Giant Dermoid Cyst of the Face: Clinical Image, Diagnosis, Surgical Management

 

Introduction

A dermoid cyst is a benign congenital lesion resulting from inclusion of ectodermal elements during embryological development. It is lined by stratified squamous epithelium and contains skin appendages such as hair follicles and sebaceous glands.

Although dermoid cysts are usually small and detected early, long-standing neglected lesions may grow to a giant size, causing significant cosmetic deformity and psychological distress.

This post highlights a clinically encountered giant dermoid cyst of the face, its diagnosis, importance, and management.

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Clinical Presentation

• Long-standing, painless facial swelling
• Gradual increase in size over several years
• Smooth, well-defined, dome-shaped mass
• Firm to cystic in consistency
• Skin stretched but intact
• No ulceration or discharge
• No facial nerve weakness

The images above show a giant dermoid cyst involving the left cheek, producing marked facial asymmetry.

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Provisional Diagnosis

Giant Dermoid Cyst of the Face (Cheek)

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Why Is It Important?

Although dermoid cysts are benign, giant lesions can cause:

• Severe cosmetic deformity
• Pressure effect on adjacent structures
• Risk of secondary infection
• Psychological and social impact

Early diagnosis and complete surgical excision are essential to prevent complications and recurrence.

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Differential Diagnosis

Condition	Key Feature
Epidermoid cyst	No skin appendages on histology
Sebaceous cyst	Central punctum present
Lipoma	Soft, lobulated, non-cystic
Neurofibroma	Button-hole sign
Benign salivary tumor	Arises from parotid region

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Management (Standard of Care)

✔ Complete surgical excision
✔ Removal of cyst with intact capsule
✔ Meticulous dissection to preserve facial nerve branches
✔ Histopathological examination mandatory

❌ Incision and drainage or partial excision leads to recurrence.

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Operative Findings

• Well-encapsulated large cystic mass
• Thick cyst wall
• Keratinous contents
• Complete en-bloc excision achieved

The post-operative image shows the entire excised giant dermoid cyst specimen.

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Histopathology

• Cyst lined by stratified squamous epithelium
• Presence of sebaceous glands and hair follicles, cartilage

Final Diagnosis:
✅ Dermoid Cyst

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Post-Operative Outcome

• Uneventful recovery
• Excellent cosmetic correction
• No facial nerve deficit
• No recurrence on follow-up

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Teaching Point (For Exams & Practice)

Dermoid cyst is a congenital lesion, but delayed presentation can result in giant size and cosmetic deformity. Complete excision with intact capsule is curative.

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Author

Dr. Partha Pratim Mandal
MS (General Surgery)
Associate Professor of Surgery
Consultant Surgeon
West Bengal, India

Copyright / Disclaimer

Images and clinical details are shared strictly for educational purposes only.
Patient identity has been fully protected.