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Dermoid cyst   

Nithin Prabhakar

Apr. 05, 2018 • 54 likes • 14,443 views

  11 of 25  

SURGERY (SWELLINGS TOPICS)

Health & Medicine

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 Dermoid cyst
1. DERMOID CYST & ABSCESS BY: NITHIN PRABHAKAR 4TH
YEAR MBBS MIMS
2. A cavity lined by Epithelium containing desquamated cells
CONTENTS: mixture of sweat, sebum, desquamated
epithelial cells, hair follicles SITES: along the lines of
embryonic fusion(midline of the body or face)
3. CLINICAL TYPES: A. Congenital/sequestration dermoid:-
External and internal angular dermoid (along the fusion of
front-nasal and maxillary processes) Sublingual dermoid
Pre- auricular & post-auricular dermoids B. Tubulo-dermoids
C. Implantation dermoids D. Teratomatous dermoids
4. A. SEQUESTRATION DERMOID: PATHOGENESIS: 1 • DURING
EMBRYONIC FUSION DERMAL CELLS GET SEQUESTRATED IN
THE SUBCUTANEOUS PLANE 2 • THESE CELLS UNDERGO
PROLIFERATION AND LATER UNDERGOES LIQUEFACTIVE
NECROSIS RESULTING IN THE FORMATION OF THE CYST 3 •
THE CYST SLOWLY GROWS N INDENTS THE MESODERM
- BONY DEFECTS
5. CLINICAL FEATURES: AGE OF ONSET: presents in the 2nd
or 3rd decade of life Swelling is insidious in onset &
gradually progressive Smooth, so! ,non-tender swelling
Skin over the swelling is pinchable Paget’s test: +ve
Method: fix the swelling with two fingers(watching fingers)
summit is indented with the index finger of other
hand(displacing finger) yeilding sensation over the watching
fingers
6. Swelling is fluctuant in nature Transillumination test: -ve
Cough impulse : may be present if the swelling has
intracranial extension Resorption & indentation of bone
beneath the swelling DIFFERENTIAL DIAGNOSIS: LIPOMA
SEBACEOUS CYST BURSITIS
7. INVESTIGATIONS: Blood: Total count, di"erential count
,Hb% , ESR Fine needle aspiration cytology (FNAC) X-RAY:
reveals resorption and indentation of the underlying bone
CT-SCAN: to indentify the size,shape& local spread of the
swelling
8. TREATMENT: Excision under general anesthesia . O!en
neurosurgical approach is required by raising the
osteocutaneous flaps of the cranium
9. B. TUBULODERMOIDS: Arises from the embryonic tubular
structures Pathogenesis : Increased secretions from the
lining epithelial cells of the ectodermal tube accumulation
of the secretions foramtion of swelling Examples:
thyroglossal cyst, ependymal cyst, postanal dermoid
10. C. IMPLANTATION / ACCQUIRED DERMOIDS: Seen in
individuals like tailors,gardeners who sustain repeated minor
injuries Sites: fingers,toes,feet Minor trauma epidermal
cells gets buried in the subcutaneous space cyst formation
Signs: painless,so! ,smooth,adherent to skin, tensely
cystic,mobile swelling Managed by surgical excision under
local anaesthesia
11. D. TERATOMATOUS DERMOID: A benign or malignant
tumor arising from all the germ layers consisting of
hair,teeth,cartilage, sebum and muscle Occurs in the testis,
ovaries,mediastinium or retro peritoneum COMPLICATIONS
OF DERMOIDS: INFECTIONS RUPTURE AND PRESSURE
EFFECTS CALCIFICATION SURFACE ULCERATION
12. Implantation & teratomatous dermoids
13. It is the collection of pus within the body Mainly of four
types: i. Pyogenic abscess ii. Pyaemic abscess iii. Metastatic
abscess iv. Cold abscess
14. PYOGENIC ABSCESS: It is the most commonest variety of
abscess usually resulting from cellulitis or lymphadenitis
Etiopathogenesis: Pathogens: staphylococcus aureus
streptococcus pyogenes ,anaerobes Mode of infection may
be direct, haematogenous,lymphatics or by extension from
the adjacent tissue Organisms enter the tissue activation of
immune cells release of mediators and lysozyme
destruction of cells and release of proteins fibrin deposition
formation of pus and pyogenic membrane
15. CLINICAL FEATURES: Patient presents with fever
associated with chills and rigors, throbbing type of pain over
the swelling( Localised,red,tender,warm,so!,smooth
swelling Visible pus & brawny indurations around the
swelling Fluctuation: may or may not be present
DIFFERENTIAL DIAGNOSIS: Haematoma Sarcoma
Aneurysm? cold abscess
16. PYAEMIC ABSCESS: These are generally multiple in
number This condition is caused when an Infective emboli
circulating in the blood gets lodged in multiple places in the
body n thus leading to abscess formation These emboli
contain bulk of organisms derived from an infective focus
such as vegetations of the valves , thrombus, skin bones The
peculiarity of these abscess is that they lie in the subfascial
plane(deeper lesions)& do not present the features of
common abscess They are non reacting but the
constitutional symptoms like weakness, weight loss
,fatiguability are severe Managed by evaluating the focus of
infection, antibiotic therapy & drainage of surface abscess if
any.
17. NOTE THE MULTIPLE LESIONS.
18. METASTATIC ABSCESS: These occurs as a spread from
other abscess Ex: lung abscess spreading to the brain COLD
ABSCESS: These are non reacting abscess caused due to
chronic inflammation usually secondary to tubercular
infection Caeseation of the lymph nodes, bones abscess
formation Sites: commonly around the neck,axilla. also seen
around the loin , back(pot’s spine),chest wall
19. INVESTIGATION • Blood: Total count will be elevated
Di"erential count (lymphocytic elevation suspect TB) • Urine
examination for presence of Glucose • Chest X-RAY in cases of
lung abscess • USG Abdomen done as and when required • CT
SCAN to identify the number size and shape of the abscess •
And other investigation relevant to the organ is done(eg.LFT
for liver abscess)
20. MANAGEMENT: • Medical management: Broad spectrum
Antibiotic therapy is started • Surgical management:- . Incision
and drainage of the abscess by HILTONS METHOD
PROCEDURE: 1) The abscess is draped, cleaned using a sterile
swab, presence of pus confirmed by aspirating the abscess
2)Under general or regional block anaesthesia,an incision is
made parallel to the nuerovascular bundle using a No.11
blade
21. 3) The pyogenic membrane of the abscess is ruptured
using a sinus forceps and the pus is collected in kidney tray. 4)
With the little finger the loculi is inspected for remant
purulent material 5) The abscess cavity is injected with
normal saline and a drain like roller gauge is placed. 6) The
wound is le! open, which later heals by formation of
granulation tissue
22. COMPLICATIONS: • Bacteremia,Septicemia and pyemia •
Multiple abscess formation • Sinus and fistula formation •
Pressure e"ects over the underlying structures • Antibioma
formation: This is typically seen in case of breast abscess. •
Metastasis to other organs
23. MOTIVATIONAL QUOTE? THANK YOU!

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