Dermoid cyst

Dermoid cyst, dermoid (dermoid) is a benign formation, from a group of chorister (teratom). The cavity cyst is formed as a result of displacement of the undifferentiated elements of the embryonic sheets under the skin and includes parts of the ectoderm, hair follicles, pigment cells, sebaceous glands.

Dermoids, mature teratomas are formed in violation of embryonic development (embryogenesis) and are formed along the lines of the developing parts of the fetal body, embryonic joints, folds, where there are all conditions for the separation and accumulation of embryonic sheets.

Most often, the dermoid cyst is located on the skin of the head, in the ocular cavity, in the oral cavity, on the neck, in the ovaries, in the retroperitoneal and pelvic area, pararectal tissue, less often the dermoid forms in the kidneys and liver, in the brain. Dermoid teratoma is usually small in size, but can reach 10-15 centimeters or more, it has a rounded shape, most often one chamber containing parts of undeveloped hair follicles, sebaceous glands, skin, bone tissue, crystallized cholesterol. The cyst develops very slowly, is not expressed by specific symptomatology, is characterized by a benign, safe current. However, a large dermoid can disrupt the functions of nearby organs due to pressure on them, in addition, up to 8% of diagnosed dermoid cysts are malignant, that is, they develop into epithelioma - squamous cell carcinoma.

[1]

Causes of a dermoid cyst

Etiology, the causes of dermoid cysts are studied so far, and basically the doctors are guided by several hypotheses. It is believed that dermoids are formed as a result of embryogenesis disorders, when some elements of all three folia embryonal - embryonic layers are preserved in the ovarian stroma. Neoplasm develops at any age, the causes of the dermoid cyst, which provoke its growth, have not yet been established. However, the versions of traumatic, hormonal factors are clinically confirmed, that is, the dermoid can develop as a result of a stroke, damage to the peritoneum or during the period of hormonal changes - puberty, menopause. The hereditary factor is not yet considered statistically confirmed, although genetics continue to study the phenomenon of failure in embryonic development, and its relationship to the formation of cysts.

The history of the study of the etiology and pathogenesis of dermoid formations began in the nineteenth century with veterinary medicine, when a well-known physician using animals, Leblen undertook the study of a hair follicle filled with hair follicles found in the horse's brain. In the future, the description of dermoid cysts has become widespread in "human" medicine, physicians have taken up the study of benign neoplasms consisting of residual elements of amniotic constrictions. According to the data to date, dermoid cysts occupy about 15% of all cystic formations and are etiologically explained by the generally accepted theory of impaired embryogenesis in three variants.

There are the following common causes of dermoid cysts: 

• Separation of cells of embryonic layers and their accumulation in the zones of separation of tissues at the embryonic stage (2-8 weeks).
• Separation of the blastomer at the earliest stage - in the division of the egg, later the elements of the three embryonic layers are formed from the separated blastomer.
• The bigerminale version is a violation of the initial stages of the division of the zygote (fertilized egg) or the pathology of the development of the twin embryo.

[2], [3], [4]

Pregnancy and dermoid cyst

As a rule, the first pregnancy and dermoid cyst are detected simultaneously, that is, the dermoid can be detected during the ultrasound of a pregnant woman. If the mature teratoma is not large, its size does not exceed 10 centimeters, the lesion is subject to observation, the operation, including laparoscopy, is not performed. A dermoid cyst that does not break the functions of nearby organs and does not grow during pregnancy, is removed after childbirth, or during a caesarean section.

It is believed that pregnancy and dermoid cyst are quite compatible with each other, according to statistics among the total number of benign formations on the ovaries, dermoids occupy up to 45% and only 20% of them are removed during the period of gestation.

The dermoid cyst most often does not affect the fetus and the very process of pregnancy, however, hormonal changes and displacement of organs can provoke its growth and cause complications - torsion, infringement, rupture of the cyst. Complicated dermoid cysts are tried to remove by laparoscopic method, but not earlier than 16 weeks. A special case is the large size of the cyst, its torsion or infringement, as a result of which necrosis and the clinic of the "acute abdomen" develop, such a tumor is removed urgently.

Also it is necessary to debunk the myth, which is very popular among pregnant women, the dermoid cyst does not dissolve in principle - under any circumstances. Neither pregnancy, nor alternative or medicamentous agents are able to neutralize the dermoid, so if the cyst did not interfere with the bearing of the child, it still has to be removed after childbirth.

Most often, when removing dermoid, a sparing, minimally invasive method is used - laparoscopy, the trasvaginal method is used less often.

