Occipitofrontalis Muscle Cyst

An occipitofrontalis muscle cyst is a fluid‐ or keratin‐filled sac that develops in or just above the epicranial aponeurosis—the broad, tendinous sheet linking the frontal (forehead) and occipital (back-of-head) bellies of the occipitofrontalis muscle. These cysts are usually benign, slow-growing lesions that arise from skin appendages or developmental remnants in the scalp overlying the occipitofrontalis muscle. PMCCleveland Clinic

---

Anatomy of the Occipitofrontalis Muscle

The occipitofrontalis (also called epicranius) is a paired muscle that spans the top of the skull. It consists of two distinct bellies:

• Occipital belly

  • Structure & Location: Broad, quadrilateral muscle over the posterior scalp.

  • Origin: Lateral two-thirds of the superior nuchal line and mastoid process of the temporal bone.

  • Insertion: Epicranial aponeurosis (galea aponeurotica).

  • Blood Supply: Occipital artery (branch of the external carotid).

  • Nerve Supply: Posterior auricular branch of the facial nerve (CN VII).

  • Primary Function: Retracts (pulls back) the scalp. WikipediaKenhub

• Frontal belly

  • Structure & Location: Thin, quadrilateral muscle across the forehead.

  • Origin: Epicranial aponeurosis near the coronal suture.

  • Insertion: Skin of the eyebrows and root of the nose, blending with procerus and orbicularis oculi.

  • Blood Supply: Supraorbital and supratrochlear arteries (branches of the ophthalmic artery).

  • Nerve Supply: Temporal branch of the facial nerve (CN VII).

  • Primary Functions (see below). WikipediaWikipedia

Functions of the Frontal Belly

1. Raises eyebrows when looking upward.

2. Wrinkles the forehead horizontally (surprise expression).

3. Assists in scalp movement by working with the occipital belly to shift the scalp forward or backward.

4. Enhances forehead tension to improve sensory perception near the hairline.

5. Facilitates eyebrow elevation during deep inspiration (as a minor accessory muscle).

6. Contributes to nonverbal communication, especially expressions of surprise or curiosity. WikipediaHome

---

Types of Cysts in the Occipitofrontalis Region

Cysts overlying or within the occipitofrontalis muscle area include:

1. Epidermal (Sebaceous) Cyst – Lined by squamous epithelium, filled with keratin debris.

2. Pilar (Trichilemmal) Cyst – Originates from the outer hair root sheath; firm, keratin-filled.

3. Dermoid Cyst – Developmental inclusion of skin adnexa; may contain hair follicles, sebaceous glands, occasionally teeth or cartilage.

4. Teratoid Cyst – Contains tissues from all three germ layers (e.g., muscle, bone).

5. Intradiploic Epidermoid Cyst – Arises within the cranial bone; may perforate the dura.

6. Meningocele – Congenital herniation of meninges through a cranial defect.

7. Cysticercosis – Parasitic cysts (Taenia solium larvae) within muscle or subcutaneous tissue.

8. Sinus Pericranii – Venous malformation with cystic components communicating with dural sinuses. DermNet®OAE Publishing

---

Causes

1. Epidermal inclusion following minor scalp trauma or surgery.

2. Obstruction of sebaceous ducts in hair follicles.

3. Deep implantation of epidermal cells (penetrating injury).

4. Developmental entrapment of ectodermal remnants (dermoid/teratoid).

5. Human papillomavirus infection in palmoplantar regions (rare).

6. Genetic predisposition (familial trichilemmal cysts).

7. Chronic scalp friction (headgear, helmets).

8. Dandruff or seborrheic dermatitis, increasing follicular blockage.

9. Congenital bony defects (meningocele formation).

10. Parasitic infection (cysticercosis).

11. Venous malformations leading to sinus pericranii.

12. Inflammatory acne lesions progressing to cysts.

13. Autoimmune conditions disrupting skin integrity.

14. Prior radiation therapy weakening scalp tissues.

15. Hormonal imbalances increasing sebum production.

16. Poor scalp hygiene allowing debris accumulation.

17. Underlying bone cysts extending into soft tissue (intradiploic).

18. Chronic sun damage altering follicular structure.

19. Mechanical obstruction by subcutaneous tumors.

20. Idiopathic (unknown origin). PMCCleveland Clinic

---

Symptoms

Patients with occipitofrontalis cysts often report:

