Cystic mass of the floor of the mouth

Abstract

BackgroundEpidermoid and dermoid cysts in the oral cavity are relatively uncommon lesions of developmental origin. They often remain asymptomatic for years until they grow enough to interfere with speech, deglutition and less often with breathing which can pose a critical risk to the airway and require immediate surgery.Case descriptionA case of an epidermoid cyst of the floor of the mouth affecting a 37-year-old man is presented; this lesion was surgically enucleated with an intraoral approach. Patient did well postoperatively and there was no evidence of recurrence up to 2 years of follow up.Clinical implicationsFloor of the mouth is a challenging site for the diagnosis of a broad variety of lesions which the surgeon should be aware. Depending on the anatomical relation to the muscles of the floor of the mouth dermoid cysts are classified as supramylohyoid or inframylohyoid, and they will both have different clinical and radiological features. This article also includes literature review about the etiopathological, clinical, radiological and histological features, the differential diagnosis and its treatment. Key words:Epidermoid cyst, dermoid cyst, floor of mouth.

Dermoid and epidermoid cysts of the oral cavity: a 48-year retrospective study with focus on clinical and morphological features and review of main topics

“…Dermoid and epidermoid cysts (DCs and ECs, respectively) are slow-growing, benign developmental cysts that arise from ectodermal tissue and can occur anywhere in the body (1,2). They are most commonly located in places where embryonic elements merge, especially in the sacral region and ovaries, while less than 7% of these cysts involve the head and neck region, with only 1.6% of cases presenting in the oral cavity (2)(3)(4). In this regard, the floor of the mouth is the second most common head and neck region site after the lateral eyebrow region, since these represent embryonic fusion sites.…”

“…In this regard, the floor of the mouth is the second most common head and neck region site after the lateral eyebrow region, since these represent embryonic fusion sites. However, these cysts can also be found on the tongue, lips and other oral mucosa locations (3,4). ECs are the most common, and several mechanisms have been proposed for their formation, such as the proliferation of ectodermal remnants during embryogenesis, obstruction of pilosebaceous units or traumatic implantation of epithelial cells (5,6).…”

“…ECs are the most common, and several mechanisms have been proposed for their formation, such as the proliferation of ectodermal remnants during embryogenesis, obstruction of pilosebaceous units or traumatic implantation of epithelial cells (5,6). In relation to DCs, these appear to be derived from epithelial remnants included during the union of the midline of the first and second gill arches (3,4,7). In addition, dysonogenic, traumatic and thyroglossus anomaly theories have been postulated as being responsible for their pathogenesis (3,4,7).…”

“…In relation to DCs, these appear to be derived from epithelial remnants included during the union of the midline of the first and second gill arches (3,4,7). In addition, dysonogenic, traumatic and thyroglossus anomaly theories have been postulated as being responsible for their pathogenesis (3,4,7). Despite their congenital origin, these cysts are often diagnosed in the second and third decades of life (3,7), clinically presenting as painless swellings which, in some cases, may interfere with phonation, chewing or swallowing (6,7).…”

“…ECs are always coated by keratinized stratified squamous epithelium without dermal appendages within the underlying fibrous connective tissue. DCs present, in addition to ECs characteristics, dermal appendages such as hair follicles, hairs and sebaceous and sweat glands (3,4,6,7). DCs and ECs can be present in approximately 60% of cases of hereditary familial polyposis and Gardner's syndrome.…”