Sublingual epidermoid cyst

Epidermoid Cyst in the Submandibular Region Mimicking Plunging Ranula: A Case Report

Epidermoid cysts rarely present in the submandibular area, constituting approximately less than 7% of all cystic lesions in the head and neck region and less than 0.01% of all oral cavity cysts. Therefore, epidermoid cysts can be easily misdiagnosed, as the differential diagnosis for a submandibular area mass is very broad. Imaging can help define characteristics of the mass; however, a pathologic specimen is usually required for the final diagnosis. Surgical excision is often required and tolerated well by most patients. However, there is a risk of recurrence of the cyst after excision, as well as a rare chance for malignant transformation if not excised, which must be discussed with the patient at the time of diagnosis of epidermoid cyst. We present a 33-year-old Caucasian female with a left submandibular cystic mass measuring 4.7 cm x 2.9 cm, that was originally thought to be a plunging ranula and subsequently diagnosed as an epidermoid cyst. This report is meant to raise awareness of the possibility of a submandibular mass being an epidermoid cyst as well as appropriate workup, treatment, and prognosis of epidermoid cysts in the submandibular region. This report also describes a unique approach to a submandibular epidermoid cyst of which the submandibular gland is divided for access to the cyst for safe and effective excision. To the author's knowledge, this surgical approach has not been described in the literature for a submandibular epidermoid cyst.

Craniofacial Epidermoid and Dermoid Cysts

BACKGROUND

Epidermoid and dermoid cysts are benign developmental anomalies that can form anywhere in the body. Despite the rarity of incidence in the head and neck, they can arise at a variety of craniofacial locations. The purpose of this study was to analyze the clinical features of epidermoid and dermoid cysts arising in the craniofacial region with a literature review.

METHODS

A retrospective study was designed, and clinical features and surgical considerations were investigated from a literature review. Cases of epidermoid cysts in the scalp, temporal area, glabellar area, mouth floor, and buccal mucosa were described.

RESULTS

Dermoid cysts in more lateral regions of the scalp are rarely associated with intracranial extension. Because temporal dermoid cysts have a high rate of intracranial extension, radiological evaluation of the lesions in the temporal area is imperative. Epidermoid cysts in the glabellar area are usually superficial. Consideration of the surgical approach for an epidermoid cyst of the mouth floor is important. Because epidermoid cysts in the buccal mucosa are extremely rare, differential diagnosis was emphasized. Epidermoid cysts in the scalp, in the temporal intradiploic area, on the glabellar area in the periorbital region, in the mouth floor, and in the buccal mucosa were surgically excised considering the depth and location. Ten cases of epidermoid cysts in the buccal mucosa were retrieved from the literature review.

CONCLUSIONS

Consideration of the anatomic locations of epidermoid and dermoid cysts in the craniofacial region might help facilitate accurate diagnosis and treatment.

Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study

Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

Giant Epidermal Cyst of Floor of Mouth: Case Report

Introduction: The epidermoid cysts of the mouth are located on the mid line of the floor of mouth, most likely caused by the retention of the germinal epithelium during the growth of the mandible and hyoid branchial arches. Here, we present a case of large epidermoid cyst involving sublingual region.

Imaging features of epidermoid cyst located in the floor of the mouth: case report and narrative review of literature

Epidermoid cysts are benign slow-growing developmental lesions resulting from ectodermal tissue that can localise anywhere in the body. Only 7% of all epidermoid cysts are located in the head and neck area and, together with dermoid cysts, account for less than 0.01% of all oral cavity cysts. Herein, we present the case of a 17-year-old male diagnosed with a sublingual epidermoid cyst and a review of the literature on this rare localisation, focusing on clinical and imaging features, management and outcomes. All the articles reporting epidermoid cysts located in oral cavity were searched using PubMed/Medline, discarding all those not located in head and neck district, not mentioning diagnostic imaging, not defined as epidermoid cysts by a histopathological diagnosis, and those for which only an abstract was available. In literature there were 35 articles, from 1993 to 2020, that meet the aforementioned requirements, for a total of 38 patients and 39 cysts. For each article, age, sex, onset time of symptoms, location, size and surgical access were analysed. Particular attention was paid to the radiological investigation used in order to understand the most common imaging aspects and also rare cases with unusual presentations.