Symptoms of the dermoid cyst

As a rule, small dermoid does not manifest itself clinically, it is due to its slow development and localization. Basically, the symptoms of dermoid cysts begin to be noticeable when the formation grows more than 5-10 centimeters, inflames, inflames or provokes pressure on neighboring organs, less often manifests itself as a cosmetic defect. Most often, the symptoms of the dermoid cyst are visible, if the tumor is localized on the scalp, it is difficult not to notice, especially in children. In other cases, the dermoid is diagnosed with an accidental or routine examination or with exacerbation, suppuration, twisting of the cyst. 

• Dermoid ovarian cyst. Neoplasm of more than 10-15 centimeters shifts or causes pressure of nearby organs, manifesting constant pulling aching pains in the lower abdomen. The abdominal cavity is strained, the abdomen is enlarged, the process of digestion is disrupted, urination becomes more frequent. An inflamed, purulent cyst can provoke an increase in body temperature, severe pain in the abdomen, a torsion or rupture of the cyst is clinically manifested by the symptoms of an "acute abdomen."
• Pararectal dermoid in the initial stage of development is not manifested by specific signs. Symptoms of the dermoid cyst are more noticeable if the cyst begins to press down the rectum, causing difficulties, pain during defecation. A characteristic feature is ribbon mass.
• The dermoid cyst of the mediastinum develops asymptomatically and can be detected on the x-ray in a planned or random survey. The clinic is noticeable only when the neoplasm presses on the pericardium, trachea, lungs, or provokes a percutaneous fistula. There is persistent shortness of breath, dry cough, cyanosis of the skin, transient tachycardia, with a large tumor size - protrusion of the cyst on the front wall of the chest.

What does the dermoid cyst look like?

It is easiest to describe external formation, although internal cysts differ little from external ones - in consistence of content, composition and density of the capsule, they are almost identical to each other.

The classical dermoid is a cavity surrounded by a dense capsule, the size of a small pea to 15-20 centimeters. As a rule, the dermoid formation consists of one chamber (cavity) filled with dense or soft contents from the keratinized parts, sweat glands, hair follicles, sebaceous elements, particles of the epidermis, bone. Dermoid cysts grow very slowly, but growth from can only be stopped by surgery, the cyst never dissolves and does not decrease in size. Over the past ten years, cases of malignization of dermoids have increased, especially if they are localized in the pelvic organs or in the peritoneum.

What does the dermoid cyst look like? It depends on the place of its localization: 

• Head area: 
  • The bridge of the nose.
  • Eyelids.
  • Lips (soft tissues of the mouth).
  • Neck (under the lower jaw).
  • Nasolabial folds.
  • The back of the head.
  • Fiber of the eye, periorbital region.
  • Ears.
  • Nasopharynx (in the form of dermoid polyps).
  • Rarely - the area of the temples.
• Other parts of the body, internal organs:
  • Stomach.
  • Buttocks.
  • Ovaries.
  • Anterior mediastinum.

Dermoid formation can form on the bone tissue, then it looks like a small concave fovea with distinct edges. Also, dermoids are very similar to atheromas, but unlike them, they are denser and not soldered to the skin, more mobile and have clear boundaries.

Dermoid ovarian cyst

Dermoid ovarian cyst is considered a benign neoplasm, which can be malignant in only 1.5-2% of all diagnosed cases. Mature teratoma, formed in the tissues of the ovary, looks like a dense capsule with contents from embryonic elements - fatty, sebaceous tissue, hair particles, bone, keratinized inclusions. The consistency of the capsule is quite dense, surrounded by a jelly-like fluid, the size of the cyst can be from a few centimeters to 15-20 cm. The etiology of cyst dermoids is unclear, but is most likely associated with abnormal embryogenesis at the stage of organ formation in the embryo. In addition, the mature teratoma develops and increases to visible ultrasound in the period of hormonal changes - at puberty or with menopause. Dermoid ovarian cyst is diagnosed with routine examinations, registration for pregnancy, according to statistics, it takes from 20% of all cysts and up to 45% of all benign tumors of the female body. The course of the disease as well as the prognosis are favorable, the cyst is treated only operatively.

[5], [6], [7]

Dermoid cyst of the brow

Mature overbrain teratoma is a congenital neoplasm of connective tissue that is diagnosed at an early age. The dermoid cyst of the superciliary arch deforms the soft tissues of the face, localizing in the region of the nose, above the eyebrows, in the middle of the forehead closer to the nose, on the back of the nose.

