A decade of neglecting sublingual mass: A case report of epidermoid cyst

Abstract

Introduction: Epidermoid cysts may occur due to anomalies during fetal development, approximately 1-2 % occur in the oral cavity. A cyst lumen filled with fluid or keratin without skin adnexal structures (such as hair, hair follicle, sweat gland, sebaceous gland) can be defined as epidermoid cyst. 7 % of these cysts occur in the head and neck, 1.6 % of which appear in the oral cavity. Gender distribution is balanced but more prevalent in males. Epidermoid cysts are the most common cutaneous cysts. These cysts are rarely discovered prior to puberty. It has been reported that 1 % of epidermoid cysts will malignantly develop into squamous cell carcinoma (SCC) or basal cell carcinoma (BCC).

Case presentation: 18-year-old male patient presented with 57.99 × 55.33 × 41.41 mm-sized epidermoid cyst treated at the Regional Hospital in Indonesia. The primary complaint was a painless, asymptomatic lump on the floor of the mouth which was felt 10 years ago. Two years prior, the lump enlarged, and the patient began to feel difficulty in swallowing, and respiratory distress appeared one year later. Supplementary examinations: ultrasonography, fine needle aspiration biopsy, plain radiography, multiple slice computed tomography scan was performed to support epidermoid cyst diagnosis.

Discussion: An intraoral approach-based cystectomy with a horizontal incision was utilized for surgical treatment to avoid adjacent anatomic structure. Histopathological examination showed a macroscopic image of pouch tissue with approximately 0.2 cm-thick wall, brownish white in color with yellow mass like cheese pulp, and microscopic image of tissue covered with monomorphous complex squamous epithelium with eosinophilic keratinized mass lumen.

Conclusion: Following the procedure, there was no longer respiratory distress nor difficulty in swallowing and the patient recovered well with no deficiency in aesthetics.

Keywords: Case report; Epidermoid cyst; Sublingual mass.

Fig. 1

(A) Front view of clinical photograph; (B) Bottom view of clinical photograph of the face; (C) Intraoral examination with the tongue superior to the lesion; (D) Intraoral examination with the tongue posterior to the lesion.

Fig. 2

(A) Ultrasonographic examination of the oral floor lesion; showing a solitary isoechoic rounded lesion with well-defined orders with non-prominent vascularization; (B) A cystic lesion compressing the airway and feeding tube, making it difficult for the patient to breathe, eat and drink.

Fig. 3

MSCT examination with contrast showing hypodense lesion in the subingual on axial, coronal, and sagittal section.

Fig. 4

(A) Dissection separates the cyst capsule from the sublingual mucosa; (B) Evacuation of capsule contents and capsule dissection with attachment to the geniohyoid muscle.

Fig. 5

(A) Installation of drain gauze and suturing; (B) Intraoral photo of the drain gauze partially removed 2 days postoperatively; (C) Intraoral photo of drain gauze fully removed 5 days postoperatively; (D) One-week postoperative intraoral photo with no signs of infection.

Fig. 6

The separated cyst capsule.