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Epicranius Muscle Cysts

Dr. Carolyn J. Agresti, MD - Otolaryngologist (ENT) Dr. Carolyn J. Agresti, MD - Otolaryngologist (ENT)
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Rx Musculoskeletal System (A - Z)

An epicranius muscle cyst is an uncommon, fluid-filled sac that develops within or adjacent to the epicranius (occipitofrontalis) muscle of the scalp. These cysts can arise from developmental anomalies, blocked skin glands, parasitic infections, trauma, or tumor formation. Though often benign, they may cause discomfort, cosmetic concerns, or functional problems when large or inflamed.

A cyst is a closed sac or pouch of tissue lined by abnormal cells and filled with fluid, semi-solid material, or gas. An epicranius muscle cyst specifically forms in the epicranius muscle layer, which spans from the forehead to the back of the skull Wikipedia.

Anatomy of the Epicranius Muscle

The epicranius (also called the occipitofrontalis) is a broad, thin muscle covering the top of the skull. It consists of two bellies—frontal (forehead) and occipital (back of the head)—connected by the epicranial aponeurosis.

Structure & Location

The frontal belly lies just under the skin of the forehead, while the occipital belly covers the back scalp. Between them, the epicranial aponeurosis (galea aponeurotica) forms a fibrous sheet across the skull Wikipedia.

Origin

  • Frontal belly: originates from the epicranial aponeurosis.

  • Occipital belly: originates from the lateral two-thirds of the superior nuchal line of the occipital bone (and sometimes the mastoid process) Wikipedia.

Insertion

Both bellies insert into the epicranial aponeurosis; the frontal belly also blends into the skin of the eyebrows and forehead Wikipedia.

 Blood Supply

  • Frontal belly: supraorbital and supratrochlear arteries (branches of the ophthalmic artery).

  • Occipital belly: occipital artery (branch of the external carotid artery) Wikipedia.

Nerve Supply

  • Frontal belly: temporal branches of the facial nerve (CN VII).

  • Occipital belly: posterior auricular branch of the facial nerve Wikipedia.

Functions

  1. Raises the eyebrows.

  2. Wrinkles the forehead skin.

  3. Retracts (pulls back) the scalp.

  4. Aids in facial expressions (e.g., surprise, shock).

  5. Distributes tension across the scalp.

  6. In some people, assists with ear wiggling Wikipedia.

Types of Epicranius Muscle Cysts

  1. Dermoid cyst
    A congenital cyst containing skin and skin‐appendage elements (hair follicles, sweat glands) that can occur along embryonic fusion lines of the scalp Wikipedia.

  2. Epidermoid (epidermal inclusion) cyst
    An acquired cyst formed by invagination of epidermal cells into deeper tissue, leading to a keratin-filled sac beneath the muscle PMC.

  3. Trichilemmal (pilar) cyst
    A benign cyst arising from hair follicles, most common on the scalp; smooth, mobile, and filled with keratin Wikipedia.

  4. Parasitic cyst (cysticercosis)
    Resulting from Taenia solium larvae lodging in muscle, forming a fluid-filled sac often visible on ultrasound or MRI ResearchGate.

  5. Sebaceous cyst
    Originates from clogged sebaceous glands, producing a pouch of oily material under the scalp MedlinePlus.

  6. Pseudocyst
    A fluid collection without an epithelial lining, often following trauma or inflammation (e.g., seroma) MedlinePlus.

Causes

These mechanisms can operate alone or in combination.

  1. Developmental anomalies: trapped epithelial remnants during embryonic scalp formation.

  2. Epidermal inclusion: trauma pushes surface skin cells into deeper layers.

  3. Blocked sebaceous glands: sebum accumulation in gland ducts.

  4. Infection: bacterial infiltration causing abscess-like cyst formation.

  5. Cysticercosis: parasitic larvae encyst in muscle fibers.

  6. Hydatid disease: Echinococcus granulosus larvae causing hydatid cysts.

  7. Neoplastic cysts: encapsulation of tumor cells (cystic tumors).

  8. Post-operative: fluid collections after scalp surgery (pseudocysts).

  9. Repetitive injury: microtrauma inducing fluid-filled pockets.

  10. Autoimmune inflammation: localized tissue breakdown.

  11. Hormonal changes: altered sebum production in puberty or menopause.

  12. Genetic predisposition: syndromes like Gardner’s syndrome.

  13. Radiation: tissue damage leading to seroma formation.

  14. Dermal inclusion: implantation of skin in needle-track biopsies.

  15. Cystic degeneration: degeneration within benign tumors (e.g., lipoma).

  16. Metabolic disorders: mucin-rich cysts in connective tissue diseases.

  17. Foreign body reactions: encapsulation of debris.

  18. Pilomatricoma: calcifying cyst from hair matrix.

  19. Traumatic hematoma: blood-filled sac evolving into a cyst.

  20. Obstructed lymphatics: lymphatic fluid accumulation (lymphatic cyst).

Based on general cyst pathogenesis Wikipedia.