Intraosseous Epidermoid Cyst: a Case Report

BACKGROUND

Epidermoid cysts are benign lesions that occur throughout the body. Their development in the oral cavity is extremely rare. Intraosseous epidermoid cysts of the jaw are even rarer and difficult to distinguish from other lesions. For this reason, we would like to draw the attention of practitioners to this pathology as a differential diagnosis through the presented clinical case.

METHODS

This study presents an unusual case of a type of epidermoid cyst in an edentulous maxilla. A 70-year-old man was referred to the Maxillofacial Surgery Division at the University Multiprofile Hospital for Active Treatment and Emergency Medicine "N. I. Pirogov", Sofia, Bulgaria, for a single radiolucent area in his anterior maxilla. The patient underwent surgery to extract the cyst.

RESULTS

Based on the clinical and radiographic evaluation, a preliminary diagnosis of dentigerous residual cyst was made. The histopathological examination of the hematoxylin and eosin stained sections revealed an epidermoid cyst based on the observed thick keratin layer resembling epidermis together with the stratified squamous epithelium lining with many layers of sheaves of orthokeratin.

CONCLUSIONS

This report presents an uncommon case of an intraosseous epidermoid cyst occurring without a history of maxillary trauma. Although intraosseous epidermoid cysts are extremely rare in jaws, they should be considered in the differential diagnosis of radiolucent lesions.

Paediatric submental epidermoid cyst

A young girl presented with an insidious onset, gradually increasing midline submental swelling of 1-year duration and pain on swallowing for 6 months. Ultrasonography of the neck suggested a hypoechoic cystic swelling of the submental region between the muscles of the floor of the mouth, with no increased vascularity. An extraoral surgical enucleation was done and a postoperative biopsy suggested an epidermoid cyst. Epidermoid cysts of the submental region are extremely rare and any midline head and neck lesion in children requires critical examination and evaluation to avoid complications. Here, we present a rare case of a paediatric submental epidermoid cyst and its clinical features and management.

Lip Epidermoid Cyst Caused by a Piercing: A Report of a Rare Case

We report the case of a lip epidermoid cyst, caused by piercing in a 23-year-old Japanese woman. She had an exophytic lesion in the lower lip associated with the piercing which was initially diagnosed as a mucous retention cyst. The lesion was resected under local anesthesia, and pathological examination revealed an epidermoid cyst, likely caused by piercings. Piercing-induced epidermoid cysts frequently occur in the tragus. There have been no reports of piercing-induced epidermoid cysts developing in the oral cavity. To our knowledge, this is the first report of a lip epidermal cyst caused by piercings. Six months have passed since the operation, and it has not recurred.

Pediatric sublingual dermoid and epidermoid cysts: A 20-year institutional review

INTRODUCTION

Pediatric cystic sublingual masses often present a diagnostic dilemma for practitioners. Though uncommon, dermoid or epidermoid cysts can present in the sublingual space at any age and are often misdiagnosed as an inflammatory pseudocyst (ranula) or lymphatic malformation. Imaging may not always identify the underlying etiology, requiring physicians to maintain a high index of suspicion for these relatively rare oral cysts.

OBJECTIVES

To describe the presentation and treatment of sublingual dermoid and epidermoid cysts presenting to a tertiary children's hospital over 20 years.

METHODS

A retrospective review of all pathology specimens identified as dermoid or epidermoid cysts within the sublingual space from 1999 to 2019. Patient charts were then reviewed for relevant clinical, imaging, and operative data.

