Benign Cutaneous and Subcutaneous Lesions of the Head and Neck
The methods to remove benign cysts and lipomas are often chosen randomly. These methods are through large and small incisions, inside and outside perceived membranes or sacs, with and without planned extrusion of lesion content. Previous literature has suggested when cysts should be drained or excised1 or when unsightly lipomas should be removed2.
This abstract reviews the benign cutaneous and subcutaneous lesions treated by the Oral and Maxillofacial Service over 2 years. It describes the most common anatomic locations and suggests maneuvers for surgical removal to minimize complications.
2. Materials and Methods
The inclusion dates of this study were June 30, 2011 to August 18, 2013. Only patients with lesions deemed large enough for the operating suite were included. Cases were reviewed for age, gender, histologic diagnosis, and anatomic location. Possible complications and recurrences were noted. Patients with large lesions which were on the lateral or posterior neck received a CT.
Sixty-six patients had a median age of forty-six years old. Forty-five of the patients were male and twenty-one were female.
Lipoma removal:
Lipoma removal was always performed within any membrane or sac. Dissection started centrally and proceeded radially.
Cyst removal:
Conversely, removal of a solitary cyst was performed with blunt dissection beginning from the peripherally. The sac was recognized and dissection proceeded centrally over the cyst.
3. Results:
Thirty of the patients were treated for lipomas (45.5%), thirteen for epidermal inclusion cysts (19.7%), six for pilar cysts (9.1%), six for pilomatricomas (9.1%), two for dermoid cysts (3.0%), two for cutaneous neurofibromas, one for a benign cyst, one for a steatocystoma multiplex, one for a sebaceous cyst, one for a follicular cyst, one for a fibrolipoma. Two presented with multiple pathologically different lesions, one for a spindle cell lipoma and a ruptured benign cyst and one for a chondroid syringoma and a lipoma. Twenty-eight patients had the lesion(s) located on their neck, fifteen on their scalp, and eight on their forehead. Of the neck lesions, twenty were lipomas being the most common location of lipomas.
Most cases were routine but unusual cases of patients with multiple cysts and huge lipomas forced expansion of treatment regimens. The proscribed methods enhanced positive results and reduced treatment times.
No complications were reported and no recurrences were noted by follow-up.
4. Conclusions:
Large benign lipomas and cysts may mostly be treated by adhering to 2 simple surgical principles:
Lipomas: Approach through an incision 2/3rds the width of the lipoma. Dissect radially from a central point. The dissection should be directly on fat, with no attention to any sac or membrane.
Cysts: Approach through an incision the size of the cyst. Bluntly dissect into the loose subcutaneous tissue from the side of the cyst and over the top of it, with the tips of the scissors or hemostat pointing toward the skin surface. Avoiding downward dissection in the central area of the cyst limits cyst rupture and conserves time.
References
1. Golden B, Zide M: Cutaneous Cysts of the Head and Neck. J Oral Maxillofac Surg 63:1613-1619, 2005.
2. Habib A. Al-basti and Hamdy A. El Khatib, The Use of Suction-Assisted Surgical Extraction of Moderate and Large Lipomas: Long-Term Follow-UP. Aesth. Plast. Surg. 26:114-117, 2002.