The clinic of the dermoid of the maxillofacial zone is always not specific in sensations, but visually clear from observations. The dermoid cyst of the brow is one of the most easily diagnosed neoplasms, since it has a typical disposition, is defined as the external deformation of the face in the early stages, usually in infancy. Often, the dermoid can be very small and unmanifested, and begins to develop rapidly in the puberty period, especially in boys. The cyst is sensitively mobile, not soldered with skin, sweaty, clearly limited and practically painless when palpated. Pain can arise as a signal of inflammation, festering cysts, in such cases, the surrounding skin is also inflamed, and the body responds to infection with common symptoms - from fever to nausea, dizziness and weakness.

The dermoid cyst is to be removed by surgery, if not done in a timely manner, the dermoid can deform the bone of the bridge of the nose, and form not only a cosmetic defect, but also internal pathological changes in the brain, nasopharynx.

[8], [9]

Dermoid eye cyst

Dermoid or hrististoma eyes - this is a benign neoplasm, most often congenital etiology. The dermoid cyst of the eye is localized in the upper part of the orbit - in the upper-lateral region, and manifests itself as a tumor of different sizes in the zone of the upper eyelid. Much less often the dermoid is located in the middle of the corners of the eyes, practically not found in the lower eyelid. The dermoid cyst of the eye is not accidentally called epibulbar, since in 90% it is localized over the eyeball (epibulbaris) - in the cornea, sclera, and on the apple, extremely rarely - on the cornea.

The benign dermoid of the eye has a rounded shape, looks like a dense, rather mobile capsule, not soldered to the skin, the cyst's leg is directed towards the bone tissues of the orbit. Education develops asymptomatically in the sense of uncomfortable sensations, it is painless, however, increasing in size, can provoke a pathological anomaly - microphthalmus or a decrease in eye size, abllyopia - various visual disturbances in the normal eye, not corrected by glasses ("lazy" eye).

The dermoid cyst of the eye is formed in the initial stage of embryogenesis, up to the 7th week, the neoplasm is a cluster of tissue rudiments in the form of a capsule with cystic contents of dermal, hair particles. These hair are often visible on the surface of the cyst and interfere with not only eyesight, but also a rather unpleasant cosmetic defect.

As a rule, dermoid hooristomy of the eye is diagnosed at an early age due to its visual appearance, the only slight difficulty is the differentiation of the dermoid and atheroma, the hernia of the brain. Dermoid is characterized by its asymptomatic and is never accompanied by dizziness, nausea and other brain symptoms. In addition, the X-ray reveals a dermoid "root" in the bone tissue with distinct edges.

Treatment of dermoid cysts of the eye is most often operative, especially with epibulbar cysts, the prognosis is favorable in 85-90% of cases, however, surgical intervention may somewhat reduce visual acuity further corrected with additional therapy, contact lenses or glasses.

[10], [11], [12]

Dermoid conjunctival cyst

The conjunctival dermoid cyst is a lipodermoid, a lipodermoid, named so, because unlike a typical cyst it does not have a capsule and consists of a lipid, adipose tissue clad in a stroma. In fact, it is a conjunctival lipoma of congenital poorly understood etiology, closely related to pathology, atrophy of the muscle lifting the upper eyelid (levator), as well as changing the location of the lacrimal gland. Most likely this is due to the intrauterine irritant effect on the fetus.

The dermoid cyst of the conjunctiva is considered to be benign choristoma and is 20-22% of all diagnosed eye tumors. Most often, lipodermoid is detected in children at an early age due to their apparent localization and a combination with other eye anomalies. In pathogenetic research or biopsy in the dermoid, as a rule, fatty elements, particles of sweat glands, and less often follicles of hair are found. Due to the fact that the content and the formation itself has a lipophilic structure, the dermoid cyst has the property of expanding into the cornea to its deepest layers. It looks like a dermoid conjunctiva cyst as a mobile, fairly dense tumor under the upper eyelid from the outside of the eye gap. Dimensions of the dermoid can be different, from millimeters to several centimeters, when the formation closes the eye and the lacrimal gland.

The dermoid develops very slowly, but progresses steadily, occasionally penetrating even the orbit of the eyeball up to the zone of the temple. With palpation and pressure, a large-sized dermoid moves easily into the orbital region.

As a rule, a biopsy to clarify the diagnosis is not required, and the conjunctival dermoid is treated only surgically. In this case, doctors try to minimize the risk of damage to the connective shell to avoid turning or shortening the eyelid.