RESULTS

Twelve pediatric patients were identified (8 female, 4 male) with a mean age of 7.2 years (SD 5.6). Eighty six percent (6/7) of dermoid cysts were found in female patients, while 60% (3/5) of epidermoid cysts were in male patients. Multiple dermoid and epidermoid cysts were each found in one patient (8%). Two epidermoid cysts presented in the neonatal period. Preoperative diagnosis included nondiagnostic "cystic mass" (33%), ranula (25%), lymphatic malformation (LM) (17%), and dermoid/epidermoid cyst (17%). Two thirds of patients (8/12) underwent imaging, with all receiving either MRI or CT. Although MRI was the most likely to suggest the possibility of a dermoid/epidermoid cyst (2/4), ranula was the most common primary radiographic diagnosis (5/8). One patient underwent sclerotherapy for presumed LM one year prior to surgical excision of the cyst. Eleven patients (92%) underwent intraoral excision, one (8.3%) underwent a combined intraoral/extraoral approach.

CONCLUSIONS

To our knowledge, this review represents the largest case series of pediatric sublingual dermoid and epidermoid cysts to date. This series contained higher levels of epidermoid cysts and female patients than previously reported in the literature. Identifying more dermoid cysts in females and epidermoid cysts in males is also a new finding. MRI was superior to CT and US regarding the presence of a dermoid/epidermoid cyst. Frequently misdiagnosed, it is important to consider these relatively rare pathologies when treating children presenting with sublingual masses in order to avoid delayed and/or inappropriate treatment.

Swelling in the Floor of the Mouth: A Diagnostic Dilemma

Epidermoid cysts are abnormal structures originating from abnormal ectoderm and are benign and slow growing. These are found anywhere in the body. They arise during embryonic fusion due to entrapment of epithelial remnants and sometimes due to faulty implantation of the epithelium. The cysts can be epidermoid (squamous epithelium), true dermoid (skin apppendages), and teratoid (all germ layers). They are usually diagnosed by fine-needle cytological aspiration and require imaging to plan line of treatment. Diagnostic dilemma is always an issue as cystic lesions are commonly found in the head-and-neck region. Here, we present a case of large epidermoid cyst involving sublingual and submandibular region.

Dermoid Cysts of the Maxillofacial Region: Case Series

The maxillofacial region can be affected by a number of subcutaneous pathologic conditions that include developmental, inflammatory, infective and neoplastic entities. Many of these lesions present as a soft to firm painless swelling. Differential diagnosis of such lesions requires thorough knowledge of maxillofacial pathology as well as anatomy to come to a correct diagnosis and provide effective treatment. Misdiagnosis and improper treatment can lead to other complications and morbidity. The commonly encountered lesions include dermoid cysts, branchial cysts, lipoma and thyroglossal cyst. Dermoid cysts are dysontogenetic cysts rarely involving the maxillofacial region (1.6-7% of all dermoid cysts of the body). The most common site of involvement in the maxillofacial region is near the frontozygomatic suture followed by cervical region. Some lesions have a deep component which may involve the cranial or orbital cavities. This is a retrospective study of the cases managed at our center from 2001 to 2017. Of the 12 cases in our study, all but one was involving the floor of the mouth. There were 11 males and 1 female. Swelling was the only symptom. The patients age ranged from 16 to 34 years (Table 2). The cysts were present for a period ranging from 6 months to 5 years at the time of reporting. All cases were managed with enucleation. The patients are on follow-up with no report of recurrence. The period of follow-up was 1 to 16 years. There were no complications postoperatively.

Rare Giant Upper Lip Epidermal Cyst in a Patient Wearing a Denture

Epidermal cysts are intradermal or subcutaneous cystic tumors that frequently occur in the face, scalp, neck, and body trunk. Acquired cases of epidermal cyst commonly occur as a result of various surgical operations, chronic irritation, or trauma, all of which may trigger the occurrence of the invagination of squamous epithelium. A 57-year-old man presented with a palpable mass 7 cm×2 cm in size in the upper lip. The patient had a 3-year history of wearing a denture to restore missing bilateral maxillary central and lateral incisors, accompanied by inflammatory findings on the buccal mucosa due to chronic lip irritation. The resected oval-shaped cyst had a size of 5.5 cm×3.0 cm×2.5 cm, and it was an encapsulated mass with a well-defined margin. The histopathology was typical of epidermal cyst. This case of a rare giant upper lip epidermal cyst in a patient wearing a denture may be of interest to clinicians.

