Iatrogenic cholesteatoma of the neck

Aural cholesteatoma with upper neck extension

We report the case of a 32-year-old Chinese woman who presented with a large cholesteatoma in her right upper neck after a history of ipsilateral chronic otitis media since childhood. Intraoperatively, a cholesteatoma was found in the mastoid cavity, and the mass in her neck was attached to the mastoid cortex by a stalk. Direct erosion of the mastoid tip may have led the cholesteatoma epidermis to enter the deep surface of the sternocleidomastoid muscle, allowing debris accumulation to form the mass, similar to the propagation of pus in a Bezold's abscess. Neck cholesteatoma secondary to aural cholesteatoma is fairly rare. Only five reports were identified before 1989 followed by no reports in the past 20 years. The case we reported is a reminder to otolaryngologists that this unusual condition still occurs.

Iatrogenic epidermal inclusion cyst of the parapharyngeal space: unusual complication of ear surgery

A 46-year-old man presented with a 12-month history of a slow-growing mass at the right anterior temporal and superior parotid region. He had a history of chronic otitis media and had undergone a modified radical mastoidectomy for cholesteatoma 5 years earlier. Physical examination revealed a sinus tract and diffuse soft tissue mass measuring 4 cm in diameter spread throughout the region of the right anterior temporal and superior parotid areas. Magnetic resonance imaging (MRI) showed three separate masses, including contrast material in the right superior parotid region and lateral skull base. The patient underwent a preauricular infratemporal approach. Six months later, a sinus tract recurred at the inferior border of the right zygomatic arch. MRI showed multiple masses in the right prestyloid parapharyngeal space, which were resected through a transparotid approach. The histopathologic diagnosis was an epidermal inclusion cyst (EIC). One year after the operation the patient was in good health and there was no sign of disease. EICs are rare tumors that are seen when epidermal elements are included in the dermis, which can follow trauma. EICs are unusual in the parapharyngeal space. Thus, until they become clinically observable, primary benign growths may not be recognized in this region. EICs must be considered in the differential diagnosis of growths in the parapharyngeal space, particularly among patients with a prior history of tympanomastoid surgery on the tumor side.

Posttraumatic epidermal inclusion cyst of the deep infratemporal fossa

The authors report a case of an epidermal inclusion cyst found in the deep infratemporal fossa 12 years after the patient sustained blunt trauma to that region. Posttraumatic epidermal inclusion cysts are rare and occur mainly in the fingers, palms, and soles. Introduction of the epidermal elements into the dermis during the trauma is thought to be the cause. This case is rare in presentation, with few reports in the English literature that describe an epidermal inclusion cyst in the deep infratemporal fossa. Review of the English literature disclosed no other cases of epidermal inclusion cyst after blunt trauma involving the deep infratemporal region.

Posttraumatic gluteal epidermal cyst with ischiorectal and presacral extension

An unusual case of rapid-growing posttraumatic gluteal epidermal cyst with ischiorectal and presacral extension is reported. Pertinent clinical history and magnetic resonance imaging allowed accurate preoperative diagnosis. Cautious complete excision was important to prevent recurrence. To our knowledge, posttraumatic gluteal epidermal cyst with this unusual clinical presentation has not been described previously.

Iatrogenic epidermoid cyst of the parotid region following ear surgery

Iatrogenic implantation of squamous epithelium may result in formation of an epidermoid cyst. These cysts have been described in various sites around the head and neck following otological procedures. A case of iatrogenic epidermal cyst in the parotid region following repeated myringoplasty is reported. The clinical features and differential diagnosis are discussed.