Skip to main content
NCBI home page
Journal of Maxillofacial & Oral Surgery logoLink to Journal of Maxillofacial & Oral Surgery
. 2012 Jul 24;14(Suppl 1):176–185. doi: 10.1007/s12663-012-0408-0

An Unusual Case of a Recurrent Seborrheic/Epidermal Inclusion Cyst of the Maxillofacial Region

Priya Jeyaraj 1,✉, N K Sahoo 1
PMCID: PMC4379255  PMID: 25838695

Abstract

A Seborrheic or epidermal inclusion cyst is basically an epidermoid cyst resulting from the traumatic implantation of epidermal elements into the dermis with their subsequent cystic transformation. A case of an epidermal inclusion cyst of the chin region is described in a 72 year old male, whose features were rather unusual, in that it presented as a fixed, indurated, inflamed, and extremely painful swelling associated with two draining extraoral sinuses, mimicking a submental space infection. The cyst was particularly persistent and recurred within a month of its excision and had to be re-excised along with the overlying epithelium.

Introduction

The terminology and nomenclature of the epidermal inclusion cyst is numerous and varied, and includes epidermal cyst, epithelial cyst, keratin cyst, follicular infundibular cyst, Seborrheic cyst, sebaceous cyst, milia and so on [1]. It is basically an epidermoid cyst resulting from the traumatic implantation of epidermal elements into the dermis with their subsequent cystic transformation [2, 3]. It represents one of the most common cutaneous cysts. An epidermal inclusion cyst (EIC) can be described as a dermal cystic enclosure of keratinizing squamous epithelium that is filled with keratin debris [4]. The terms traumatic epidermoid cysts and EIC describe the same phenomenon, and both indicate a traumatic etiology [2, 3].

Epidermal inclusion cysts usually present as a firm, slow-growing, smooth, freely movable, painless mass or lump underneath the skin at the subcutaneous-dermal level, with an intact skin surface with no apparent drainage point. They contain soft, cheesy-like skin secretions. They usually appear on the scalp, face, neck, chest, upper back, genitals, or behind the ears. They are also often observed in the fingers, palms, and soles [3]. They are usually indolent in nature, slow to progress and remain asymptomatic; however, they may become inflamed or secondarily infected, which is partly due to chemotaxis induced for polymorphs by horny layer in the cyst, resulting in an increase in size and tenderness. They are treated by simple pericapsular excision without the need to excise the overlying epithelium and recurrence is rare.

A case of an epidermal inclusion cyst of the chin region is described, whose features were rather unusual, in that it presented as a fixed, indurated, inflamed, and extremely painful swelling associated with two draining extraoral sinuses, mimicking a submental space infection. The cyst was particularly persistent and recurred within a month of its excision and had to be re-excised along with the overlying epithelium.

Case Report

A 72 year old male patient reported with the complaints of a painful swelling under the chin for the past one month, which had been slowly increasing in size with discharge of pus from it. On examination, there was a single, localized, ovoid swelling below and on the lateral aspect of the chin on the left side extending from the symphyseal to the submental region, measuring approximately 4 × 3 cm in size (Fig. 1a, b). The swelling had diffuse and indistinct borders and the surface showed the presence of two extraoral sinus openings, one above and one below the inferior border of the mandible, which discharged foul smelling, purulent material (Fig. 2a, b). The swelling was firm, tender, fixed to the underlying and adjacent tissues and the overlying skin was stretched and nonpinchable. There was induration around both the extraoral sinuses. Two submandibular lymph nodes were palpable on the left, which were tender and freely movable. On intraoral examination, the patient was completely edentulous and the swelling extended intraorally from 41 to 34 region, with obliteration of the mucolabial fold and vestibular sulcus. Intraoral periapical and occlusal radiographs as well as extraoral posteroanterior and lateral radiographs of the mandible and orthopantomogram revealed absence of any bony involvement or pathology, with intact labial, buccal and lingual cortices and a normal trabecular pattern of the cancellous bone and an undisturbed contour and morphology of the inferior border of the mandible.

Fig. 1.

Fig. 1

Open in a new tab

72 Year old patient with an inflamed swelling in the mental region

Fig. 2.

Fig. 2

Open in a new tab

Two extraoral sinus openings draining foul smelling, purulent material

Clinical impression was that of a submental space infection with discharging sinuses. The differential diagnosis included a secondarily infected submental dermoid cyst, infected epidermoid or sebaceous cyst, or submental lymph node enlargement secondary to a granulomatous disease such as cat-scratch disease or lymphoma, tuberculous lymphadenitis (scrofula) or HIV-related lymphadenopathy.

