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

Abstract

IntroductionEpidermoid 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 presentationTwo 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.ConclusionsSurgery 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.

Epidermoid Cysts in Head and Neck: Our Experiences, with Review of Literature

“…In certain instances, even CT scan was non-confirmatory in its details. We consistently tried to perform FNAC to get an idea regarding the pathological nature of the lesion, and though FNAC has often been rendered only as a corroborative evidence prior to surgery secondary to imaging [6,13], even being considered non-diagnostic in few instances [14,15], in our caseseries, this was not always true. In fact, in some of the recent studies, the role of FNAC as an important tool in the diagnostic work-up in various epidermal lesions has been underlined and well-explored, like in nose and paranasal sinus masses that included epidermal inclusion cysts [16], in pediatric neck masses like dermoids, sebaceous cysts etc.…”

“…Irrespective of the etiology, such a cyst mostly remains asymptomatic and unreported until it assumes a size large enough to cause mechanical obstruction [8,21], mostly in the age group of 15-35 years [2], as we have seen in our patient. Mass lesion above the mylohyoid pushes the tongue above causing mechanical obstruction, while that below it causes its protrusion into the chin, in front of the neck [15]. Surgical excision is the treatment of choice [6,7,[13][14][15] and grossly, depending upon its position with respect to the muscle plane in the floor of the mouth, it may be removed either perorally (small sublingual lesions, above the geniohyoid) or externally (cervical approach; large lesions extending to the neck in the submandibular or submental region, or large sublingual lesion, when below the geniohyoid) [4,15].…”

“…Mass lesion above the mylohyoid pushes the tongue above causing mechanical obstruction, while that below it causes its protrusion into the chin, in front of the neck [15]. Surgical excision is the treatment of choice [6,7,[13][14][15] and grossly, depending upon its position with respect to the muscle plane in the floor of the mouth, it may be removed either perorally (small sublingual lesions, above the geniohyoid) or externally (cervical approach; large lesions extending to the neck in the submandibular or submental region, or large sublingual lesion, when below the geniohyoid) [4,15]. A combined approach may also be undertaken in huge lesions.…”

“…The imaging in the patient we encountered did not provide us with a clear-cut indication for a definite surgical approach, and the lesion was large enough to extend from the palate to the chin. And we were clinically biased in favor of ranula, as it is a much more common entity than an epidermoid cyst in that region [15].…”

A Large Lateral Neck Swelling in an Elderly Patient: A Case Report

“…Most clinicians and researchers believe that epidermoid cysts that appear in the floor of the mouth are a result of entrapped ectodermal tissue of the first and second branchial arches, which fuse during the third and fourth weeks in utero. A second theory suggests that midline epidermoid cysts may be a variant of the thyroglossal duct cyst with predominating ectodermal elements 6 . Even if they are congenital, the diagnosis is commonly possible in the second to fourth decade of life.…”