1. Visible lump on the scalp or forehead.

2. Slow enlargement over weeks to years.

3. Firm, mobile swelling under the skin.

4. Tension or tightness when moving forehead/scalp.

5. Itching or irritation at the site.

6. Tenderness or pain if infected or ruptured.

7. Erythema (redness) around the cyst.

8. Warmth over the cyst indicating inflammation.

9. Fluctuance on palpation (fluid wave).

10. Discharge of cheesy, foul-smelling material if ruptured.

11. Headache localized to the cyst area.

12. Pressure sensation under headgear.

13. Restricted scalp mobility in large lesions.

14. Hyperpigmentation or scarring after repeated rupture.

15. Visible skin dimple if central punctum present.

16. Secondary infection signs (fever, malaise).

17. Neurological symptoms (rare in intradiploic cysts): cranial pressure effects.

18. Palpable bony defect (meningocele).

19. Transillumination may reveal fluid (meningocele).

20. Multiple lesions in familial cases. Cleveland ClinicDermNet®

---

Diagnostic Tests

1. Clinical examination (inspection & palpation).

2. Ultrasound – differentiates solid vs. cystic lesion.

3. Magnetic Resonance Imaging (MRI) – defines intracranial extension.

4. Computed Tomography (CT) – assesses bony involvement.

5. Fine-needle aspiration cytology (FNAC) – keratinous content.

6. Core needle biopsy – histological classification.

7. Dermatoscopy – surface features of epidermal cysts.

8. Color Doppler ultrasound – rules out vascular malformation.

9. Skin ultrasound elastography – cyst consistency.

10. Histopathology post-excision.

11. Electromyography (EMG) – rare for cysticercosis involvement in muscle.

12. Serology for Taenia solium (if parasitic cause suspected).

13. Skull X-ray – intracranial or bony cysts.

14. Transillumination test – meningocele vs. solid cyst.

15. In‐office punch biopsy – dermoid vs. epidermoid.

16. PCR for HPV in atypical epidermal cysts.

17. Culture & sensitivity of aspirated fluid (infection).

18. Allergy testing (if dermatitis complicates).

19. Genetic testing (familial trichilemmal cysts).

20. Pre-op anesthetic assessment (for surgery planning). thefetus.netThieme

---

Non-Pharmacological Treatments

1. Watchful waiting for small, asymptomatic cysts.

2. Warm compresses to promote drainage.

3. Sterile incision & drainage for abscessed cysts.

4. Complete surgical excision with entire cyst wall.

5. Minimal excision technique (punch excision).

6. Laser ablation (CO₂ laser for small cysts).

7. Cryotherapy – especially for superficial cysts.

8. Marsupialization (cutting slit & suturing edges).

9. Ultrasound-guided aspiration for large fluid cysts.

10. Compression bandages post-drainage.

11. Scalp hygiene measures (medicated shampoos).

12. Topical keratolytic agents (salicylic acid).

13. Avoidance of headgear pressure.

14. Silicone gel sheets for scar minimization.

15. Massage therapy to improve local circulation.

16. Physical therapy for associated muscle stiffness.

17. Photodynamic therapy (experimental).

18. Endoscopic excision (minimal scarring).

19. Radiofrequency ablation of cyst wall.

20. Dermabrasion for post-excision smoothing.

21. Pressure garment therapy (for large scars).

22. Scalp cooling caps (prevent hair follicle stimulation).

23. Nutritional optimization (support wound healing).

24. Stress management (reduces inflammatory flares).

25. Cold spray for immediate analgesia in acute flares.

26. Ultraviolet (UV) therapy (for inflammatory scalp disorders).

27. Botulinum toxin injection (experimental, reduces sebum).

28. Pulsed dye laser (for residual erythema).

29. Silk pillowcases (reduce friction).