After a routine haemogram, urine examination and examination for HIV and HbsAg, an intraoral incisional biopsy was carried out after aspiration of the contents of the swelling using a wide bore needle. The aspirate, which was cheesy, yellowish-white in colour with a semisolid, granular, paste-like consistency, was sent for protein estimation (Fig. 3a, b). The total protein content was determined from cellulose acetate electrophoresis and was found to be high, 14.3 mg/g wet weight. Histopathologic examination of a biopsy specimen showed the presence of a cyst lining composed of keratinizing stratified squamous epithelium, desquamated keratin contents filling the lumen and a fibrous connective tissue wall containing no skin appendages, which confirmed the diagnosis of an epidermoid or epidermal inclusion cyst (Fig. 4). There also was a rich infiltration of polymorphonuclear leukocytes and lymphocytes, suggestive of secondary infection and inflammation.

Fig. 3.

Fig. 3

Open in a new tab

Cheesy-white granular aspirate with a protein content of 14.3 mg/g wet weight

Fig. 4.

Fig. 4

Open in a new tab

H&E section ×40, showing a cystic lining composed of keratinizing stratified squamous epithelium, desquamated keratin within the lumen and a fibrous connective tissue wall with an inflammatory cell infiltration

The patient was taken up for complete excision of the cyst, together with sinus tract excision via combined transoral–transcutaneous approaches (Fig. 5a, b). An intraoral incision was placed from incisor to bicuspid region on the left and submucosal dissection was carried out exposing the cyst. Cheesy, keratinous material extruded through the not so well defined cyst wall, which showed extensive fibrosis with the surrounding tissues and had to be separated by meticulous sharp dissection. Excision proceeded down up to the buccal cortex of the symphyseal region, where a bony window was made to rule out intrabony extension or origin of the lesion. After excision of the entire cyst (Fig. 6), the sinus tracts were carefully dissected free from the surrounding tissues and their openings excised with a margin of surrounding skin. Skin closure was followed by a watertight intraoral closure of the wound. Post operative healing proceeded uneventfully and histopathologic examination of the excised specimen corroborated with the diagnosis of an epidermal inclusion or Seborrheic cyst. Healing proceeded satisfactorily (Fig. 7).

Fig. 5.

Fig. 5

Open in a new tab

A combined intra- and trans-oral approach to excise the lesion

Fig. 6.

Fig. 6

Open in a new tab

Excised mass

Fig. 7.

Fig. 7

Open in a new tab

Healing at 2 weeks post op

However, after a period of two months, the patient reported with recurrence of the lesion, presenting with a localized swelling, measuring 3 × 2 cm, in the left parasymphyseal region, which was extremely painful and tender (Fig. 8). The overlying skin was stretched, shiny and inflamed. The swelling was indurated with fixity to the surrounding tissues. There was no sinus opening. Intraorally, the swelling obliterated the labial vestibule in the region and reached up to the level of the edentulous alveolar crest. The yellowish intracystic contents were also visible through the stretched, translucent labial mucosa which had been distended by the cyst. Radiographs again revealed no bony pathology or involvement.

Fig. 8.

Fig. 8

Open in a new tab

Recurrence of the lesion two months thereafter

Owing to the recurrent nature, large size, obvious dermal involvement, together with repeated secondary infection and adherence of the dermoid cyst with the adjacent tissues, a wide local excision of the lesion was planned, using a combined transoral–transcutaneous route, with excision of the overlying skin, followed by reconstruction of the skin defect using an advancement flap (Fig. 9a, b). 1:100,000 Adrenaline was infiltrated into the area and incision was made through the skin and subcutaneous tissue encircling the entire lesion, leaving a margin of 5 mm of normal appearing skin all around. The lesion in continuity with the overlying skin was carefully retracted upwards, taking care not to allow any of the cheesy keratinous material from within to extrude out into the surgical site. As there was extensive fibrosis and adherence of the lesion with the surrounding tissues, meticulous sharp dissection was employed to excise it completely. Electrocautery was used to control the bleeding points. It was also noticed that the mental neurovascular bundle after exiting from the mental foramen, traversed the lesion (Fig. 10a) and hence it was excised in continuity with the lesion (Figs. 10b, 11) and the bleeding from the foramen controlled with elctrocautery. The incisive foramen and canal were located too and deroofed followed by thorough curettage to ensure no pathological remnant to eliminate all possible chances of a second recurrence (Fig. 10b). The cyst was then excised in toto with the overlying skin along with its dermal appendages like hair follicles, sebaceous and sweat glands, so as to eliminate all possible sources of origin of the lesion. A modified transposition skin flap was raised and used to reconstruct the skin defect, followed by intraoral wound closure (Figs. 12a, b, 13). Histopathologic examination demonstrated the typical features of the epidermal inclusion cyst (Figs. 14, 15, 16, 17, 18), including the flaky keratin squames shed from the cornified epithelial lining and an intense inflammatory infiltrate in the connective tissue wall, signifying chemotactic response to the keratin as well as a secondary infection of the cyst.