Rare Locations of Epidermoid Cyst: Case Reports and Review

Background

Epidermoid cysts are benign lesions encountered throughout the body. Eighty percent of epidermoid cyst seen in ovaries and testicles, whereas in head and neck region they account for only 1.6–7.0%. 1.6% of epidermoid cysts occur in oral cavity and they account for 0.01% of all the oral cavity cysts.

Case Details

Two case reports of epidermoid cyst has been discussed. One patient reported with well defined swelling in the right lower one third of the face, another one in the upper lip. Initially the cases were diagnosed as Lipoma and salivary adenoma respectively but histologically they turned out to be epidermoid cyst. Hence, we aim at highlighting the differential diagnosis pertaining to the anatomical location. The PubMed database search made on January 2016 yielded 674 articles of epidermoid cyst in the head and neck region. In that there is only one case reported occuring in the lower one third of face. In the current report, we outline the second case of epidermoid cyst localized to the right mandibular body region without bone involvement. Another case in our report was localized in the upper lip. In the literature totally seven cases were reported till now occurring in the lip.

Conclusion

Although epidermoid cysts are rarely encountered in the oral cavity, the possibility that they may occur warrants the need for successful management to avoid misdiagnosis.

Extensive epidermoid cyst of the submental region

Epidermoid cysts are malformations that are rarely observed in the submental region. Imaging has an important role in surgical planning according to the size and location of the cyst in relation to geniohyoid and mylohyoid muscles. This article reports the case of a 15-year-old female patient complaining of submental swelling. The differential diagnosis included infection, tumor, ranula, and abnormalities during embryonic development. The lesion was surgically excised using an extra-oral approach. The histopathological examination revealed a cyst wall lined with stratified squamous epithelium with the presence of several horny scales consistent with the diagnosis of an epidermoid cyst. No recurrences were found after 1 year of follow-up.

An unusual occurrence of multiple epidermoid cysts in both sides of buccal mucosa: A unique and rare first case report

Intraoral epidermoid cyst of buccal mucosa is generally an uncommon entity. Epidermal inclusion cyst refers sequestration of epidermal elements into the dermal and deeper tissue during the fetal period in line of fusion of embryonic process or acquired due to implantation of the epithelium due to trauma or surgery. It usually presents as slow growing asymptomatic cysts but may be symptomatic due to large size, interfering with mastication and speech or secondary infection. Surgical excision is done for removal of these cysts. We report an interesting case of multiple epidermal cysts in both sides of buccal mucosa in a 35-year-old male patient.

Pediatric epidermoid cysts masquerading as ranulas: A case series

Pediatric neck masses represent a variety of differential diagnoses. A common pathology in pediatric cystic neck tumors include ranulas, mucus retention cysts due to salivary gland obstruction. Epidermoid cysts are lesions infrequently encountered in the pediatric population and may appear similarly to ranulas on computed tomography imaging. MRI more easily differentiates these masses, and should therefore be the preferred imaging modality. Due to their distinct intraoperative management, ranulas and epidermoid cysts should be distinguished preoperatively through proper workup.

A Giant Plunging Sublingual Dermoid Cyst Excised by Intraoral Approach

OBJECTIVE

Dermoid and epidermoid cysts are rare cysts of the head and neck region, which should be considered in differential diagnosis of sublingual mass, constituting 0.01 % of all oral cavity cysts. There are suspected theories regarding the basis of the pathology.

CASE REPORT

30-year-old male referred to our clinic with a chief complaint of sublingual mass which had been present for many years but the lesion enlarged over the past 3 years. MRI examination revealed a giant cystic mass which was 3.6 × 3.9 mm in diameter and medially located at sublingual region.

TREATMENT AND PROGNOSIS

Intraoral approach was preferred for surgery and no recurrence or complaints were detected during follow-up period.

CONCLUSION

When a cystic mass is detected on the floor of oral cavity, we must consider dermoid cysts for differential diagnosis. Surgery is the only treatment. If possible, intraoral approach should be preferred because of its perfect cosmetic results.

