Case Report Chandra 40yrs/Male

Case History
Patient particulars
Chief complain History of present illness

Past history
Past medical history Past dental history

Personal history
Family history

General Physical Examination

Built
Nourishment Pallor

Pulse
Blood pressure Respiration

Cyanosis
Icterous Clubbing Lymph-adenopathy

Temperature

Local examination
Inspection Site- behind the ear lobule Size- 22 cm Shape- ovoid Number- solitary Colour

Surface & skin over the swelling-

pigmented with smooth surface Edge- distinct edges

Palpation Size Shape Extent-

Surface Edge Tenderness- non tender Temperature

Consistency- soft to firm

Fluctuation- negative Translucency- negative Fixity to overlying skin & underlying

structure.- freely movable over underlying structure n skin over the lesion pinchable. Reducibility - negative Compressibility- negative

Differential Diagnosis
1. Development

Dermoid cyst (epidermal cyst)

2. Inflammatory

Epidemoid cyst

3. Neoplastic

Lipoma Fibroma Papilloma

Dermoid cyst
Also called as, also called epidermal cyst.
It lies deep to the skin & lined by the skin containing

pultaceous or tooth paste like material that is desquamated epithelial cells.

Types of dermoid cyst-

1. 2. 3. 4.

Sequestration dermoid Inplantation dermoid( acquired) Tubulo dermoid Teratomatous dermoid.

Sequestration Dermoid
Origin- congenital variety, formed by inclusion of epithelium

buried at the line of embryonic fusion into the deeper plane. Pathology- lined by stratified squamous epithelium containing pultaceous or tooth paste like material that is desquamated epithelial cells with or without hair. So its a mixture of sebum, sweat & desquamated epithelial cells. Common site1. in the midline of the body, root of nose, neck, submental area. 2. external angular outer canthus of eye. 3. Fusion of skull bones 4. post auricular area (fusion of mesodemal hillocks)

Implantation Dermoid
Origin- acquired variety, formed by in driven

epithelium beneath the skin due to puncture injury. Pathology- lined by stratified squamous epithelium containing white cheesy material that is desquamated epithelial. Common site1. Palm of the hand 2. Any part of finger 3. Sole

Tubulo-dermoid
Cyst develop from unobliterated portion of congenital ectodermal duct or

tube. This is formed by accumulation of secretion of the lining ectodermal cells of unobliterated portion of an embryonic duct. Examples1. Thyroglossal cyst (thyroglossal duct) 2. Post anal dermoid cyst (remnant of neuroenteric canal/ post anal gut) 3. Ependymal cyst in the brain (derived from infolding neuroectoderm)

Teratomatous dermoid
Cyst develop from totipotent cell with ectodermal predominenece. Common site-

Ovarian cyst 2. Testcular teratoma 3. Retroperitoneal cyst.

1.

Sebaceous cyst
When duct of sebaceous gland becomes blocked ,

get distended with its own scrertion forms a sebaceous cyst. Common site1. Scalp 2. Face 3. scrotum Appear as cystic swelling, fixed to overlying skin with presence of puncta, indentation due to pressure with finger tip. It may show sebaceous horn.

Lipoma
Benign tumor composed of fat cells. Occurs anywhere in the

body called universal tumor. Varieties1. Encapsulated2. Diffuse variety (pseudo lipoma)- its not a true tumor but overgrowth of the fat in specific regions ( subcutaneous or intramuscular areas) 3. Multiple lipomas (lipomatosis)- Dercums disease.
Lipoma may contain other tissues-

1. Fibrolipoma 2. Naevolipoma 3. Neurolipoma

 Based on the different anatomical situation-

1. 2. 3. 4. 5. 6. 7. 8. 9.

Subcuatneous Subfascial Intramuscular Subserous Submucosal Intra articular Parosteal Exteradural Intraglandular

Ear Anatomy

 The auricle is a single thin plate of elastic fibrocartilage

covered by skin, its surface moulded by eminences and depressions. Ligaments of the auricle.

Extrinsic
Anterior-extends from the tragus and the spine of the helix to the root of the zygomatic process of the temporal bone

Intrinsic
First- a strong fibrous band which passes from the tragus to the helix completing the meatus anteriorly and forming part of boundary of the concha.

Posterior-from the posterior surface of the concha to the lateral surface of the mastoid process

Second- a band which passes between the antihelix and the tail of the helix.

Muscles of auricle
Extrinsic muscle1) Auricularis Anterior- smallest of all muscle. arises from the lateral edge of the epicranial aponeurosis: inserts into the spine of helix 2) Auricularis Superior- largest of the three, arises from epicranial aponeurosis via a thin, flat tendon attach to the upper part of cranial surface of the auricle. 3) Auricularis Posterior -arises from mastoid part of temporal bone and insert into the ponticulus on the eminentia conchae
Intrinsic muscle1) Helicis Major - narrow vertical band on the anterior margin of the helix, which passes from its spine to its anterior border, where the helix is about to curve back. 2) Helicis Minor- covers the crus helicis. 3) Tragicus - short, flattened, vertical band on the lateral aspect of the tragus. 4) Antitragicus - passes from outer part of the antitragus to the tail of the helix and the antihelix. 5) Transversus Auriculae- on the cranial aspect of the auricle, extend between the eminentia conchae and the eminentia scaphae. 6) Obliquus Auriculae- on the cranial aspect of the auricle, extend from the upper and posterior parts of the eminentia conchae to the eminentia scaphae.

Vascular & nerve supply

Arterial supply1) Posterior Auricular Artery- cranial surface of the auricle (lateral surface,round the margin of the helix.) & posterior surface of auricle 2) Anterior Auricular Branches of the superficial temporal artery- lateral surface 3) Occipital Artery. Venous drainageAuricular veins correspond to the arteries of the auricle Lymphatic drainage1) Parotid lymph node. 2) Mastoid lymph node 3) Upper deep cervical lymph node. Nerve supply1) Great auricular nerve- cranial surface & posterior part of the lateral surface (helix, antihelix, lobule) 2) Lesser occipital nerve- upper part of the cranial surface 3) Auricular branch of vagusconcavity of concha and posterior part of the eminentia. 4) Auriculotemporal nerve- tragus, crus of helix and the adjacent part of the helix. 5) Facial nerve- small areas on both aspects of the auricle, in depression of concha, and over its eminence.