[13], [14]

Dermoid cyst in the century

Most often, the dermoid cyst on the eyelid is localized outside or inside the upper skin fold and looks like a rounded formation of a dense consistency from the size of a small pea to 2-3 x centimeters in diameter. As a rule, the skin of the eyelid is not inflamed, the eyelid itself can maintain normal mobility if the dermoid is small and grows slowly. Cysts on the eyelids are rarely bilateral, the dermoid is located laterally, less often in the medial part of the eyelid and is well palpated in the form of a capsule-bound tumor, elastic, painless, rather mobile.

Diagnosis of the dermoid cyst of the eyelid is quite simple, as it is visible to the naked eye, rarely a biopsy is prescribed for clinical symptoms similar to those of a cerebral hernia. If the formation during palpation is not corrected, does not go deep, there is no dizziness, nausea and headache and radiography of the cyst shows its clear contours, the dermoid can be considered definite and subject to surgical treatment.

Usually the cyst is detected at an early age of up to 2 years and must be monitored regularly, as it develops extremely slowly and indications for immediate surgery are not urgent. If there is no sharp increase in the mobility of the eyelid, ptosis of 2-4 degree, there is no pressure on the eyeball or optic nerve, the dermoid cyst is operated on later in life at a later age, starting from 5-6 years, the intervention is performed under general anesthesia in a hospital. The course of dermoid development is benign in 95% of cases, the cyst ceases to grow as soon as the growth of the eye ends and in fact it represents only a cosmetic defect. However, there is a small risk of malignancy and the possibility of tumor progression (no more than 2%), so almost all ophthalmologists recommend removal of the dermoid at the first opportunity.

[15], [16], [17],

Dermoid cyst of orbit

The cyst of the orbit, which is diagnosed as dermoid, can develop for decades and begins to increase rapidly during the period of hormonal storms - in puberty, during pregnancy and with menopause. However, most often the dermoid cyst of the orbit is determined at the age of up to 5 years and amounts to 4.5-5% of all neoplasms of the eye.

The tumor is formed from undifferentiated epithelial cells that accumulate near the joint of bone tissue, the cyst is localized under the periosteum. The shape is rounded, often yellowish due to secreted cholesterol crystals from the inner wall of the capsule. Inside, lipid elements, particles of hair, sebaceous glands can be found. Most often, the dermoid is located in the upper quadrant inside the eye's orbit, without provoking a displacement of the eyeball (exophthalmos), if the cyst is located outside, it causes the exophthalmus of the apple down-inward.

The dermoid cyst of the orbit develops asymptomatically, complaints can only concern the puffiness of the upper eyelid and some inconvenience in blinking. Also, the formation can be located deep in the orbit, such a cyst is diagnosed as a Komleuk cyst, or a retrobulbar dermoid cyst. With this localization, the tumor provokes exophthalmos, the apple is displaced to the side opposite to the location of the cyst. In such situations, the patient can make complaints about the feeling of raspiraniya in the orbit, pain and headache.

Diagnosis of the orbital dermoid does not cause difficulties, it is immediately differentiated from cerebral hernia or atheroma, in which the tumor visually increases on inspiration, with inclinations and other physical efforts. In addition, atheromas and hernias are characterized by a slowing of pulsation with pressure, as the cavity of the cyst is permeated with blood vessels, which is not present in the dermoid with dense contents. An additional diagnostic and confirmatory diagnostic tool is computed tomography, which visualizes the localization, shape and clear contours of the cyst.

The orbital dermoid is treated with an operation that is performed according to the indications in case of rapid progression of the tumor, the danger of its suppuration or in connection with the violation of visual functions.

[18], [19], [20], [21], [22],

Dermoid cyst above the eyebrow

Benign neoplasm in the area of the eyebrow is most often a dermoid, that is, an innate cyst, filled with embryonic elements. The etiology of dermoid development has not been fully understood, but there is a theory adopted by many physicians that speaks of a violation of embryogenesis, when parts of the ectoderm are displaced and separated at an early stage of embryo formation. Over time, these elements are grouped and encapsulated by the epithelial membrane. Inside the cyst can be found parts of sebaceous and sweat glands, keratinized elements, cells of the hair follicle, bone tissue. Also in the cyst is a jelly-like lipid liquid and cholesterol crystals.

Surgeons argue that the arc zone is the most typical place that the dermoid cyst over the eyebrows chooses for itself. The size of education varies from millimeter parameters to 3-5 centimeters in diameter, the older a person is, the larger the dermoid, which increases parallel to the growth of the head.

