J Oral Maxillofac Surg 67:52-57, 2009 Cutaneous Cysts of the Head and Neck Taiseer Hussain Al-Khateeb, BDS, MScD, FDSRCSEd, FFDRCSI,* Nidal M. Al-Masri, MD,† and Firas Al-Zoubi, MBBS, FRRC‡ Purpose: A retrospective study on the features of cutaneous cysts of the head and neck as seen in a North Jordanian population. Patients and Methods: The records of the Department of Pathology at Jordan University of Science and Technology were reviewed for patients with cutaneous cysts of the head and neck during the 12-year period extending between 1991 and 2002. Applicable records were retrieved, reviewed, and analyzed. Primary analysis outcome measures included patient age, gender, location of the cyst, type, clinical presentation, and treatment. The records of 488 patients were available for analysis. Results: Epidermoid cyst was the most frequent lesion (49%) followed by pilar cysts (27%), and dermoid cysts (22%). The site affected most frequently was the scalp (34%), predominantly with pilar cysts (96%). Epidermoid cyst was the most frequent lesion in the neck (68%), cheeks (77%), periauricular area (70%), and the nasal area (55%). Dermoid cyst was the most frequent lesion in the periorbital area (52%). Females represented 51% of the patients and males accounted for 49%. The peak of age distribution for patients with dermoid cysts was at the first decade, and both of epidermoid and pilar cysts peaked at the third decade. Infection presented in 2.5% of cases. All cysts were enucleated surgically. Conclusion: Maxillofacial surgeons often encounter cutaneous cysts of the head and neck, and they must be familiar with the clinicopathologic characteristics of these lesions. © 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:52-57, 2009 Cutaneous cysts are frequently benign head and neck lesions. The most common cutaneous cysts are reten- tion cysts from skin appendages, with developmental or embryonic cysts presenting much less routinely. 1 Cysts of skin appendages are labeled as sebaceous cysts commonly. The sebaceous cyst is preferably described as either an epidermal cyst or trichilemmal (pilar) cyst. 2 Sweat gland elements may also produce cysts classified as hidrocystomas. 1 Dermoid and epidermoid cysts are developmental cysts that occur in the head and neck with an inci- dence ranging from 1.6% to 6.9%. 3 They represent less than 0.01% of all cysts of the oral cavity. 4 An epidermal cyst is derived from epidermis, and is formed by cystic enclosure of epithelium within the dermis that becomes filled with keratin and lipid-rich debris. 5 It occurs in young to middle-age adults. It is usually solitary and connects with the surface by ker- atin-filled pores. Dermoid cysts lack any entry port and have a predilection for lines of embryonic fu- sion. 6 Younger patients predominate for dermoid cyst presentation. Histologically, pilosebaceous structures may be noted within the wall of a dermoid cyst. 5 According to Fitzpatrick, 5 a pilar cyst is seen most often on the scalp in middle-age females. It occurs frequently as multiple smooth, firm, dome-shaped nodules that are not connected to the epidermis. The usually thick cyst wall is composed of stratified squa- mous epithelium with a palisaded outer layer resem- bling that of the outer root sheath of hair follicles, and an inner corrugated layer. The cyst contains very dense keratin; it is often calcified, with cholesterol clefts. If the cyst ruptures, it may be inflamed and very painful. Cutaneous cysts are diagnosed and treated by max- illofacial surgeons around the world on an almost regular basis. Nevertheless, there is a notable paucity of comprehensive studies in the literature on the various lesions encountered in clinical practice. This *Associate Professor, Division of Maxillofacial Surgery, Jordan University of Science and Technology and King Abdullah University Hospital, Irbid, Jordan. †Associate Professor, Department of Pathology and Microbiol- ogy, Jordan University of Science and Technology and King Abdul- lah Teaching Hospital, Irbid, Jordan. ‡Assistant Professor, Division of Otorinolaryngology, Jordan Uni- versity of Science and Technology and King Abdullah Teaching Hospital, Irbid, Jordan. Address correspondence and reprint requests to Dr Al-Khateeb: Department of Oral & Maxillofacial Surgery, Jordan University of Science & Technology, Irbid, PO BOX 3030, Jordan; e-mail: taiseerhhk@yahoo.com © 2009 American Association of Oral and Maxillofacial Surgeons 0278-2391/09/6701-0009$34.00/0 doi:10.1016/j.joms.2007.05.023 52