Dysontogenetic cysts of the mouth floor

Congenital cysts of the floor of the mouth are rarely seen. We investigated in the years 1987 and 1988 four patients with swellings in the floor in the mouth. The histological examination results dermoid and epidermoid cysts. A teratoma was not seen. Sonographic investigation and computertomography were both helpful by getting the correct diagnosis of these cysts and their location. The treatment was the exstirpation from the outside of the throat because all cysts were located under the geniohyoid muscle.     

True lateral dermoid cyst of the floor of the mouth

Congenital dermoid cysts of the floor of the mouth are relatively rare but when they occur, they do so inevitably in the midline. We present a case of a true lateral dermoid cyst of this region without any intra-oral extension. We discuss the anatomical and histological classification of dermoid cysts within the floor of the mouth.     

Dermoid cysts of the floor of the mouth and lateral neck

Dermoid cysts of the floor of the mouth and submandibular area represent an unusual clinical entity. We present three such cases and review their clinical presentation and pathologic classification. This study stresses the importance of recognizing and excising any tract leading from such cysts to the midline mandible or hyoid, in order to avoid a recurrence, since these tracts may be epithelialized.     

Current diagnosis and therapy of cysts of the mouth floor]

Cystic tumors of the floor of the mouth are relatively rare. Until today the exact localisation of the cysts in relationship to the muscles of the floor of the mouth is established mainly during operation. Therefore the preoperative decision for the optimal surgical approach can be difficult, at least in large space occupying lesions. In the present study the case of a 24-year-old female patient with an extensive dermoid cyst of the floor of the mouth is demonstrated. The preoperative use of magnetic resonance imaging enabled us to determine the exact localisation of the cyst in relationship to the muscular structures of the floor of the mouth. The differential diagnosis of dermoids of the floor of the mouth as well as the adequate therapeutic approach is discussed according to the relevant literature.     

Lateral dermoid cyst of the floor of mouth: unusual radiologic and pathologic findings

A lateral dermoid cyst is a rare lesion of the floor of mouth, with only 12 cases reported in the literature. We describe the case of a 60-year-old man with a slowly enlarging mass in the submandibular region. Magnetic resonance imaging demonstrated a lesion containing multiple uniformly rounded foci, creating a “sack-of-marbles” appearance. Needle aspirations showed atypical findings, and the mass was excised. Histopathology revealed a cyst containing a keratinizing stratified squamous epithelial lining with apocrine and eccrine glands. These findings were diagnostic of a dermoid cyst, which should be considered in the differential diagnosis of any midline or lateral cervical lesion.     

Neonatal dermoid cyst of the floor of the mouth extending to the midline neck.

We describe a male neonate who presented at birth with a compressible dermoid cyst that extended from the floor of the mouth to the midline of the neck. Ultrasonography revealed a fluid-filled sublingual mass. Magnetic resonance imaging performed when the patient was 1 week old demonstrated a 2-cm, cystic, left-sided, sublingual mass that crossed the midline without extension inferior to the mylohyoid muscle. At 3 months of age, the patient developed a 1-cm, solid, submental mass. At the time of surgery, the lesion had a fibromembranous tract that extended through the myolohyoid muscle to a 1-cm cyst in the submental region. Histologic sections depicted 2 dermoid cysts and a connecting fistula. This case represents the first report (to our knowledge) of a dermoid cyst presenting in a neonate as a mass in the floor of the mouth with extension to the midline of the neck.     

Congenital dermoid cysts of the tongue

A case of large dermoid cyst in the tongue in a 3 1/2-month-old child is presented. Histologically it was an epidermoid cyst. Typically corresponding cysts are diagnosed during the first four months of life. When the cyst was punctured, some keratin escaped and caused a granulation tissue reaction with granulocytes between the muscles of the tongue. The cyst was treated by marsupialization. No abnormality in the shape or function of the tongue was seen after 24 months.     

Nasal dermoid cysts and sinuses

The authors discuss problems of the nasal dermoids treatment. They point at difficulties with settlement of right term of operation, and they stress that X-ray diagnosis before operation should be taken into consideration to exclude the contact of the dermal cyst or sinuses with cranial cavity. They confirm necessities of radical removal of the cyst or/and the sinus to gain the recovery. They analyse the material of 6 patients with dermal cysts or sinuses who were operated since 1988 to 1997 in the ENT Department of Municipal Hospital, Gdynia. They were 4 boys and 2 girls. In each case a cyst with fistulas was observed. All children were treated surgically, and their ages were 2-14 years (mean 6 1/2). In 2 cases there was self-existent destruction of the nasal bones, other 2 patients had median rhinotomy made, in 2 cases only simple excision of the cyst and sinuses was performed. In any case it was no recurrence of the disease (time of follow-up is 1-10 years). The analysis is illustrated with two case reports. The first case was a 2-year-old boy who had a dermal cyst with sinus penetrating into the cranial cavity. CT imaging did not reveal obvious evidences of that. During operation, a momentary CSF leak was observed but it was stopped using oxycel and tissucol. The second case, a 7-year-old boy, was treated by curettage of the dermoid, with recurrence after 6 months. This patient was cured after total resection of the cyst and sinuses. In conclusion, the authors present in detail signs that can attest that contact of the cyst with the cranial cavity exists. They stress the necessity of right surgical treatment in cases of dermal cysts of the nose to avoid recurrence or complications.     

Management of congenital lingual dermoid cysts

Background

Lingual dermoid cysts are squamous epithelial-lined cavities with variable numbers of skin adnexae in the capsule and are rare entities in the head and neck. We discuss the presentation, possible aetiologies and the surgical management of these lesions and report on the ninth lingual dermoid cyst as an illustrative example, the first to be excised by laser.

Methods

An extensive literature search was undertaken. We present the case of a 4-month-old di-zygotic twin girl with a firm midline anterior tongue dermoid cyst. Its extent was defined by magnetic resonance imaging. The cyst was excised using the CO₂ laser via an extended median sagittal glossotomy approach.

Results

Lingual dermoid cysts most commonly present in early childhood or adolescence and are located in the anterior two thirds of the tongue. Eight lingual dermoid cysts have been reported, all of which were surgically excised, using varying techniques, and no recurrences have been reported.Our patient recovered well and was extubated immediately post-operatively. However, feeding was delayed for 48 h post-operatively due to pain, requiring opiate analgesia. The tongue healed completely with only a small indent in the tip.

Conclusions

Treatment of these lesions consists of complete surgical excision. We propose that the midline sagittal glossotomy incision using the CO₂ laser offers surgical precision, superior haemostasis and wound healing and minimal post-operative oedema. The involvement of the sensitive tongue tip in this approach may be its one drawback, however this may be compensated for with appropriate post-operative analgesia.