Vol.2, No.6, 613-614 (2010) Health
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Sublingual epidermoid cyst—a case report
Satheesh kumar Bhandary*, Vadisha Bhat, M. Shwetha Shenoy
Department of ENT and Head-Neck Surgery, K.S.hegde Medical Academy, Mangalore, India;
*Corresponding Author: sakubaraj@yahoo.com
Received 3 November 2009; revised 7 December 2009; accepted 9 December 2009.
In this article we present the case of an epi-
dermoid cyst of sublingual space along with
submental extension in a 35 year old lady who
presented with a mass in the oral cavity. On
examination a mass was seen on the floor of the
mouth displacing the tongue superiorly. Diffuse
fullness was noted in the submental region. The
lesion was excised under general anaesthesia
with nasotracheal intubation. The entire mass
was removed intra orally. The histological fea-
tures were suggestive of epidermoid cyst. The
patient did well postoperatively and no recur-
rence was seen during 8 months follow up.
Keywords: Sublingual; Epidermoid Cyst;
Intraoral Approach
The epidermoid cysts are those benign cysts which are
lined by epithelium only, where as dermoid cysts are
those which contain skin and adnexa and teratoid cysts
are those which cartilage, bone and even muscle are pre-
sent [1]. Dermoid and epidermoid cysts are develop-
mental pathologies that occur in the head and neck with
an incidence of 6.9-7% [1,2]. About 11.5% of dermoid
cysts of the head and neck are in the floor of the mouth,
the second most common location after the cervical re-
gion. They represent less than 0.01% of all oral cavity
cysts [3]. Surgical excision is the treatment of choice.
A 35 year old lady was presented to the department of
ENT, K.S.Hegde Hospital, Mangalore, with the history
of mass in the oral cavity since one and half months. The
swelling was painless. She had no difficulty in moving
the tongue and there was no history of dysphagea or
On examination of the oral cavity, an ovoid solitary
mass measuring about 4 cm × 3 cm was present in the
midline on the floor of the mouth. Edges could not be
distinctly made out. Mucosa over the swelling was nor-
mal but appears stretched. The swelling was soft to cys-
tic in consistency. The lesion extends into the submental
region causing diffuse fullness in the submental region.
Transmission of movements between intra-oral and
submental swelling was felt. Transillumination was
negative. A provisional diagnosis of sublingual dermoid
cyst or plunging ranula was made.
Routine haematological tests were within normal limits.
Excision of the mass was done under general anaes-
thesia with nasotracheal intubation. A horizontal incision
was placed intra orally on the floor of the mouth. The
mass appeared to be a thick walled tense cyst and it was
excised in toto. The submental extension through the
mylohyoid muscle was excised from the same incision.
Post-operative period was uneventful and she was dis-
charged after 5 days. She was seen in the outpatient de-
partment after 2 weeks and then after 4 months and 8
months and no recurrence is noted.
Meyer classified cysts of the floor of the mouth into
three groups namely Epidermoid, Dermoid and Teratoma
[4]. Histologically midline cysts of the floor of the
mouth are divided into epidermoid cysts which consist
of an epithelial lined wall that may be partly keratinized;
dermoid cysts, which show evidence of skin appendages
such as hair follicles, hair, sweat and sebaceous glands;
and teratomas which contain, in addition to skin ap-
pendages, mesodermal elements like bone, muscle, res-
piratory and gastrointestinal tissues and a fibrous capsule.
The later type may have malignant potential [1,4].
Congenital cysts are dysembryogenetic lesions that
arise from ectodermal elements entrapped during mid-
line fusion of first and second branchial arches between
the third and fourth weeks of intrauterine life. Congenital
cysts may rise from the tuberculm impar during the for-
S. K. Bhandary et al. / HEALTH 2 (2010) 613-614
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Figure 1. Excision of the cyst by Intraoral Approach.
mation of the floor of the mouth [5,6].
Epidermoid cysts have thin squamous lining because
of lack of dermal appendages, which rarely contains
calcifications. These cysts contain debris from the des-
quamation of the epithelial lining. The debris contain
mainly keratin, a proteinaceous material and some cho-
lesterol. These are often described as pearly tumours
because of the shiny smooth waxy character of the “dry
keratin” on gross inspection [1].
Dermoid cysts are well circumscribed lesions most
commonly seen at the lateral canthus of the eye. They
are typically lined by squamous epithelium and contain
skin appendages but unlike epidermoid cyst they have a
thicker lining and may contain dystrophic calcification
Ultrasonographically the solid and cystic structures
within a heterogenous mass and calcifications are seen
Treatment is by surgical excision of intra oral cysts in
the floor of the mouth to relieve symptoms caused by the
cyst and possible infection. Usually intra oral incision is
placed for small cysts but large ones require an external
approach. Post operative complications are rare and are
reduced by closely following the capsule and its com-
plete removal [8].
We report a case of epidermoid cyst in the sublingual
region with extension into submental region through the
mylohyoid muscle, presenting as an intraoral and sub-
mental swelling. The cyst was completely excised
through intraoral incision without any complications and
without any evidence of recurrence in 8 months follows
[1] Koeller, K.K., et al. (1999) Congenital cystic masses of
the neck: Radiological-Pathologic correlation. Radio-
graphics, 19(1), 121-146.
[2] Dimov, Z.H., et al. (2000) Dermoid, epidermoid and
teratoma cysts of the tongue and oral cavity. Sofiia, 56(2),
[3] Saverio, D.P.F., et al. (2002) Sublingual Epidermoid Cyst.
Journal of Craniofacial Surgery, 13(2), 308-310.
[4] Calderon, S. (1993) Concomitant Sublingual and Sub-
mental Epidermoid cyst of the floor of the mouth. Jour-
nal of Oral and Maxillofacial Surgery, 51(7), 790-792.
[5] Longo, F., et al. (2003) Midline Dermoid cysts of the
floor of the mouth: Report of 16 cases and review of sur-
gical techniques. Plastic and Reconstructive Surgery, 112
(6), 1560-1565.
[6] De Ponte, F.S., et al. (2002) Sublingual epidermoid cyst.
Journal of Craniofacial Surgery, 13(2), 308-310.
[7] Smirinitopolus, J., Chiechi, M., et al. (2005) Tertomas,
Dermoids and Epidermoids of the head and neck. Radio-
graphics, 25(4), 931-948.
[8] Leveque, H., et al. (1979) Dermoid Cyst of the floor of
the mouth and lateral neck. Laryngoscope, 89(2 Pt 1),