face, which can be usually removed without complications
- In the brain, which rarely occur. In cases where these cysts have to be removed, the procedure is carried out by a neurosurgeon.
- In the nasal sinuses, which also rarely occur. However, if they do, they are taken out through a complicated procedure.
- In the ovaries, which can develop in a woman during her reproductive years and can lead to infection, torsion, rupture, and in rare cases, cancer.
- In the spinal cord
It is important to note that the excision of dermoid cysts is not immediately offered upon diagnosis and doctors may initially recommend a wait-and-see approach. However, the procedure is highly considered when the cyst becomes bigger, starts changing in colour, or becomes infected leading to inflammation and development of pus. This can be quite painful and can disrupt normal daily activities.
Dermoid cyst excision generally has a good prognosis, with high success rate and rare associated complications. Patients can go home and resume normal activities after the procedure. Depending on the need, the excised dermoid cyst may be sent to a pathology lab for examination. If the cyst is determined to be malignant, additional procedures may be prescribed to address the patient’s condition. Meanwhile, the excision of internally located cysts, such as ovarian or spinal cysts, may require a few days of rest or recuperation before resuming daily tasks.
How is the Procedure Performed?
For dermoid cysts occurring externally, the skin over the site is cleansed with antiseptic and topical anaesthesia may be applied. An incision is then made in the centre of the cyst and hemostat is used to apply compression, allowing cyst contents to pass through the opening. The hemostat is then removed and the surgeon manually squeezes out the cyst. If there are remaining cyst materials, the hemostat can be inserted again and the process is repeated until all components are completely removed. Care is taken to make sure that all fat or sebaceous tissues are taken out to avoid recurrence or spread of the cyst to nearby parts.
After removing the cyst material, the hemostat is reinserted to remove the entire sac covering the cyst. The sac has to be detached from the surrounding tissue and gently pulled out through the incision opening. If the sac breaks, the process is repeated until the cyst sac is completely removed. For small sized cysts, the wound is covered with antibiotic ointment and gauze. The patient is asked to hold down the gauze for a few hours to encourage wound closure. For larger incisions, the surgeon may need to close them using sutures.
For internally occurring dermoid cysts, incisions are made on the surface near the affected part where a laparoscope is inserted for visualisation. Special tools are also inserted and guided into the location of the cyst. The cyst is then detached from the surrounding tissue and slowly taken out. If there is a need, the surgeon may use sutures to close the incisions.
Possible Risks and Complications
Risks and complications of dermoid cyst removal are rare, but a small percentage of patients may experience the following:
- Excessive bleeding in the surgical site
- Infection and pus formation
- Spread of fat tissue around the cyst into the cerebral fluid, especially for patients with spinal dermoid cyst
- Recurrence and spread of the condition
- Remaining dermoid cyst tissue transforming into a malignant tumour
Tas A, Yagiz R, Altaner S, Karasalihoglu AR. Dermoid cyst of the parotid gland: first paediatric case. Int J Pediatr Otorhinolaryngol. 2010 Feb. 74(2):216-7.
Bonilla JA, Szeremeta W, Yellon RF, Nazif MM. Teratoid cyst of the floor of the mouth. Int J Pediatr Otorhinolaryngol. 1996 Dec 5. 38(1):71-5.