The dermoid cyst above the eyebrow is removed at the age of 5-6 years, before it is observed and not touched. If the education does not cause harm, does not violate visual functions, does not get inflamed, it can be left under observation and longer. However, due to possible inflammation as a result of bruises, head trauma, concomitant infectious diseases and in order to exclude the risk of degeneration into a malignant tumor, the dermoid should be removed at the first opportunity and favorable conditions. The course and prognosis of dermoid cysts are usually favorable, relapse after surgery is rare if the cyst has not been removed completely.

[23]

Dermoid cyst on face

A favorite place that the dermoid cyst chooses for its location is the face, the head.

The dermoid cyst on the face, on the head can develop in such zones: 

• Edge of the eye.
• Glaznitsa (cyst of orbit).
• Hairy area of the head.
• Zone of superciliary arches.
• Eyelids.
• Whiskey.
• Nose.
• The oral cavity (bottom).
• Lips.
• Nasolabial folds.
• Ears.
• Neck (under the lower jaw).

The dermoid cyst on the face develops and grows very slowly, often for decades. Patients turn to the surgeon for help only in case of a sharp increase and an obvious cosmetic defect, less often in situations when the cyst is inflamed or inflamed. It is extremely rare neoplasm causes functional disorders, most often it happens with a cyst of the oral cavity - to talk and even take food becomes difficult.

Palpation of the cyst does not cause painful sensations, if the tumor is small, expanding, it can become inflamed, especially if it is located on the bottom of the mouth in the middle, in the hyoid bone or in the chin zone. Cysts of this kind seem to stick out under the tongue, interfering with its work (it rises).

Dermoids on the face are subject to surgical treatment, as a rule it is shown at the age of 5 years, not earlier. The operation is performed in a hospital under general anesthesia, taking into account the patient's state of health and size, the localization of the cyst. The course of the disease is favorable, relapses are extremely rare.

[24], [25], [26], [27]

Dermoid cyst of the angle of the eye

The dermoid of the corner of the eye is considered to be a completely benign entity and differs from other types of cysts by a favorable course and prognosis.

The dermoid cyst of the angle of the eye can have very small dimensions - from millet grains to fairly obvious, visually manifested formations of 4-6 centimeters. The main danger of dermoid in the eyes is the potential for germination in depth and a small percentage of malignancy (up to 1.5-2%). Also, external location and access to the cyst provokes the danger of her injury, inflammation and suppuration.

If the dermoid located in the corner of the eye does not interfere with vision, does not interfere with the development of the orbit, the eyelid does not provoke ptosis, it is observed and not treated until the age of 5-6 years. Cosmetic defect at an early age is not an unconditional indication to the operation, although in the future it can not be dispensed with. In addition, surgery is contraindicated in the presence of chronic diseases, cardiac pathologies, since radical treatment involves the use of general anesthesia.

In cases of growth of the cyst, its enlargement is performed excision (excision), especially when amblyopia develops (visual impairment). To tighten with treatment should not be, since the dermoid cyst of the angle of the eye can germinate further and affect the nearby tissues of the eyeball, the eyelids. Complications and relapses are possible, as well as after any other operation, but their risk is minimal and not comparable with the obvious benefit of removing the dermoid.

[28], [29], [30], [31], [32], [33]

Dermoid coccyx cyst

The dermoid of the sacrococcygeal zone due to the constant increase provokes the deviation of the coccyx and the appearance of symptoms similar to the epithelial coccygeal passage.

Previously, these diagnoses were identical and were treated equally, currently in clinical practice the diseases are differentiated and there are different definitions - dermoid coccyx cyst, coccyx fistula, pilonidal sinus and so on. There are no significant differences in the diagnosis, but due to their etiological characteristics these formations are still different, although the true causes of coccygeal dermoids have not yet been established.

Dermoid coccyx cyst, etiology.

In clinical practice, two versions of the development of dermoids in the sacrococcygeal region have been adopted: 

• The epithelial dermoid cyst is formed as a congenital, embryonic defect caused by incomplete degenerative formation (reduction) of ligaments and muscle tissue of the tail. 
• The dermoid of the coccyx develops due to pathological embryonic abnormalities and the separation of growing hair follicles penetrating the subcutaneous tissue of the coccygeal region.

It is interesting that static data show practically zero percent of the dermoid cyst in the coccygeal bone of representatives of the Negroid race, and a large percentage of representatives of Arab countries and Caucasians. The dermoid cyst in the coccyx is diagnosed mainly in men, women suffer it three times less often.

