Imaging of pediatric floor of mouth lesions

Abstract

There is a vast spectrum of pathology that afflicts the floor of mouth in children. These span inflammatory conditions, vascular malformations, developmental anomalies, benign tumors and malignancies. While this area is readily evaluated on clinical exam, imaging is often performed to better characterize the disorder prior to management. The imaging modalities most frequently utilized are US, CT and MR. The purpose of this article is to describe the primary conditions that occur in this location in children so that radiologists may provide an appropriate differential diagnosis. These include ranula, venolymphatic malformation, dermoid, teratoma, foregut duplication cyst, hairy polyp, thyroglossal duct cyst and rhabdomyosarcoma. For each pathological condition, there will be a focus on describing its imaging manifestation. Floor of mouth anatomy, imaging approach during both prenatal and postnatal life and etiologies will be discussed. Surgical considerations and operative photographs will also be presented.

Modified L-shaped surgical approach to excision of the sublingual gland

“…13,14 Plunging ranulas, extravasations of saliva from the sublingual glands, 15 arise when an oral ranula extends beyond the floor of the mouth into the neck. 16 Diagnosis is difficult even with modern imaging techniques such as ultrasound, computed tomography, and magnetic resonance imaging, 17,18 as they mimic other lesions in the neck. 16 We propose an algorithm to simplify investigation that has a low threshold for fine-needle aspiration.…”

Lumps and Bumps of the Neck in Children—Neuroimaging of Congenital and Acquired Lesions

“…The extravasation is in the vast majority the consequence of infection, inflammation, or trauma to the involved gland causing an occluded gland duct. Ranulas are categorized into simple (oral) ranulas with a peripheral epithelial layer or plunging/diving (cervical) ranulas . A plunging ranula is the consequence of a ruptured simple ranula and therefore lacks an epithelial lining (pseudocyst).…”

“…In incidental cases, a giant ranula may extend posterosuperiorly into the parapharyngeal space. Identification of the narrow tail connecting to the sublingual space on MR imaging may be an important diagnostic clue . Plunging ranulas have to potential to demonstrate trans‐spatial extension, similar to vascular malformations.…”

A midline neck lump in a child

“…2 5 Thyroglossal cysts are found within 2 cm of the midline and classically move upwards with protrusion of the tongue because of their close association with the hyoid bone. 6 Most thyroid cysts do not fistulate and therefore present as midline neck lumps beneath normal skin.…”

“…2 Scintigraphy can be used to look for ectopic thyroid activity. 6 Flexible laryngoscopy has a role in detecting primary tumours, but its use in children is limited. Computed tomography or magnetic resonance imaging can further delineate structures if the diagnosis is uncertain.…”