30. Post-op lymphatic drainage massage. Cleveland ClinicACS

---

Drugs

Always tailor antibiotic choice to culture results. Cleveland ClinicDermNet®

---

Surgical Options

1. Simple excision – complete removal under local anesthesia.

2. Punch excision – minimal-invasion technique.

3. Enucleation – shelling out cyst intact.

4. Wide local excision – for proliferating or atypical cysts.

5. Flap closure – for large defects (rotation or advancement flap).

6. Endoscopic excision – tiny incisions, scalp tunnels.

7. Laser excision – CO₂ or erbium:YAG laser.

8. Curettage & cauterization – low recurrence on small lesions.

9. Marsupialization – for deep, multiloculated cysts.

10. Cranioplasty – combined with bony defect repair (meningocele). Mansa PublishersScienceDirect

---

Preventive Measures

1. Maintain scalp hygiene – regular washing with mild shampoo.

2. Minimize scalp trauma – avoid harsh brushes, tight hairstyles.

3. Control seborrheic dermatitis with medicated shampoos.

4. Treat acne early to prevent follicular cysts.

5. Avoid scalp friction – use silk or satin pillowcases.

6. Manage stress – reduces inflammatory skin flares.

7. Apply topical keratolytics as directed to prevent plugging.

8. Protect scalp from UV – wide-brim hats.

9. Monitor familial lesions – early removal in genetic cases.

10. Promptly treat head lice – prevents excoriations leading to cysts. Cleveland ClinicDermNet®

---

When to See a Doctor

Seek evaluation if you notice:

• Rapid growth (>1 cm/month)

• Severe pain or tenderness

• Redness, warmth, or fever (infection)

• Neurological signs (headache, visual changes)

• Discharge of foul material

• Scalp deformity or bony defect

• Recurrence after prior excision

• Multiple cysts appearing suddenly

• Suspicion of malignancy (hard, immobile)

• Cosmetic concerns affecting quality of life PMCACS

---

Frequently Asked Questions (FAQs)

1. What is an occipitofrontalis muscle cyst?
   A benign fluid- or keratin-filled sac over the scalp muscle. PMC

2. How do these cysts form?
   From blocked hair follicles, epidermal inclusion, or developmental remnants. PMC

3. Are they cancerous?
   Almost always benign; very rarely proliferating tumors. Cleveland Clinic

4. How can I tell an epidermal from a pilar cyst?
   Pilar are firmer, familial, often multiple; epidermal have a visible central punctum. Cleveland Clinic

5. Do they hurt?
   Usually painless unless infected or ruptured. Cleveland Clinic

6. Can I squeeze it out myself?
   No—self-expression often leads to infection and scarring. PMC

7. Is treatment always needed?
   No—small, asymptomatic lesions may be observed. thefetus.net

8. What is the best surgical method?
   Complete excision with intact cyst wall removal has lowest recurrence. Mansa Publishers

9. Will it come back after removal?
   Rarely, if any cyst wall remnants remain. Mansa Publishers

10. Can antibiotics alone cure it?
    Antibiotics treat infection but do not remove the cyst itself. Cleveland Clinic

11. Is laser therapy effective?
    Yes for small cysts; offers minimal scarring. ACS

12. Are there home remedies?
    Warm compresses may relieve discomfort but won’t eliminate the cyst. thefetus.net

13. Can these cysts occur in children?
    Yes—especially dermoid or congenital inclusion cysts. OAE Publishing

14. How long is recovery after surgery?
    Usually 7–10 days for simple excision, longer if flaps are needed. Mansa Publishers

15. When should I worry about malignancy?
    Hard, rapidly growing, fixed lesions warrant biopsy. ACS

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 27, 2025.

References