Fig. 9.

Fig. 9

Open in a new tab

Excision of the lesion along with the overlying skin

Fig. 10.

Fig. 10

Open in a new tab

Lesion found attached to the mental nerve. Peripheral neurectomy of the mental nerve and its incisive branch carried out

Fig. 11.

Fig. 11

Open in a new tab

Excised specimen. On the right is the lesion excised in continuity with the mental nerve

Fig. 12.

Fig. 12

Open in a new tab

Reconstruction of the skin defect using a modified transposition flap

Fig. 13.

Fig. 13

Open in a new tab

Healing at one week post op

Fig. 14.

Fig. 14

Open in a new tab

H&E section ×10 and ×20, showing shredded keratin fibres desquamating from the keratinized stratified squamous epithelial lining of the epidermal inclusion cyst. Also seen are proliferating epithelial cells embedded within the fibrous connective tissue wall

Fig. 15.

Fig. 15

Open in a new tab

H&E section, ×10 and ×20, demonstrating a true epidermis with a granular cell layer and adjacent laminated keratinous material within the cyst lumen

Fig. 16.

Fig. 16

Open in a new tab

H&E section ×20 and ×40, showing an intense inflammatory cell infiltrate and a foreign body reaction with multinucleated giant cells within the connective tissue wall of the cyst

Fig. 17.

Fig. 17

Open in a new tab

H&E section ×10 and ×20, demonstrating luminal content of lamillated horny keratin pearls which were shed from the cornified epithelial lining

Fig. 18.

Fig. 18

Open in a new tab

H&E section ×20 and ×40, showing exfoliated keratin squames, arranged in laminated layers, resembling an onion

Discussion

Historically, epidermal inclusion cysts have been referred to by various terms, including, sebaceous cysts, epidermal cysts, Seborrheic cysts, follicular infundibular cysts and epidermoid cysts [1–3]. Epidermal inclusion cysts are approximately twice as common in men as in women. They may occur any time in life, but they are most common in the 3rd and 4th decades of life. The origin of the epidermal inclusion cyst is varied. They may form by sequestration and implantation of epidermal rests during embryonal period, occlusion of the pilosebaceous unit, or iatrogenic or surgical implantation of epithelium into the jaw mesenchyme [4–8] resulting in proliferation of epidermal cells within a circumscribed space of the dermis, in which case it is referred to as an epidermal inclusion cyst. Although most patients deny a history of trauma a mechanical pressure or a minor trauma may be a contributing factor. The source of this epidermis is often the infundibulum of the hair follicle, which may get implanted accidentally during shaving. Infundibular cyst refers to the site of origin of the cyst: the infundibular portion of the hair follicle. In fact, the majority of epidermal inclusion cysts originate from the infundibular portion of the hair follicle thus explaining the interchangeable [6–8], yet technically incorrect, use of these two terms.

Sebaceous cyst is a misnomer as these cysts are not of sebaceous origin. Human papillomavirus type 57 or 60 infections may be additional factors in the development of palmoplantar epidermoid cysts [9–11]. Oral and pharyngeal epidermoid cysts of the inclusion cyst variety also occur, but are rare in adults and are frequently so small that they are not biopsied. Syndromes associated with multiple cutaneous epidermoid cysts, such as Gardner syndrome, Gorlin syndrome and pachyonychia congenita [12], do not demonstrate cysts of the oral mucosa, but facial cysts may occur. Epidemiologic investigation has determined a prevalence rate of 1 cyst per 2,000 adults.

