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Lucas JP, Allen M, Siegel B, Gonik N. Diagnosis and management of congenital floor of mouth masses: A systematic review. Int J Pediatr Otorhinolaryngol 2021; 140:110541. [PMID: 33296834 DOI: 10.1016/j.ijporl.2020.110541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Determine the utility of preoperative imaging and the optimal course of management for congenital floor of mouth (FOM) cysts in infants. METHODS A systematic review of the literature was performed conforming to PRISMA guidelines. Pubmed, Embase and Cochrane Library databases were queried to identify cases of infants with congenital floor of mouth masses. Patient demographics, presenting findings, imaging, management, complications, and outcomes were determined. RESULTS 85 patients were evaluated. 98% of patients presented at 16 months of age or younger. The most common presenting symptom was submental mass or swelling, 31.3%. Among the patients that underwent imaging, the suspected diagnosis obtained from imaging findings was consistent with the final pathologic diagnosis 59% of the time reported and inaccurate 34% of the time. There were multiple definitive treatment modalities described in the literature review including surgical excision, 82.3%, marsupialization, 12.9%, chemical injection 2.3%, sclerotherapy 1.2%,% and radiation, 1.2%. Recurrence rate after initial definitive treatment was as follows, surgical excision, 8.8%, marsupialization, 80%, sclerotherapy, 100%, chemical injection, 50%, and radiation, 100%. CONCLUSION Preoperative imaging studies should not be relied upon alone to determine suspected pathology and subsequent management in pediatric patients with FOM masses. It may be beneficial for these patients to undergo primary surgical excision regardless of imaging studies or suspected pathology. Needle aspiration offers limited addition to pathologic diagnosis and should only be performed in the setting of acute symptomatic management. Surgical excision should be considered as definitive treatment modality in all patients with FOM masses, regardless of the suspected diagnosis of ranula. Further multi-institutional cohort studies could be invaluable to elucidate definitive treatment guidelines in this patient population.
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Affiliation(s)
- Jordyn P Lucas
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Meredith Allen
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Bianca Siegel
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Children's Hospital of Michigan, Detroit, MI, USA
| | - Nathan Gonik
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Children's Hospital of Michigan, Detroit, MI, USA
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Khatri A, Singh L, Jain N, Sengar M, Das A. Intraoral Foregut Cystic Developmental Malformations: Three cases with a brief review of literature. Sultan Qaboos Univ Med J 2019; 19:e257-e261. [PMID: 31728226 PMCID: PMC6839678 DOI: 10.18295/squmj.2019.19.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/01/2019] [Accepted: 05/06/2019] [Indexed: 12/03/2022] Open
Abstract
Foregut cystic developmental malformations (FCDM) are a type of rare cystic lesion. The occurrence of FCDM is exceedingly uncommon in the intraoral location. We report three cases of FCDM with intraoral location who presented at Chacha Nehru Bal Chikitsalaya, New Delhi, India, in 2016, 2017 and 2018 with symptoms of respiratory distress and feeding difficulties. Two patients were male and one was female with an age range of 29 days to eight years. The clinical differential diagnosis included mucocele, ranula, dermoid, lymphangioma, teratoma, thyroglossal duct cyst, etc. All patients were treated with simple surgical excision and diagnosed, based on histopathology, with FCDM. These should be considered as differential diagnosis of head and neck midline cystic mass lesions. This case report aimed to discuss differential diagnosis and appropriate terminology for these cystic masses as there is varied and ambiguous nomenclature.
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Affiliation(s)
- Arti Khatri
- Department of Pathology, Chacha Nehru Bal Chikitsalya, Delhi, India
| | - Lavleen Singh
- Department of Pathology, Chacha Nehru Bal Chikitsalya, Delhi, India
| | - Neha Jain
- Department of Otolaryngology, Chacha Nehru Bal Chikitsalya, Delhi, India
| | - Mamta Sengar
- Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalya, Delhi, India
| | - Abhijit Das
- Department of Pathology, Chacha Nehru Bal Chikitsalya, Delhi, India
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Méndez Sáenz MA, de Jesús Villegas González M, Ponce Camacho MA, Cavazos Cavazos LM, Ibarra BS, Esquivel García BI, Treviño González JL. Respiratory distress associated with heterotopic gastrointestinal cysts of the oral cavity: A case report. Ann Med Surg (Lond) 2016; 12:43-46. [PMID: 27895906 PMCID: PMC5121137 DOI: 10.1016/j.amsu.2016.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 12/03/2022] Open
Abstract
Heterotopic gastrointestinal cysts of the oral cavity are benign lesions usually discovered during infancy. Their pathogenesis is not very clear. They are rare congenital anomalies that result from remnants of foregut-derived epithelium in the head, neck, thorax or abdomen during embryonic development. The majority of these lesions occur in the anterior ventral surface of the tongue and extend to the floor of the mouth. They are confused clinically by surgeons in cases of head and neck masses in children as ranulas, dermoid and thyroglossal cysts, and lymphangioma. We report the case of a 28-day newborn with a 3.6 cm oval mass on the floor of the mouth causing difficulty eating and cyanosis during crying. Complete surgical excision was performed by an oral approach under general anesthesia. Microscopic examination revealed gastric epithelium with tall columnar mucous cells on the surface and numerous short closed crypts, resembling fundal glands and mature gastric epithelium. There are less than a hundred cases reported in the medical literature. It is vital for surgeons and physicians to include this pathology in their differential diagnosis. Imaging studies are essential for obtaining clearer diagnostic possibilities. Complete surgical resection is needed to prevent recurrence.