Epidermoid cyst in the floor of the mouth of a 3-year-old

Epidermoid cysts are a rare entity in the oral cavity and are even less frequent in the floor of the mouth, representing less than 0.01% of all the cases. We present the case of a 3-year-old girl with a growth in the floor of the mouth with 2 months of evolution and without changes since it was discovered by her parents. The lesion was asymptomatic; it did not cause dysphagia, dyspnea, or any other alteration. A CT scan with contrast was done which revealed the location and exact size of the lesion, allowing an intraoral approach for its excision. The histological examination confirmed the clinical speculation of an epidermoid cyst.

Congenital epidermoid cyst results in muscle fusion defect in the upper lip

Epidermoid cysts are rarely detected malformations in the oral cavity. Their development sites are the sublingual, submaxillary, and submandibular spaces. In this paper, we report a three-month-old infant who was admitted to our hospital due upper lip swelling. Magnetic resonance imaging showed that she had a two-centimeter cystic lesion and fusion defects of orbicularis oris muscle. The cyst was surgically removed and histopathological diagnosis was "epidermoid cyst." In recent literature, we could not find reports related to orbicularis oris muscle fusion defects because of epidermoid cyst.

Dermoid cysts of maxillofacial region

The dermoid cyst is an uncommon clinicopathological lesion of developmental origin. The term dermoid cyst is used to describe 3 cysts that are closely related histologically: dermoid cyst, epidermoid cyst, and teratoma. Epidermoid and dermoid cysts are benign nature, which may occur anywhere in the body, but most predominantly in the ovary and scrotal regions. Only about 7% are found in the head and neck. The occurrence of such cysts in the oral cavity is extremely rare, with approximately 1.6% located in this area. The floor of the mouth is one of the most commonly affected area, however, these cysts can also be found in the tongue, lips, buccal mucosa and jaw bones. There is always a difficulty of making a correct diagnosis of these lesions with clinical examinations and conventional radiography. To achieve a diagnosis and to develop correct surgical strategy specialized imaging examinations such as ultrasonography (US), computed tomography (CT), Magnetic Resonance Imaging (MRI) and histopathological examination should be carried out. Treatment comprises total surgical excision the approach remains dictated logically by the cyst's location. Ample understanding and vigilance about this slow growing painless mass is essential not only because of the symptoms it produces but also due to its malignant potential. When dermoid cysts occur on the floor of the mouth, they may enlarge to such an extent that they can interfere with deglutition and produce respiratory obstruction. Early diagnosis and treatment are essential for these cystic entities.

Giant sublingual epidermoid cyst resembling plunging ranula

Epidermoid and dermoid cysts represent less than 0.01% of all oral cavity cysts. We describe a rare case of large epidermoid cyst in floor of mouth, with an oral as well as submental component resembling plunging ranula reported in the literature from India. We present a case of a 16-year-old girl with complaints of a mass in sublingual region, difficulty chewing, and dysphagia for about 5 months. Fine-needle aspiration cytology showed keratin flakes and proteinaceous material. Contrast-enhanced CT oral cavity was done and showed 7.0 × 5 × 4.5 cm well-circumscribed non-enhancing cystic mass extending into the floor of the mouth. On examination, a firm swelling was noticed in the submental area, extending down to the thyroid notch. The patient underwent surgical removal of the mass. On histopathology, acidophilic stratum corneum and basophilic dot like staining of stratum granulosum, which is the hallmark of an epidermoid cyst, were seen.