EICs lack ectodermal appendages, such as hair, nerve, bone, teeth, and sweat glands, which are associated with dermoid cysts. The cyst wall is composed of stratified epithelium and lumen that contain keratin in addition to desquamated cells, which are found in laminated layers [13]. Occasionally, the walls may be calcified. If the cyst ruptures, the result may be a granulomatous foreign body reaction, which can be diagnosed erroneously as an infection of the cyst. Inflammation is in part mediated by the horny keratinous material contained within, which has been shown to be strongly chemotactic for polymorphonuclear leukocytes, and partly due to secondary infection. Discharge of a foul smelling yellowish-white cheese-like material is a common complaint. They are most common in the third and fourth decades of life and are twice as common in men as in women.

Rarely, malignancies, including basal cell carcinoma, Bowen disease, SCC (most common of these rarities), mycosis fungoides, and melanoma in situ, have developed in epidermoid cysts. These cysts are benign lesions; however, very rare cases of various associated malignancies have been reported [14–18]. In the uncommon event of malignancy, rapid growth, friability and bleeding are characteristic features.

Dermoid and epidermoid cysts are a different entity from the epidermal inclusion cysts, are developmental in origin rather than traumatic and occur in the head and neck region with an incidence ranging from 1.6 to 6.9 %, and both cysts reported in less than 0.01 % of all oral cavity cysts [19].

Epidermal inclusion cysts are of traumatic origin and are found mainly on palms and fingers of the hands and soles of the feet. They are believed to originate through implantation of epithelium by either surgical or accidental trauma into deeper mesenchymal tissue [20].

They are also often seen on the neck, chest and back [21].

Only about 7 % of all epidermal inclusion cysts are found in the maxillofacial region, usually on the scalp (due to trauma while combing hair), on the hair bearing parts of face and neck (possibly due to traumatic implantation during shaving), periauricular and nasal areas [22]. The head and neck sites affected most frequently with these cutaneous cysts are the scalp (34 %), neck (18 %), periorbital area (17 %), cheeks (including lips;16 %), periauricular area (7.4 %), and nasal area (including forehead; 6 %) [23].

Only about 1.6 % involves the oral cavity, mainly in the soft tissues of the tongue and floor of the mouth [24].

The size of these cysts normally varies from 1 to 5 cm in diameter. Only a few giant epidermal inclusion cysts have been reported in the literature and those of the face are even rarer [25].

A case of multiple huge epidermal inclusion cysts has been reported, which presented as longstanding multiple masses on the face and scalp region, which was misdiagnosed as neurofibromatosis owing to the accompanying history of seizure disorder and mental retardation. Magnetic resonance imaging helped to reach the correct diagnosis and total excision was carried out. Multiple huge epidermal inclusion cysts mistaken as neurofibromatosis [26].

Epidermal inclusion cysts usually involve only the soft tissues, and intraosseous presentation is rare. There are very few reported intraosseous cases of epidermoid cysts, three having been reported in the jaw bones [24, 27].

EICs have been found in the upper neck region as a result of ipsilateral radical mastoidectomy. Similarly, the following may lead to the formation of cysts in the temporal or infratemporal fossae regions—harvest of temporal fascia and facial nerve decompression. EICs may form after these procedures, possibly because the disease moves through the mastoid area into these adjoining regions by direct propagation. Tympanomastoid surgery, the insertion of ventilation tubes, and stapedectomy are examples of otological procedures that have been reported as etiologic factors in the development of EICs in areas such as the tympanic membrane, middle ear, and temporal fossae [3, 28].

A recurrent intracranial epidermal inclusion cyst requiring combined treatment with neurosurgery has also been reported [29].

Treatment modalities include incision and drainage [30], which is fast and simple; however recurrences are frequent if keratin producing lining of the cyst is not removed. Surgical excision is the treatment of choice as it is more definitive. The excision should be designed around the punctum and sutured immediately, or be allowed to drain prior to closure, especially if secondary infection is suspected. The possible complications of excising epidermal inclusion cysts are the risk of scarring and possible recurrence.

Conclusion

Although benign, a Seborrheic or epidermal inclusion cyst can on rare occasions, be particularly persistent exhibiting a repeated recurrence after seemingly adequate and definitive management. The characteristic histopathologic features demonstrated in this case included a cystic lining composed of keratinizing stratified squamous epithelium with a distinct granular cell layer (Figs. 4, 14, 15). Shredded fibres and flakes of keratin and lamillated horny keratin pearls were found desquamated from the cornified epithelial lining and lying within the cyst lumen (Figs. 4, 14, 15, 17). The exfoliated keratin squames in many areas were found arranged in laminated layers, resembling an onion (Figs. 17, 18). Also seen, were proliferating epithelial cells embedded within the fibrous connective tissue wall of the cyst (Fig. 14). The connective tissue wall also showed an intense inflammatory cell infiltrate and a foreign body reaction with multinucleated giant cells (Fig. 16) probably as a chemotactic response to the keratin as well as secondary infection of the cyst. The etiology of the epidermal inclusion cyst of the chin in this case is likely to be trauma sustained while shaving.