The localization of the dermoid is typical - in the middle of the interannual line with the end in the subcutaneous tissue of the coccyx with frequent opening in the form of a fistula (epithelial course).

Such a course provides a constant allocation of the contents of the cyst, and a blockage leads to its inflammation, infection. In the contents of the cysts, particles of hair, fat or elements of the sebaceous glands are found.

For the dermoid coccyx cyst, suppurations are characteristic, which provoke obvious clinical manifestations. Uncomplicated dermoid coccyx cyst can develop asymptomatically for years, rarely showing temporary pain with prolonged sedentary work. Suppuration provokes an increase in body temperature, throbbing pain, a person can not sit, bend, squat.

The dermoid of the coccyx is treated only in a radical way - by surgery, by excising the epithelial passage, scars and possible fistulas at the same time. Most often, surgery is performed under local, local anesthesia when the cyst is in remission, without suppuration. Further treatment involves taking antibiotics, sanation of the coccyx region, local anesthesia.

[34], [35], [36], [37]

Dermoid cyst on the head

Dermoid is the formation in the form of a cyst with a capsule and contents of hair elements, sebaceous glands, fats, bone tissue, keratinized particles, scales. The dermoid cyst on the head is the most frequent localization of benign forms of congenital etiology. The inner and outer walls of the cyst are most often structurally similar to the skin and consist of ordinary dermal layers - the cuticle, the epithelium.

A typical arrangement of dermoids on the head is as follows: 

• The upper eyelids.
• Corners of the eyes.
• Nasal bridge or zone of brow ridges.
• Lips.
• Ears.
• Nasolabial folds.
• The back of the head.
• Neck.
• The submaxillary region.
• The bottom of the oral cavity.
• Glaznitsa, conjunctiva of the eye.
• Rare cornea of the eye.

Since the dermoid cyst on the head is formed as a result of disturbed embryogenesis in places of embryonic furrows and branches, it is most often located in three regions: 

• Mandibular zone.
• Periorbital zone.
• Perinasal area.
• Less often dermoids are localized at the bottom of the oral cavity, in the tissues of the neck, temples, in the area of chewing muscles, on the cheeks.

The dermoids of the head, like all other benign congenital cysts, develop slowly and gradually, they can maintain their small size for many years without appearing clinically and without causing any discomfort, except cosmetic. Treatment of dermoid cysts of the head is carried out in an operative way, under stationary conditions under general anesthesia. The course and outcome of the operation are favorable, relapses are possible only in the case of a combination of dermoids with other tumor or inflammatory processes, as well as with incomplete excision of the cyst.

[38], [39], [40], [41]

Dermoid cyst on the neck

The dermoid cyst on the neck belongs to the group of congenital mature teratomas. Cystic cavity cavity is filled with dermoid-specific contents - hair follicles, keratinized scales, fatty, greasy elements, skin particles. Most often, neck dermoids are localized in the sublingual region or in the area of the thyroid-lingual passage. Geneticists studying the etiology of dermoids argue that the cysts of the neck are formed before the fifth week of embryo development, when the thyroid gland and tongue are formed.

The dermoid cyst on the neck is visible almost immediately after the birth of the child, however, small formations can go unnoticed due to typical infant folds. The cyst develops very slowly and does not interfere with the child, does not cause painful sensations. Pain can manifest itself in case of inflammation of the formation or its suppuration. Then there is the first sign - difficulty with swallowing food, then there is intermittent breathing.

The dermoid cyst of the neck located in the area of the hyoid bone provokes deformation of the skin, is visible to the naked eye, in addition, the cyst can be hyperemic and have an orifice in the form of a fistulous opening.

Dermoids of the neck are treated with surgery, which is rendered at the age of 5-7 years, earlier operative intervention is possible only under urgent conditions - risk of malignancy, acute inflammatory process or violation of the function of swallowing, breathing. Treatment of a cyst of this type is complex, the operation is performed under general anesthesia and may have complications due to the proximity of the cyst and many functionally important muscles.

[42], [43], [44], [45]

Dermoid cyst of the brain

Among all neoplasms of the brain, the dermoid is considered to be the most safe and well treatable.

The dermoid cyst of the brain is formed at the earliest time of embryogenesis, when the skin cells, whose purpose - the formation of the face, fall into the dorsal or brain. The etiology of all dermoids has not been completely clarified, but its congenital nature does not cause doubts among doctors. It should also be noted that dermoid formations are most often located on the surface of the head, but not in the brain itself, such cases are very rarely diagnosed, mainly in boys under the age of 10 years.

Typical localization, which is chosen by the dermoid cyst of the brain - is the cerebellopterygium angle or median structures.