Epidermoid cysts in head and neck: our experiences, with review of literature

Epidermoid cysts are benign lesions, characterized by cystic spaces lined by simple squamous epithelium (epidermoid cyst), containing skin adnexa ("true" dermoid cyst) or tissues of all three germ layers (teratoid cyst). Head and neck constitute ~7% of all cases of epidermoid and dermoid cysts. There is often a diagnostic dilemma with the more common cystic lesions of this region. A retrospective case-series study of histologically proved epidermoid cysts in the head-neck region, from February 2008 to January 2011, in the Department of Otorhinolaryngology and Head-Neck Surgery of a tertiary Government teaching hospital in eastern India. The diagnosis was reached by fine needle aspiration cytology FNAC and subsequent histopathology where feasible. Necessary imaging was done for evaluation and management. A total of 28 cases were analyzed. 5 were female, with a male: female ratio of 4.6. Age range was from 2 to 60 years (mean = 30). Excision was the preferred treatment in 20 cases (71.4%). Various sites like the submandibular region (5), pinna (5), sublingual region (1), periorbital (6), suprasternal (6), along the anterior border of sternocleidomastoid (1) and glabella (3) were involved, along with an iatrogenic implantation epidermoid cyst in a tracheostomy scar. Some of the interesting cases presenting with clinical dilemma have been emphasized. Epidermoid cysts are relatively less common in the head-neck region, hence are liable to be misdiagnosed. In this case-series, few cases presenting with enough elements of confusion and dilemma are discussed with overall analysis and review of the related literature.

Epidermoid cyst of the tongue causing airway obstruction

Epidermoid cyst occurring within the tongue is rare. The aim of this article is to discuss the management of an adult patient who presented with respiratory obstruction due to this congenital epidermoid cyst within the tongue. A 32-year-old male patient who was brought to the accident and emergency department of the University of Port Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria was presented. He came with a history of difficulty in breathing as a result of a slow growing swelling of the tongue which started from birth. There was associated pain, difficulty in speech and mastication as the swelling increased in size. Detailed physical examination, sonographic imaging and histopathology were carried out. On examination, patient was acutely ill-looking, in severe respiratory distress, febrile, mildly pale and dehydrated but anicteric. Extra-oral examination revealed mildly protruded upper and lower dento-alveolar arch as well splaying and recession of the anterior and posterior teeth of the upper arch. Intra-oral examination revealed moderately tender, fluctuant and grossly enlarged tongue obstructing the oro- and nasopharyx. A diagnosis of dermoid cyst was made and the patient was booked for surgery after resuscitation. Excision of the cyst was done under general anaesthesia/naso-tracheal intubation by an intra-oral approach. Ultrasound was able to give a thorough assessment of the cystic nature of the swelling while post-operative histopathology was used to confirm the specific type of teratoma. The relationship of the cyst to the intrinsic and extrinsic muscles of the tongue and mylohyoid muscle was relevant to the surgical approach to the lesion.

A case of sublingual dermoid cyst: extending the limits of the oral approach

We present the case of a dermoid cyst with an oral and a submental component in a 21-year-old Japanese woman who presented with complaints of a mass in the oral cavity and difficulty in chewing and swallowing solid foods for about 2 years. MRI shows a 55 × 65 mm well-circumscribed cystic mass extending from the sublingual area to the mylohyoid muscle. Under general anesthesia and with nasotracheal intubation, the patient underwent surgical removal of the mass. Although the cyst was large and extending mylohyoid muscle, intraoral midline incision was performed through the mucosa overlying the swelling and the cyst was separated from the surrounding tissues with appropriate traction and countertraction and successfully removed without extraoral incision. Oral approach in surgical enucleation is useful procedure to avoid cosmetic problems in large and extending mylohyoid muscle cyst.

[Submandibular dermoid cyst extended to the cervical region]

INTRODUCTION

Dermoid cysts of the submandibular region are rare. We report an exceptional case with extension to the neck.

OBSERVATION

The patient presented with a voluminous left submandibular cystic tumor with extension to the neck and to floor of the mouth. Ultrasonography and CT scan contributed to the diagnosis and to chose the best surgical approach in case of large cyst. In our case, the tumor was removed using a double cervical and intraoral approach. Histopathological examination confirmed a dermoid cyst.

DISCUSSION

We report an exceptional case of dermoid cyst originating from submandibular region. A double surgical approach was necessary for tumor resection. Tumor removal must be complete; the submandibular gland may be removed if necessary.