The treatment of choice is surgical excision, rather than incision and drainage. Care has to be taken to excise it in toto, often along with the overlying skin and the punctum involved, in order to prevent recurrences from the residual keratin producing lining of these cysts and to prevent possible malignant transformation.

References

  • 1.William J, Timothy B, Dirk E (2005) Andrews’ diseases of the skin: clinical dermatology, 10th edn. Saunders. ISBN 0721629210
  • 2.Fitzpatrick TB, Johnson RA, Wolff K, et al. Color atlas and synopsis of clinical dermatology. 3. New York: McGraw Hill; 1997. pp. 162–164. [Google Scholar]
  • 3.Acartürk TA, Stofinan GM. Posttraumatic epidermal inclusion cyst of the deep infratemporal fossa. Ann Plast Surg. 2001;46:68–71. doi: 10.1097/00000637-200101000-00015. [DOI] [PubMed] [Google Scholar]
  • 4.Sullivan DP, Liberatore LA, April MM, Sassoon J, Ward RF. Epidermal inclusion cyst versus thyroglossal duct cyst: sistrunk or not? Ann Otol Rhinol Laryngol. 2001;110:340–344. doi: 10.1177/000348940111000409. [DOI] [PubMed] [Google Scholar]
  • 5.Thompson AC, Bradley PJ. Iatrogenic epidermoid cyst of the parotid region following ear surgery. J Laryngol Otol. 1991;105:227–228. doi: 10.1017/S0022215100115452. [DOI] [PubMed] [Google Scholar]
  • 6.Cotran RS, Kumar V, Robbins SL. Pathologic basis of disease. 5. Philadelphia: WB Saunders; 1994. pp. 1182–1183. [Google Scholar]
  • 7.Epstein WL. Epithelial cysts in buried human skin. Arch Dermatol. 1957;76:437–445. doi: 10.1001/archderm.1957.01550220045009. [DOI] [PubMed] [Google Scholar]
  • 8.Farrer AK, Forman WM, Boike AM. Epidermal inclusion cysts following minimal incision surgery. J Am Pediatr Med Assoc. 1992;82(10):537–541. doi: 10.7547/87507315-82-10-537. [DOI] [PubMed] [Google Scholar]
  • 9.Lee S, Lee W, Chung S, et al. Detection of human papillomavirus 60 in epidermal cysts of nonpalmoplantar location. Am J Dermatopathol. 2003;25(3):243–247. doi: 10.1097/00000372-200306000-00009. [DOI] [PubMed] [Google Scholar]
  • 10.Morgan MB, Stevens GL, Somach S, Tannenbaum M. Carcinoma arising in epidermoid cyst: a case series and aetiological investigation of human papillomavirus. Br J Dermatol. 2001;145(3):505–506. doi: 10.1046/j.1365-2133.2001.04400.x. [DOI] [PubMed] [Google Scholar]
  • 11.Park HS, Kim WS, Lee JH, et al. Association of human papillomavirus infection with palmoplantar epidermal cysts in Korean patients. Acta Derm Venereol. 2005;85(5):404–408. doi: 10.1080/00015550510032878. [DOI] [PubMed] [Google Scholar]
  • 12.Leppard B, Bussey HJ. Epidermoid cysts, polyposis coli and Gardner’s syndrome. Br J Surg. 1975;62(5):387–393. doi: 10.1002/bjs.1800620515. [DOI] [PubMed] [Google Scholar]
  • 13.Wade CL, Haley JC, Hood AF. The utility of submitting epidermoid cysts for histologic examination. Int J Dermatol. 2000;39(4):314–315. doi: 10.1046/j.1365-4362.2000.00930-2.x. [DOI] [PubMed] [Google Scholar]
  • 14.Cameron DS, Hilsinger RL., Jr Squamous cell carcinoma in an epidermal inclusion cyst: case report. Otolaryngol Head Neck Surg. 2003;129(1):141–143. doi: 10.1016/S0194-5998(03)00466-2. [DOI] [PubMed] [Google Scholar]
  • 15.Lopez-Rios F, Rodriguez-Peralto JL, Castano E, Benito A. Squamous cell carcinoma arising in a cutaneous epidermal cyst: case report and literature review. Am J Dermatopathol. 1999;21(2):174–177. doi: 10.1097/00000372-199904000-00012. [DOI] [PubMed] [Google Scholar]
