|Year : 2015 | Volume
| Issue : 1 | Page : 86-88
Dermoid cyst of floor of the mouth: A case report
Sellappampatty Veerappapillai Dhanasekaran1, Shivakumar Senniappan1, Shankar Radhakrishnan2
1 Department of ENT, Vinayaka Mission's Kirupananda Variyar Medical College, Tamil Nadu, India
2 Department of Community Medicine, Vinayaka Mission's Kirupananda Variyar Medical College, Tamil Nadu, India
|Date of Web Publication||8-Dec-2014|
Department of Community Medicine, Vinayaka Mission's Kirupananda Variyar Medical College, Salem - 636 308, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Dermoid cysts are malformations that are rarely observed in the oral cavity. They can be congenital or acquired. They are further classified as anatomical and histological. We present here a case of an 11-year-old boy with a swelling in the floor of the oral cavity. Although various investigations pinpoint to the diagnosis, the final confirmation is obtained after histopathological examination of the excised cyst. Following enucleation via the intraoral approach the patient has been followed up for a period of 10 months, with no recurrence.
Keywords: Dermoid cyst, enucleation, floor of mouth
|How to cite this article:|
Dhanasekaran SV, Senniappan S, Radhakrishnan S. Dermoid cyst of floor of the mouth: A case report. Muller J Med Sci Res 2015;6:86-8
|How to cite this URL:|
Dhanasekaran SV, Senniappan S, Radhakrishnan S. Dermoid cyst of floor of the mouth: A case report. Muller J Med Sci Res [serial online] 2015 [cited 2019 Aug 25];6:86-8. Available from: http://www.mjmsr.net/text.asp?2015/6/1/86/146475
| Introduction|| |
A dermoid cyst occurs in sites of embryonic fusion, present mostly in the midline of the body.  These cysts occur most often in patients in their second or third decades of life. Dermoid cysts in the floor of mouth are of three types, dermoid, epidermoid, and teratoid cysts.  The incidence of cysts in the floor of the mouth is quite less. Its common occurrence is around the periorbital area.  In the head and neck region only 23-34% of the dermoid cysts are present, in the oral cavity. 
| Case Report|| |
A 11-year-old male came to the Ear, Nose, and Throat (ENT) Outpatient Department (OPD), with complaints of swelling in the floor of the mouth since one year. Insidious in onset, it started as small swelling and gradually progressed to the present size.
Examination showed a swelling in floor of the oral cavity, in the sublingual region. Further clinical examination revealed an ovoid swelling, around 4 cm, with diffuse edges, covered with intact mucosa, no pulsation, and absent cough impulse.
On palpation, the findings on inspection with regard to the site, size, shape, and surface of the swelling were confirmed. The swelling was non-tender, soft, and cystic in consistency. No cough impulse was elicited, it was not reducible, and the transillumination test was negative.
A sonogram showed a well-defined cystic lesion in the floor of the mouth. Axial computed tomography (CT) showed a cyst-like lesion, with a thin wall in the sublingual region, consistent with a dermoid cyst.
The patient was operated under general anesthesia using the intraoral route, A curved incision was applied over the mucosa covering the swelling. Retractors were placed. Dissection was done to separate the cyst from the overlying mucosa. Once freed, the cyst was dissected off the floor of the oral cavity and it was removed intact. Hemostasis was secured and the wound sutured. The patient emerged and recovered from general anesthesia. The cyst was oblong in shape, measuring 5 × 3 cm at one end and 5 × 4 cm at the other end. The cyst was cut open revealing its pultaceous contents and was sent for histopathological examination, which confirmed the presence of a dermoid cyst. [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5] anad [Figure 6] represent the clinical picture, operating procedure, and the histopathological image of the patient.
Postoperatively the patient was put on antibiotics Ϳ Cefixime 100 mg bid × 7 days.
| Discussion|| |
Dermoid cysts are of two types, congenital and acquired. With regard to the origin of the cyst in the floor of mouth, the theories are:
- Congenital: Origin from the embryonic cells of the first and second branchial arch entrapment during the third to fourth weeks of intrauterine life
- Acquired form: Due to epithelial cell implantation of the injury or surgery
- Variation of the thyroglossal duct cyst
We have three histological variants of the dermoid cyst namely:
- Dermoid cyst
Skin adnexa in the cyst wall are found in a dermoid cyst. A simple squamous epithelium lines the epidermal cyst, whereas, a teratoid cyst consists of tissue derived from all three germ layers.  They may contain cheesy keratinous material. 