Symptoms

  1. Scalp swelling: a palpable lump under the skin.

  2. Local tenderness: pain when pressed.

  3. Redness or warmth: signs of inflammation.

  4. Itching: skin irritation around the cyst.

  5. Scalp tightness: discomfort when moving the scalp.

  6. Headache: referred pain from muscle involvement.

  7. Limited eyebrow movement: if frontal belly is affected.

  8. Muscle spasm: involuntary contractions.

  9. Fluctuance: wave-like feel indicating fluid.

  10. Cosmetic deformity: visible bulge on the head.

  11. Discharge: cheesy or purulent fluid if ruptured.

  12. Fever: systemic response in infection.

  13. Lymphadenopathy: swollen lymph nodes nearby.

  14. Neuropathic pain: if nerve supply is irritated.

  15. Scalp ulceration: overlying skin breakdown.

  16. Fluctuating size: changes with position or pressure.

  17. Firm mass: in case of calcified or neoplastic cyst.

  18. Audible popping: sometimes felt when pressing.

  19. Hair loss: over the cyst due to pressure.

  20. Recurrence: new lumps after simple drainage.

Diagnostic Tests

  1. Physical exam: inspection and palpation.

  2. Ultrasound: defines cyst content and scolex in parasitic cases PMC.

  3. Magnetic resonance imaging (MRI): gold standard for intramuscular cysts, shows fluid characteristics and walls PMC.

  4. Computed tomography (CT): identifies calcifications and deep extension.

  5. X-ray: detects calcified cyst walls.

  6. Fine-needle aspiration cytology (FNAC): retrieves fluid for microscopic analysis.

  7. Core needle biopsy: tissue sampling for histology.

  8. Dermatoscopy: for superficial cysts.

  9. Doppler ultrasound: assesses blood flow around cyst.

  10. Electromyography (EMG): rules out primary muscle disease.

  11. Nerve conduction studies: if neuropathic pain present.

  12. Serology: antibodies for echinococcus or cysticercosis.

  13. Complete blood count (CBC): looks for infection.

  14. ESR/CRP: inflammatory markers.

  15. Culture & sensitivity: if fluid is purulent.

  16. PCR testing: for parasitic DNA.

  17. Histopathology: confirms cyst type post-excision.

  18. CT angiography: if vascular involvement suspected.

  19. Ultrasound-guided aspiration: both diagnostic and therapeutic.

  20. Biochemical fluid analysis: protein and enzyme levels.

Non-Pharmacological Treatments

  1. Warm compresses to encourage drainage MedlinePlus.

  2. Cold packs to reduce inflammation.

  3. Gentle scalp massage.

  4. Ultrasound-guided aspiration.

  5. Sclerotherapy (injecting irritant).

  6. Cryotherapy (freezing).

  7. Laser ablation.

  8. Photodynamic therapy.

  9. Micromarsupialization for mucoceles MedlinePlus.

  10. Compression bandages.

  11. Acupuncture for pain relief.

  12. Physiotherapy to maintain scalp mobility.

  13. Manual drainage under aseptic conditions.

  14. Graduated exercise for muscle spasm.

  15. Stress management to reduce muscle tension.

  16. Scalp hygiene to prevent secondary infection.

  17. Dietary adjustments (anti-inflammatory foods).

  18. Avoidance of trauma or pressure.

  19. Ultrasound therapy (low-level).

  20. Chiropractic head and neck adjustments.

  21. Helmet padding or soft caps.

  22. Moist dressings for draining cysts.

  23. Microneedling around lesion edges.

  24. Herbal compresses (e.g., turmeric paste).

  25. Relaxation techniques for muscle tightness.

  26. Surgical glue injection (pilonidal approach) MedlinePlus.

  27. Photocoagulation.

  28. Endoscopic drainage.

  29. Sterile aspiration plus pressure dressing.

  30. Watchful waiting for small, asymptomatic cysts MedlinePlus.

Drugs

  1. Acetaminophen: pain relief.

  2. NSAIDs (ibuprofen, naproxen): reduce pain and inflammation.

  3. Cephalexin: oral antibiotic for skin flora.

  4. Clindamycin: covers MRSA.

  5. Dicloxacillin: anti-staphylococcal antibiotic.

  6. Albendazole: treats cysticercosis Turkish Journal of Parasitology.