A rare case of congenital epidermoid cyst of the hard palate

Epidermoid cysts are benign conditions that are thought to derive from abnormally situated ectodermal inclusions in the oral cavity. They are generally found in hands, fingers, feet, ovaries and testicles but in oral cavity they represent a very rare event. This is the first case of an intraosseous epidermoid cyst situated in the hard palate. Healing was uneventful and there was no sign of recurrence in 2-years follow-up.

Giant sublingual dermoid cyst in floor of the mouth

The dermoid cysts of the mouth are most frequently located on the median line of the mouth floor and are most likely caused by the retention of the germinal epithelium during the growth of the mandible and hyoid branchial arches. We report an unusual case of giant dermoid cyst of the floor of the mouth in a 17-year female who presented with progressively increasing swelling below her tongue and reviewed the relevant literature.

A huge epidermoid cyst endangering life

Epidermoid cyst of the neck or auricular area are relatively more common than that of the oral cavity. In most cases about 80% they remain asymptomatic. But in about 20% cases it becomes painful because of secondary infection seeking treatment. Here we present a case report of biopsy proved Epidermoid cyst with life threatening infection.

Epidermoid cyst of the floor of the mouth: two case reports

Introduction

Epidermoid cysts that appear in the midline floor of the mouth are, usually, a result of entrapped ectodermal tissue of the first and second branchial arches, which fuse during the third and fourth weeks in utero. The incidence in the floor of the mouth of the oral cavity is rare and development sites are the sublingual, submaxillary and submandibular spaces.

It was present two cases of epidermoid cyst of the floor of the mouth and discussed the different surgical approaches for this lesion.

Cases presentation

Two cases of midline epidermoid cysts of the floor of the mouth are presented, evaluating the different surgical approaches. The preoperative assessment was made using ultrasonography and computed tomography in both cases. Regarding surgical techniques used, a transcutaneous approach was adopted when the cysts were under the geniohyoid muscle and a midline incision of the oral mucosa along the lingual frenulum was used for sublingual cysts. During the postoperative course, there were no complications, except for mild edema in one case. Follow-up ranged between 5 months and 4 years; no recurrence or malignant changes were observed.

Conclusions

Surgery of epidermoid cyst of the floor of the mouth is the treatment of choice. Access depends on the lesion's location in relation to the mylohyoid or geniohyoid muscles. If the cyst is located over the mylohyoid, surgery is carried out only through the oral cavity, whereas the extraoral incision was necessary only when the cysts were under the geniohyoid muscle.

Cutaneous cysts of the head and neck

PURPOSE

A retrospective study on the features of cutaneous cysts of the head and neck as seen in a North Jordanian population.

PATIENTS AND METHODS

The records of the Department of Pathology at Jordan University of Science and Technology were reviewed for patients with cutaneous cysts of the head and neck during the 12-year period extending between 1991 and 2002. Applicable records were retrieved, reviewed, and analyzed. Primary analysis outcome measures included patient age, gender, location of the cyst, type, clinical presentation, and treatment. The records of 488 patients were available for analysis.

RESULTS

Epidermoid cyst was the most frequent lesion (49%) followed by pilar cysts (27%), and dermoid cysts (22%). The site affected most frequently was the scalp (34%), predominantly with pilar cysts (96%). Epidermoid cyst was the most frequent lesion in the neck (68%), cheeks (77%), periauricular area (70%), and the nasal area (55%). Dermoid cyst was the most frequent lesion in the periorbital area (52%). Females represented 51% of the patients and males accounted for 49%. The peak of age distribution for patients with dermoid cysts was at the first decade, and both of epidermoid and pilar cysts peaked at the third decade. Infection presented in 2.5% of cases. All cysts were enucleated surgically.

CONCLUSION

Maxillofacial surgeons often encounter cutaneous cysts of the head and neck, and they must be familiar with the clinicopathologic characteristics of these lesions.

Sublingual epidermoid cyst: a case report

Epidermoid and dermoid cysts represent less than 0.01% of all oral cavity cysts. The cysts can be defined as epidermoid when the lining presents only epithelium, dermoid cysts when skin adnexa are found, and teratoid cysts when other tissue such as muscle, cartilage, and bone are present.