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Affiliation(s)
- Marco Antonio Méndez Sáenz
- Department of Otolaryngology and Head and Neck Surgery, Medicine School and University Hospital "Dr. José Eleuterio González", University of Nuevo Leon, Mexico
| | - Mario de Jesús Villegas González
- Department of Otolaryngology and Head and Neck Surgery, Medicine School and University Hospital "Dr. José Eleuterio González", University of Nuevo Leon, Mexico
| | - Marco A Ponce Camacho
- Department of Pathology and Citopatology, Medicine School and University Hospital "Dr. José Eleuterio González", University of Nuevo Leon, Mexico
| | - Lucia M Cavazos Cavazos
- Department of Otolaryngology and Head and Neck Surgery, Medicine School and University Hospital "Dr. José Eleuterio González", University of Nuevo Leon, Mexico
| | - Bárbara Sáenz Ibarra
- Department of Pathology and Citopatology, Medicine School and University Hospital "Dr. José Eleuterio González", University of Nuevo Leon, Mexico
| | - Blanca I Esquivel García
- Department of Otolaryngology and Head and Neck Surgery, Medicine School and University Hospital "Dr. José Eleuterio González", University of Nuevo Leon, Mexico
| | - José Luis Treviño González
- Department of Otolaryngology and Head and Neck Surgery, Medicine School and University Hospital "Dr. José Eleuterio González", University of Nuevo Leon, Mexico
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4
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Histopathologic Finding of Both Gastric and Respiratory Epithelia in a Lingual Foregut Cyst. Case Rep Med 2015; 2015:278376. [PMID: 26294913 PMCID: PMC4534602 DOI: 10.1155/2015/278376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/16/2015] [Indexed: 11/17/2022] Open
Abstract
Foregut cysts are uncommon, mucosa-lined congenital lesions that may occur anywhere along the gastrointestinal or respiratory tract and typically present within the first year of life. Although infrequent, these cysts may generate feeding or respiratory difficulties depending on the size and location of the lesion. Foregut cysts of the oral cavity are rarely seen and of those cases localized to the tongue are even more uncommon. We describe a 4-month-old girl with a foregut cyst involving the floor of mouth and anterior tongue. Subsequent histologic analysis demonstrated a cyst lined with both gastric and respiratory epithelia. This case represents an extremely rare finding of both gastric and respiratory epithelia lined within a single cystic structure in the tongue. Although a very rare finding, a foregut cyst should be on the differential diagnosis of any lesion involving the floor of mouth or tongue in an infant or child.
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Hambarde S, Bendre P, Taide D. Foregut duplication cyst presenting as lingual swelling: Case report and review of literature. Natl J Maxillofac Surg 2012; 2:2-5. [PMID: 22442600 PMCID: PMC3304225 DOI: 10.4103/0975-5950.85844] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Congenital lingual cystic masses are challenging entities that can be detected prenatally or are discovered in various forms after birth. Foregut duplication cyst of tongue is an extremely rare condition. Here we present the eleventh case in literature on foregut duplication cyst in tongue lined with gastric mucosa. Complete excision was curative with no recurrence on followup.
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Affiliation(s)
- Sandeep Hambarde
- Department of Paediatric Surgery, B J Wadia Children Hospital, Parel, Mumbai, India
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Burkart CM, Brinkman JA, Willging JP, Elluru RG. Lingual cyst lined by squamous epithelium. Int J Pediatr Otorhinolaryngol 2005; 69:1649-53. [PMID: 15955574 DOI: 10.1016/j.ijporl.2005.03.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 03/29/2005] [Indexed: 11/30/2022]
Abstract
Lingual choristomas or foregut duplication cysts are infrequently reported congenital anomalies that typically present in the perinatal period, and can cause respiratory or feeding problems. These cysts are lined by epithelial cells characteristic of the upper aerodigestive tract. We describe two children who presented shortly after birth with lingual cysts lined with squamous epithelium and foci of respiratory epithelium. Unlike previously reported lingual choristomas, these cysts did not contain gastrointestinal epithelium. In both these cases, the lingual cysts were successfully excised via a transoral approach. This article will discuss the histological findings in these two cases, the differential diagnosis and attempt to classify these lesions in the context of existing terminology.