  7. Praziquantel: alternative parasitic therapy.

  8. Prednisone: short-course steroid for inflammation.

  9. Colchicine: off-label for recurrent inflammatory cysts.

  10. Topical mupirocin: for superficial infected cysts.

  11. Lidocaine injection: local anesthesia for procedures.

  12. Botulinum toxin: muscle relaxation in refractory spasm.

  13. Cyclobenzaprine: oral muscle relaxant.

  14. Trimethoprim-sulfamethoxazole: MRSA coverage.

  15. Fluconazole: if fungal infection suspected.

  16. Topical clobetasol: potent steroid for local inflammation.

  17. Oral doxycycline: anti-inflammatory and antibiotic.

  18. Tetracycline ointment: topical antibiotic.

  19. Metronidazole: anaerobic coverage if abscess suspected.

  20. ACE inhibitors: manage hypertension in polycystic conditions (rare).

Surgical Options

  1. Excisional biopsy: complete cyst removal with margin.

  2. Simple drainage: under local anesthesia.

  3. Marsupialization: opening and suturing cyst edge to skin.

  4. Curettage: scraping interior lining.

  5. Cryoexcision: freeze and excise.

  6. Laser excision: precise removal with minimal bleeding.

  7. Endoscopic resection: minimal-invasiveness for deep cysts.

  8. Reconstructive flap: for large defects.

  9. Fasciocutaneous flap: cover excision area.

  10. Galea repair: reconstruct epicranial aponeurosis if disrupted.

Prevention

  1. Maintain good scalp hygiene.

  2. Avoid picking or squeezing lumps.

  3. Treat scalp infections promptly.

  4. Wear protective headgear during activities.

  5. Manage acne to prevent blocked glands.

  6. Seek early care for parasitic exposures (undercooked pork).

  7. Avoid repetitive head trauma (sports safety).

  8. Regular check-ups if you have genetic syndromes.

  9. Use non-comedogenic hair products.

  10. Keep scalp moisturized to prevent cracking.

When to See a Doctor

Seek medical attention if you notice:

  • Rapid growth or sudden pain in a scalp lump

  • Redness, warmth, or fever suggesting infection

  • Neurological symptoms (headache, vision changes)

  • Recurrence after drainage

  • Cosmetic concerns impacting quality of life

Frequently Asked Questions

  1. What is an epicranius muscle cyst?
    A fluid-filled sac in the epicranius muscle layer of the scalp.

  2. Are these cysts cancerous?
    Most are benign; only cystic tumors carry malignancy risk Wikipedia.

  3. How common are they?
    Very rare—few case reports exist for intramuscular cysts in the scalp.

  4. What causes them?
    Congenital remnants, blocked glands, parasites, trauma, or tumors.

  5. How are they diagnosed?
    Exam, ultrasound, MRI, and sometimes biopsy.

  6. Can they resolve without treatment?
    Small, asymptomatic cysts may regress on their own MedlinePlus.

  7. What non-surgical options exist?
    Warm compresses, aspiration, sclerotherapy, or watchful waiting.

  8. When is surgery needed?
    Painful, infected, rapidly growing, or suspicious cysts.

  9. Will the cyst come back after removal?
    Recurrence is possible, especially after simple drainage.

  10. What is the recovery time?
    Simple excision heals in about 1–2 weeks; more complex repairs take longer.

  11. Can parasites cause these cysts?
    Yes—cysticercosis from pork tapeworm can lodge in muscle Turkish Journal of Parasitology.

  12. Is it painful?
    Often painless until inflamed or large enough to compress surrounding tissues.

  13. Are there genetic risks?
    Certain syndromes (e.g., Gardner’s) predispose to multiple cysts.

  14. How can I prevent recurrence?
    Proper removal of the cyst capsule and good scalp care.

  15. When should I worry about cancer?
    If the cyst is hard, rapidly growing, has irregular borders, or shows ulceration.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: April 26, 2025.

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