A 12-year-old male presented with a right preauricular swelling associated with discharge. The lesion had been noted for a period of time and prompted medical evaluation. There were no associated constitutional symptoms or other systemic complaints. His past medical history and past surgical history were unremarkable, with no history of chronic illnesses or previous surgical interventions. Family history was negative for similar lesions or significant hereditary diseases.

Laboratory investigations revealed normal hematological parameters, with a white blood cell (WBC) count of 8.7 × 10⁹/L, hemoglobin level of 13.1 g/dL, and platelet count of 354 × 10⁹/L. The erythrocyte sedimentation rate (ESR) was 5 mm/hr, and the C-reactive protein (CRP) level was 0.452 mg/L, Renal function tests were within normal limits, with a blood urea level of 36.6 mg/dL and a serum creatinine level of 0.652 mg/dL. Viral screening for HIV antibodies, hepatitis B surface antigen (HBsAg), and hepatitis C virus antibodies (HCV Ab) was negative. Overall, the laboratory findings were unremarkable and did not indicate any underlying systemic inflammatory.

A 21 × 9 × 3 mm heterogeneously hypoechoic mildly peripherally vascular lesion was noted within the skin and subcutaneous tissue overlying the right parotid region, consistent with focal inflammatory change or an infected skin sinus. The major salivary glands and thyroid gland were otherwise unremarkable, with no focal lesions identified. Ultrasound revealed multiple bilateral cervical lymph nodes, predominantly at levels I and II, with preserved benign morphology, including normal shape, echogenic hila, and cortical thickness <2 mm. The largest node measured 29 × 7.7 mm in the right submandibular region, favoring reactive inflammatory lymphadenopathy.

Under general anesthesia, the patient was positioned supine with the neck rotated to the left side. A wide local excision (WLE) was performed through an elliptical incision. The lesion was completely excised, meticulous hemostasis was achieved, and the wound was closed in anatomical layers using Monocryl sutures, which do not require removal. The procedure was completed without intraoperative complications.

Histopathological evaluation of the right facial lesion wide local excision specimen revealed a ruptured epidermoid inclusion cyst with associated inflammatory changes. Sections demonstrated fragments of tissue lined by benign epidermis with focal surface erosion and a residual cyst wall lined by benign stratified squamous epithelium. The cyst contained keratinous material and was associated with extensive mixed inflammatory cell infiltration, multinucleated giant cell reaction, hemorrhage, and vascular congestion. No evidence of malignancy was identified.

The patient had an uneventful postoperative recovery following wide local excision of the right facial lesion. The surgical wound healed well, with no evidence of infection, hematoma, or wound dehiscence. No postoperative complications were noted.