In this article, we present the case of an epidermoid cyst, with an oral as well as a submental component, in an 11 year old boy who presented with complaints of a mass in the oral cavity, difficulty chewing and swallowing of solid foods for about 3 years. He was admitted to the otolaryngology department. On examination, a mass displacing the tongue superiorly and posteriorly was noticed. An MRI scan was done and showed a 40 × 35 mm well-circumscribed non-enhancing cystic mass extending from the sublingual area to the level of the thyroid notch. The content of the cyst was homogenous. On examining the neck, a firm swelling was also noticed in the submental area, extending down to the thyroid notch. Under general anesthesia and with nasotracheal intubation, the patient underwent surgical removal of the mass. Extraorally, a midline submental horizontal incision was performed through the mucosa overlying the swelling and the cyst was dissected from the surrounding tissues and removed. On histological examination, acidophilic stratum corneum and basophilic dot like staining of stratum granulosum, which is the hallmark of an epidermoid cyst, were seen. The patient did well postoperatively, and no recurrence was noticed at the 6-months follow-up.

Congenital oral cysts in neonates: report of two cases

Oral cysts in the neonatal period are very uncommon and may cause morbidity and mortality if not treated expeditiously. We report 2 cases of neonatal oral cysts that were managed successfully.

Concurrent extravasation mucocele and epidermoid cyst of the lower lip: a case report

An uncommon case of concurrent extravasation mucocele and epidermoid cyst in the lower lip of a 13-year-old boy is described. To our knowledge, there is no other report of such a concurrence, neither at the same site nor at different locations, involving these two lesions in the oral mucosa.

Intrathyroid dermoid cyst presenting as a unilateral "Cold" nodule

A dermoid cyst arising in the left lobe of the thyroid gland in a 5-year-old boy was managed with a left hemi-thyroidectomy. While congenital lesions feature frequently in the differential diagnosis of childhood neck masses, dermoid cysts presenting as a unilateral neck mass are rare. When found within the thyroid, their pathogenesis may be explained by a disruption of normal thyroid development. Excision appears the treatment of choice.

Kyste dermoïde de la langue : aspects en imagerie d’un kyste géant

Dermoid cysts of the oral cavity are rare and most commonly involve the floor of mouth. Intralingual dermoid cysts are extremely rare and usually large at the time of diagnosis in adult patients. We report the case of 6 year old girl with macroglossia and swallowing and respiratory difficulties due to a giant intralingual dermoid cyst. Ultrasonography showed a large cystic intralingual lesion. MRI allowed accurate evaluation of the size, the extension and the relationship of the cystic mass with adjacent structures, the fat component of the cystic mass confirmed the dermoid origin. This case illustrates the diagnostic contribution of US and MRI in this disease.

Intrarenal epidermal cyst

An epidermal cyst is a very unusual cause of a renal mass, with only three cases reported in English literature. The authors report a case of this in a 51-year-old man with left flank pain and hematuria. A 5 x 4 cm-sized cystic mass, having an irregular margin with stippled calcification, was identified in the lower pole of the left kidney. A retroperitoneal laparoscopic simple nephrectomy was performed under the assumption that it was a renal tumor. Histologically, the tumor was identical in appearance to an epidermal cyst within the skin. Aberrant ectodermal implantation during embryogenesis has been postulated as a histogenesis of intrarenal epidermal cyst. However, the present case had a history of renal stone, which was treated with extracorporeal shock wave lithotripsy. Therefore, the authors suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin. The diagnosis of an epidermal cyst was not made preoperatively in the present case, or in the cases described in the literature. This diagnosis should be included in the differentiation of calcified intrarenal masses.

Cysts and tumors of the oral cavity, oropharynx, and nasopharynx in children

A wide variety of developmental and neoplastic lesions arise in the oral cavity, oropharynx, and nasopharynx in children. The clinical manifestations and cross-sectional imaging findings provide complementary information, which is used to establish a probable or definitive diagnosis. This article describes imaging techniques and findings for developmental cystic masses and solid tumors in the pediatric population.