title: Conservative management of typical pediatric postauricular dermoid cysts.
abstract: OBJECTIVE
  Congenital dermoid cysts of the skull and face frequently arise in embryonic fusion planes. They may follow these planes to extend intratemporally or intracranially. Advanced imaging and operative techniques are generally recommended for these lesions. Postauricular temporal bone dermoid cysts seem to form a distinct subgroup with a lesser tendency toward deep extension. They may be amenable to more conservative management strategies.
  
  
  METHODS
  With IRB-approval, we queried a prospectively-accrued computerized patient-care database to find all postauricular temporal dermoid lesions surgically managed by a single pediatric otolaryngologist from 2001 to 2014. We reviewed the English-language literature to identify similar series of surgically treated pediatric temporal bone dermoid cysts.
  
  
  RESULTS
  Ten postauricular temporal dermoid cysts with pathological confirmation were identified in our surgical series. The average size of the lesions was 1.5 cm (0.3-3 cm). The average age at time of surgery was 4 years (6 months-17 years). No intracranial extension was observed at surgery. There were no recurrences noted on last follow-up (mean 65 months, range 10-150 months). A computerized literature review found no examples of intracranial extension among typical postauricular dermoid cysts.
  
  
  CONCLUSIONS
  There was no intracranial or temporal extension in our series or among postauricular lesions described in the literature. Given the low incidence of deep extension we advocate neither advanced imaging nor routine neurosurgical consultation for typical postauricular lesions. Dissection in continuity with cranial periosteum facilitates intact removal of adherent lesions. Surgery is curative if the dermoid is removed intact.
authors: Department of Otolaryngology - Head & Neck Surgery and Temple University School of Medicine, Philadelphia, PA 19140, USA.
authors: Gary
authors: G
authors: Linkov
authors: Department of Neurosurgery, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
authors: Paul M
authors: PM
authors: Kanev
authors: Department of Otolaryngology - Head & Neck Surgery and Temple University School of Medicine, Philadelphia, PA 19140, USA; Department of Pediatrics, Temple University School of Medicine, Philadelphia, PA 19140, USA. Electronic address: glenn.isaacson@temple.edu.
authors: Glenn
authors: G
authors: Isaacson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003884:Dermoid Cyst / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D012189:Retrospective Studies; D013701:Temporal Bone / Q000473:pathology*
keywords: Branchial lesions; Dermoid cyst; Intracranial extension; Pediatric head neck mass; Temporal bone lesion