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April 2002
Case submitted by Youn W. Park, MD and
J. Chris Cook, DO
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CASE:
A 22 year-old woman presents with a painful, tender swelling
of the preauricular area following an upper respiratory infection.
The soft mass she has had on the area for several weeks was
originally asymptomatic. A computed tomography scan characterizes
it as a cystic mass superficial to the parotid gland.
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The patient has an infected sebaceous cyst of
the preauricular area. Containing sebum, a cheese-like material,
these cysts are found most often around the ear. They are usually
soft and mobile, and are asymptomatic unless they become infected
or enlarge rapidly. Acute infection is treated with antibiotics,
application of hot compresses, incision, and drainage if indicated.
Spontaneous resolution can occur, but the treatment of choice
is complete removal of the cyst by meticulous dissection of
the entire capsule to preclude recurrence. Lesions like this
patient's should be differentiated from the infected preauricular
cyst and fistula that occur as a result of disunion of the hillocks
of the first and second branchial arches, which usually present
as a small opening in the preauricular skin. The clinician should
also keep in mind that sebaceous adenoma, sebaceous lymphadenoma,
or sebaceous carcinoma can arise from the sebaceous gland that
rests within the parotid glands. |
Dr. Park is clinical professor of otolaryngology at Northeastern
Ohio Universities College of Medicine and attending physician
in the section of otolaryngology at Akron General Medical Center,
Akron, Ohio. Dr. Cook is attending physician, department of family
practice, Akron General Medical Center.
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