  • 16.Perse RM, Klappenbach RS, Ragsdale BD. Trabecular (Merkel cell) carcinoma arising in the wall of an epidermal cyst. Am J Dermatopathol. 1987;9(5):423–427. doi: 10.1097/00000372-198710000-00009. [DOI] [PubMed] [Google Scholar]
  • 17.Tanaka M, Terui T, Sasai S, Tagami H. Basal cell carcinoma showing connections with epidermal cysts. J Eur Acad Dermatol Venereol. 2003;17(5):581–582. doi: 10.1046/j.1468-3083.2003.00807.x. [DOI] [PubMed] [Google Scholar]
  • 18.Swygert KE, Parrish CA, Cashman RE, Lin R, Cockerell CJ. Melanoma in situ involving an epidermal inclusion (infundibular) cyst. Am J Dermatopathol. 2007;29(6):564–565. doi: 10.1097/DAD.0b013e3181513e5c. [DOI] [PubMed] [Google Scholar]
  • 19.Ozan F, Polat HB, Ay S, Goze F. Epidermoid cyst of the buccal mucosa: a case report. J Contemp Dent Pract. 2007;8(3):90–96. [PubMed] [Google Scholar]
  • 20.Ramakrishna Y, Sudhindra B, Munshi AK. Post-traumatic epidermoid inclusion cyst in the chin region. J Clin Pediatr Dent. 2009;33(3):251–252. doi: 10.17796/jcpd.33.3.812225u343773155. [DOI] [PubMed] [Google Scholar]
  • 21.King ES. Post-traumatic epidermoid cysts of hands and fingers. Br J Surg. 1933;21:29–43. doi: 10.1002/bjs.1800218105. [DOI] [Google Scholar]
  • 22.Handa U, Kumar S, Mohan H. Aspiration cytology of epidermoid cyst of terminal phalanx. Diagn Cytopathol. 2002;26(4):266–267. doi: 10.1002/dc.10075. [DOI] [PubMed] [Google Scholar]
  • 23.Al-Khateeb TH, Al-Masri NM, Al-Zoubi F. Cutaneous cysts of the head and neck. Am Assoc Maxillofac Surg J Oral Maxillofac. 2009;67:52–57. doi: 10.1016/j.joms.2007.05.023. [DOI] [PubMed] [Google Scholar]
  • 24.Jayade BV, Upadya VH, Gopalkrishnan K, Shirganvi MS (2011) Epidermal inclusion cyst of the mandible after extraction of a third molar: case report. Br J Oral Maxillofac [Epub ahead of print] [DOI] [PubMed]
  • 25.Baek SO, Kim SW, Jung SN, Sohn WI, Kwon HJ. Giant epidermal inclusion facial cyst. J Craniofac Surg. 2011;22(3):1149–1151. doi: 10.1097/SCS.0b013e318210bb0e. [DOI] [PubMed] [Google Scholar]
  • 26.Hwang DY, Yim YM, Kwon H, Jung SN. J Craniofac Surg. 2008;19(6):1683–1686. doi: 10.1097/SCS.0b013e31818971d1. [DOI] [PubMed] [Google Scholar]
  • 27.Noffke CE. Implantation-type epidermoid cyst of the mandible. Dentomaxillofac Radiol. 1999;28:383–385. doi: 10.1038/sj.dmfr.4600477. [DOI] [PubMed] [Google Scholar]
  • 28.Tovi F, Bartal N, Zirkin C. Epidermal cysts of temporal fossa: an unusual complication of ear surgery. Ann Otol Rhinol Laryngol. 1985;94:162–164. doi: 10.1177/000348948509400213. [DOI] [PubMed] [Google Scholar]
  • 29.Ulku CH, Uyar Y, Kocaogullar Y, Avunduk MC. Iatrogenic epidermal inclusion cyst of the parapharyngeal space: unusual complication of ear surgery. Skull Base Interdiscip Approach. 2004;14:47–51. doi: 10.1055/s-2004-821362. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Suliman MT. Excision of epidermoid (sebaceous) cyst: description of the operative technique. Plast Reconstr Surg. 2005;116(7):2042–2043. doi: 10.1097/01.prs.0000192460.98612.d3. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Maxillofacial & Oral Surgery are provided here courtesy of Springer

RESOURCES