In relation to the mylohyoid muscle it can be divided into infra- and supra-cysts.  They are found in any age group, but commonly are seen in persons between the ages of 15 and 35 years.  Some literature also mentions male preponderance, in the ratio of 3:1.  The patients present with a complaint of painless swelling in the floor of mouth, usually firm, which may rarely raise the tongue if the swelling is very large.
Other symptoms include, dysphagia, dysarthria, discomfort in chewing, dysphonia,  and pain, suggesting infection, as was seen in our case. Investigations like ultrasonagraphy (USG), computed tomography (CT), magnetic resonance imaging (MRI), and fine needle aspiration cytology (FNAC), all help in the preoperative diagnosis.  Differential diagnosis from the ectopic thyroid tissue is by Scintiscan.  The specific histological type can be confirmed by histopathological examination, after excision. 
Treatment is total extraction (enucleation) via the intraoral or extraoral approach or a combination of both.  The extraoral approach is generally performed for a large cyst.  In our case, we have used the intraoral approach, as the cyst had been found above the mylohyoid muscle. The patient is being followed up for the past 10 months, and the follow-up has been uneventful.
| Conclusion|| |
A case of dermoid cyst was diagnosed and managed by a simple intraoral excision under general anesthesia. The intraoral approach gives the added advantage of the absence of a cosmetic scar. The final confirmation of diagnosis is given by a histopathological examination after excision.
| Acknowledgment|| |
The author wishes to acknowledge the guidance and support extended by the Head of the Institution, Professor, Dr. K Jayapal, for conducting this study and for his valuable advice for completing the manuscript.
| References|| |
Prasant MC, Ali FM, Singhai A, Patil K. An Unusual Site of Epidermoid Cyst. J Eval Med Dent Sci (JEMDS) 2013;2:8119-22.
Jham BC, Duraes GV, Jham AC, Santos CR. Epidermoid cyst of the floor of the mouth: A case report. J Can Dent Assoc 2007;73:525-8.
Makos C, Noussios G, Peios M, Gougousis S, Chouridis P. Dermoid cysts of the floor of the mouth: Two case reports. Case Rep Med 2011;2011:362170.
Howell CJ. The sublingual dermoid cyst. Report of five cases and review of the literature. Oral Surg Oral Med Oral Pathol 1985;59:578-80.
Yilmaz I, Yilmazer C, Yavuz H, Bal N, Ozluoglu LN. Giant sublingual epidermoid cyst: A report of two cases. J Laryngol Otol 2006;120:E19.
Chikui T, Shimizu M, Goto TK, Nakayama E, Yoshiura K, Kanda S, et al
. Interpretation of the origin of a submandibular mass by CT and MRI imaging. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:721-9.
Marino R, PenteneroM, Familiari U, Gandolfo S. Dermoid cyst of the floor of the mouth: A case report. J Clin Case Rep 2012;2:9.
Di Francesco A, Chiapasco M, Biglioli F, Ancona D. Intraoral approach to large dermoid cysts of the floor of the mouth: A technical note. Int J Oral Maxillofac Surg 1995;24:233-5.
Burger MF, Holland P, Napier B. Submental midline dermoid cyst in a 25-year-old man. Ear Nose Throat J 2006;85:752-3.
Koca H, Seckin T, Sipahi A, Kaznac A. Epidermoid cyst in the floor of the mouth: Report of a case. Quintessence Int 2007;38:473-7.
Sahoo NK, Choudhary AK. Dermoid cyst of floor of mouth: A case report. Natl J Med Dent Res 2012;1:24-30.
Armstrong JE, Darling MR, Bohay RN, Cobb G, Lawen D, Daley TD. Trans-geniohyoid dermoid cyst: Considerations on a combined oral and dermal surgical approach and on histogenesis. J Oral Maxillofac Surg 2006;64:1825-30.
De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg 2002;13:308-10.
Babuccu O, Iºiksaçan Ozen O, Hoºnuter M, Kargi E, Babucca B. The place of fine-needle aspiration in the preoperative diagnosis of the congenital sublingual teratoid cyst. Diagn Cytopathol 2003;29:33-7.
Longo F, Maremonti P, Mangone GM, De Maria G, Califano L. Midline (dermoid) cysts of the floor of the mouth: Report of 16 cases and review of surgical techniques. Plast Reconstr Surg 2003;112:1560-5.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]