Symptomatically, the cyst may not appear for quite a long time, pain and brain manifestations in the form of dizziness, nausea, coordination disorders are rare in the case of a sharp growth of the tumor or its proliferation, suppuration.

The method of treatment is only operational, the method is determined depending on the location and size of the cyst. Endoscopy or trepanation of the skull can be used. The outcome, as a rule, is favorable, the rehabilitation period is also rarely accompanied by complications. The dermoid of the brain is operated not earlier than 7 years according to the urgent indications.

[46], [47], [48]

Pararectal dermoid cyst

Para rectal dermoid cyst is a mature teratoma that contains elements of keratinized particles, hair, elements of sebaceous and sweat secretions, skin, crystals of cholesterol. The etiological causes of the pararectal dermoids are not specified, but it is believed that they are associated with embryonic developmental defects, when the embryonic leaves begin to separate into an atypical place for organ formation.

Clinically, the pararectal dermoid cyst is seen in the form of a round convex formation, painless feel. Such a dermoid quite often spontaneously breaks through, forming a fistula or even an abscess. Unlike the coccyx dermoid, the paraverctal cyst opens into the perineum or into the rectum.

Most often, the dermoid is diagnosed with a planned rectal examination using palpation, or in case of suppuration, inflammation. In addition to palpation, a sigmoidoscopy and fistulography are performed. It is believed that the coccygeal dermoid and the paraverctal cyst are similar in symptomatology, so you need to differentiate them, in addition, you must exclude tumors of the rectum, which are often combined with dermoids.

Pararectal formations are prone to malignancy more often than benign cysts located in other areas, so early diagnosis and timely operation are necessary conditions for minimizing the risk.

Dermoid cyst in a child

The dermoid cyst in a child, as a rule, is detected very early, in 60-65% of cases in the first year of life, in 15-20% in the second year, and extremely rarely in later periods. Bounded earlier is the identification of benign cysts with embryonic, dysontogenetic etiology, that is, education is formed in the pre-natal stage and is visible almost immediately after birth.

Fortunately, a dermoid cyst in a child is a rarity, among all benign neoplasms it is no more than 4%.

Dermoid in children is an organoid cyst, consisting of tissues of various structures, organs. In the capsule, hair follicles, particles of bone, nails, teeth, skin, sebaceous glands can be found. Cysts develop slowly, but constantly and can be localized on the head, in the eyes, coccyx, in the internal organs - in the ovaries, brain, kidneys. Accordingly, the dermoid cyst may be external or internal. Cysts increase without provoking clinical symptoms, but all of them are subject to excision at the age of 5-7 years, since they are potentially dangerous in terms of violation of the functions of nearby organs, in addition there is a risk of their development into malignant formations (1.5-2% of cases) .

[49], [50], [51], [52], [53]

Can a dermoid cyst resolve?

It is necessary to debunk the myth that dermoids can disappear on their own. The question is whether the dermoid cyst can be resolved can be considered unreasonable, because the very content of education suggests that the lipid elements, particles of the teeth, skin, bone parts, hair in principle can not disappear and dissolve in the body.

Of course, many try alternative methods, delaying the operation, especially if it concerns the child. However, one has to admit the fact that dermoids never dissolve either with medication or with herbal treatments.

Whether the dermoid cyst can resolve - definitely can not. Unlike cysts of a different kind, for example follicular ones, dermoids consist of a very dense capsule with such content that you only need to cut, as well as a diseased tooth, which are not capable of magic spells or herbal lotions to disappear by itself. Dermoids can and do not operate if they do not interfere with other organs and systems and the cosmetic defect does not cause an acute desire to neutralize it. Nevertheless, it is necessary to recall the risk of malignancy, that is, the potential for the dermoid cyst to grow into cancer, including squamous cell. Therefore, radical excision of cysts is the only way to get rid of it forever.

[54]

Relapse of the dermoid cyst

Dermoids are treated only operatively, as a rule, the outcome of the operation is favorable in 95% of cases. However, there are complications, including relapse of the dermoid cyst. This is possible under such circumstances and conditions: 

• Severe inflammation and suppuration of the cyst.
• Evacuation of purulent contents into nearby tissues upon rupture of the cyst.
• Incomplete excision of dermoid with unclear localization or strong growth in nearby tissues.
• Incomplete removal of the cyst capsule due to deterioration of the patient during surgery.
• At a laparoscopy cysts of the big size.
• With insufficient drainage of purulent contents.