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Affiliation(s)
- Collin M Burkart
- University of Cincinnati College of Medicine, Department of Otolaryngology-HNS, Cincinnati, OH, USA
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El-Bitar MA, Milmoe G, Kumar S. Intralingual Foregut Duplication Cyst in a Newborn. EAR, NOSE & THROAT JOURNAL 2003. [DOI: 10.1177/014556130308200617] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Congenital lingual cystic masses are challenging entities that can be detected prenatally or discovered in various forms after birth. We report what we believe is only the ninth case of an intralingual foregut duplication cyst that was lined with gastric mucosa. The preoperative evaluation of lingual cystic masses in newborns can include palpation, high-resolution sonography, computed tomography (CT), or magnetic resonance imaging (MRI). However, CT and MRI can pose a risk to the infant because they require sedation in order to properly position the patient for imaging. In our patient, we found that high-resolution sonography was most useful in revealing the nature of the mass as a nonvascular cystic lesion and in delineating its extension. We excised this lesion via bipolar cautery, which we prefer to cold-knife or CO2 laser surgery.
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Affiliation(s)
- Mohamed A. El-Bitar
- Department of Pediatric Otolaryngology–Head and Neck Surgery, Children's National Medical Center, George Washington University School of Medicine, Washington, D.C
| | - Gregory Milmoe
- Department of Otolaryngology–Head and Neck Surgery, Georgetown University Medical School, Washington, D.C
| | - Shimareet Kumar
- Department of Pathology, Children's National Medical Center, George Washington University School of Medicine, Washington, D.C
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Abstract
Congenital granular cell tumor, also known as congenital epulis, is a very rare lesion seen in newborns. The typical presentation is a solitary nodule occurring on the gingiva of the anterior alveolar ridge of either jaw. Multiple-site involvement is seen very seldom but has been noted on the same or different alveolar ridges. However, tongue involvement is exceptional, and there have been only three cases reported involving both the alveolus and the tongue. A female newborn with multiple congenital epulis on the mandibular alveolar ridge and tongue is presented, and her preferred treatment and histopathological diagnosis are discussed.
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Affiliation(s)
- R Yavuzer
- Department of Plastic and Reconstructive Surgery, Gazi University, Medical Faculty, Ankara, Turkey
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Said-Al-Naief N, Fantasia JE, Sciubba JJ, Ruggiero S, Sachs S. Heterotopic oral gastrointestinal cyst: report of 2 cases and review of the literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 88:80-6. [PMID: 10442949 DOI: 10.1016/s1079-2104(99)70197-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Oral heterotopic gastrointestinal cyst is a rare entity occurring in infants and children and showing a predilection for males. The cyst usually appears as an asymptomatic swelling in the floor of the mouth. Difficulty in feeding, swallowing, respiration, and speech have been reported in approximately 30% of those affected. The tongue-in particular, its anterior aspectis involved in up to 60% of reported cases. The clinical, radiographic, and histopathologic features of cases of heterotopic gastrointestinal cyst involving the anterior tongue in a 2-year-old girl and the anterior floor of the mouth in a 2-month-old boy are presented, and theories of pathogenesis are discussed.
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Affiliation(s)
- N Said-Al-Naief
- Department of Oral Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA
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Abstract
Foregut cysts are usually found in the mediastinum, the lung, or the wall of the upper gastrointestinal tract, but only rarely at the base of tongue. We report a sublingual foregut cyst in a 27-year-old man.
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Affiliation(s)
- Y S Kim
- Department of Dermatology, Youngdong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Gorlin RJ, Myers SL. Gastrointestinal cyst of the tongue: A possible duplication cyst of foregut origin. J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0278-2391(97)90498-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Affiliation(s)
- T F Tsai
- Department of Dermatology, National Taiwan University Hospital, Taiwan, Republic of China
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13
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Boué DR, Smith GA, Krous HF. Lingual bronchogenic cyst in a child: an unusual site of presentation. PEDIATRIC PATHOLOGY 1994; 14:201-5. [PMID: 8008683 DOI: 10.3109/15513819409024253] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We describe a 4-year-old hispanic male with a bronchogenic cyst (BC) in the base of the tongue. To our knowledge, a BC has not been previously reported in the oral cavity. BC is a developmental anomaly believed to originate from abnormal detachments of accessory lung buds from the ventral foregut. We postulate that the unusual location of the BC in the present case is related to the primitive foregut origin of tongue epithelium posterior to the foramen cecum and the sulcus terminalis. A BC in the base of the tongue appears to represent the most proximal expression of aberrant accessory lung bud detachment from the primitive foregut.
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Affiliation(s)
- D R Boué
- Department of Pathology, University of California-San Diego Medical Center
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