As a rule, relapse of the dermoid cyst is rare, most often the operation is performed with minimal risk and traumatism, the seams are almost invisible and resolve quickly. Radical excision of the cyst is only indicated if the cyst is frozen in development, or after inflammation it is in the stage of persistent remission.

Treatment of dermoid cysts

Dermoids are subject to surgical treatment, as a rule, excision of such cysts is carried out from the age of 5-7 years and in a later period.

Treatment of the dermoid cyst suggests excision (excision) within the boundaries of healthy tissues, and a nearby area is less often excised to neutralize possible complications. Operative intervention is performed under general anesthesia, as well as under local anesthesia, for example, in the dermoid of the coccyx.

If the formation is small in size, treatment of the dermoid cyst does not exceed half an hour, more complex procedures are required for purulent cysts of large size.

Also, a long operation is assumed with a dermoid cyst of the brain.

Today, medical technologies are so perfect that after the intervention the patient can almost forget about the operation on the second day, especially the laser methods of cyst removal, endoscopy, laparoscopy.

In addition, surgeons tend to minimize traumas of nearby tissues, impose such virtuosic cosmetic sutures that even during surgery on the face the patient after a time forgets that he once had a cosmetic defect in the form of a dermoid. The operation consists in opening the cyst, evacuating the cystic contents and draining the cavity, if it becomes inflamed. Also, a deep excision of the capsule is possible to exclude recurrences of the cyst. Treatment of dermoid cysts has a favorable outcome and is considered one of the safest in surgical practice.

Laparoscopy of the dermoid cyst

Laparoscopy has long been popular because of its low traumatic efficiency. Currently, dermoid cyst laparoscopy is an ash standard in surgical practice, which is used to excise a dermoid of any size, even maximal to 15 centimeters.

With laparoscopy, the incisions are virtually bloodless, as surgeons use electrical, laser instruments and ultrasound. All this in a complex allows not only to control the process well, but simultaneously with the incisions to weld damaged tissues, processing their edges. Especially effective laparoscopy of the dermoid cyst during operation on the ovaries, as any woman tends to maintain a genital function and indeed, after half a year conception is quite possible and will not cause any complications. In addition, the laparoscopic method is also good in the cosmetic sense, because postoperative scars are almost invisible and resolve within 2-3 months without a trace.

The only area that can be treated with laparoscopy may not be appropriate: it is the brain, especially if the dermoid is located in a remote location. Then trepanation of the skull is inevitable, however, even with such surgical intervention, the prognosis is quite favorable.

Removal of the dermoid cyst

Removal of the dermoid cyst is possible only by a surgical method, the choice of which depends on the location of the tumor, its size, the state of health of patients and other factors.

As a rule, removal of the dermoid is carried out not earlier than the age of five, when Oragnimis is already able to tolerate both local and general anesthesia.

If the cyst has purulent contents, it is removed only after anti-inflammatory treatment and transition to the stage of persistent remission. When the formation develops slowly and without inflammation, the removal of the dermoid cyst is performed routinely by routine surgery or by laparoscopic method.

The cyst is opened, its contents are scraped, while the doctor makes sure that all the elements are evacuated without any rest to avoid relapses, so do the cysts with the capsule. Excision of capsular walls is important, especially if the cyst has grown in depth, into nearby tissues. Operative intervention is carried out within the boundaries of healthy tissues and lasts from 15 minutes to several hours with intervention in the brain (trepanation).

With small dermoids localized on the coccyx or head region (epidermal cysts), local anesthesia is possible, but small children who are unable to stay for long periods under operating conditions are subject to general anesthesia.

Removing the dermoid cyst is not only desirable, but mandatory, given the risk of suppuration, impaired function of many organs due to an increase in the dermoid, and due to the risk of malignancy, albeit low - only up to 2%.

Treatment of dermoid cyst by alternative means

Unlike other diseases that you can try to neutralize with phototherapy and non-traditional methods, treating dermoid cysts with alternative means is a myth. In addition to losing time and increasing the risk of suppuration, inflammation and transformation of the cyst into a malignant tumor, nothing else such treatment will not bring.

Dermoids are treated only in an operative way, as a rule, low-traumatic and effective. Lotions, compresses, decoctions, plots and other methods can not help, it's a fact that is not even disputed. No matter how much the person wants to avoid surgery, especially if it's a child, it will have to be done, because the dermoid is simply not able to dissolve because of its embryonic contents consisting of hair, fat, sebaceous elements, bone particles. Treatment of a dermoid cyst by alternative means does not replace a truly effective method - surgery.