Submental epidermoid cysts in children

Epidermoid cyst of the midline neck in an 8-year-old girl: A case report

Epidermoid cysts (ECs) are usually small, benign, keratin-filled cysts, can be congenital or acquired and encountered anywhere in the body. EC and dermoid cyst constitute approximately 7% of all cysts in the head and neck region and tend to occur in areas of embryonic fusion. Neck masses are commonly present in children, and there is often a diagnostic dilemma clinically with common differential diagnoses of this region such as thyroglossal cyst, pre-tracheal lymph nodes, thyroid mass, EC and dermoid cyst. EC is mostly present in middle-aged males, and here, we are going to present an EC of the midline neck in an 8-year-old girl, which is not common.

Imaging features of epidermoid cyst located in the floor of the mouth: case report and narrative review of literature

Epidermoid cysts are benign slow-growing developmental lesions resulting from ectodermal tissue that can localise anywhere in the body. Only 7% of all epidermoid cysts are located in the head and neck area and, together with dermoid cysts, account for less than 0.01% of all oral cavity cysts. Herein, we present the case of a 17-year-old male diagnosed with a sublingual epidermoid cyst and a review of the literature on this rare localisation, focusing on clinical and imaging features, management and outcomes. All the articles reporting epidermoid cysts located in oral cavity were searched using PubMed/Medline, discarding all those not located in head and neck district, not mentioning diagnostic imaging, not defined as epidermoid cysts by a histopathological diagnosis, and those for which only an abstract was available. In literature there were 35 articles, from 1993 to 2020, that meet the aforementioned requirements, for a total of 38 patients and 39 cysts. For each article, age, sex, onset time of symptoms, location, size and surgical access were analysed. Particular attention was paid to the radiological investigation used in order to understand the most common imaging aspects and also rare cases with unusual presentations.

Pediatric sublingual dermoid and epidermoid cysts: A 20-year institutional review

INTRODUCTION

Pediatric cystic sublingual masses often present a diagnostic dilemma for practitioners. Though uncommon, dermoid or epidermoid cysts can present in the sublingual space at any age and are often misdiagnosed as an inflammatory pseudocyst (ranula) or lymphatic malformation. Imaging may not always identify the underlying etiology, requiring physicians to maintain a high index of suspicion for these relatively rare oral cysts.

OBJECTIVES

To describe the presentation and treatment of sublingual dermoid and epidermoid cysts presenting to a tertiary children's hospital over 20 years.

METHODS

A retrospective review of all pathology specimens identified as dermoid or epidermoid cysts within the sublingual space from 1999 to 2019. Patient charts were then reviewed for relevant clinical, imaging, and operative data.

RESULTS

Twelve pediatric patients were identified (8 female, 4 male) with a mean age of 7.2 years (SD 5.6). Eighty six percent (6/7) of dermoid cysts were found in female patients, while 60% (3/5) of epidermoid cysts were in male patients. Multiple dermoid and epidermoid cysts were each found in one patient (8%). Two epidermoid cysts presented in the neonatal period. Preoperative diagnosis included nondiagnostic "cystic mass" (33%), ranula (25%), lymphatic malformation (LM) (17%), and dermoid/epidermoid cyst (17%). Two thirds of patients (8/12) underwent imaging, with all receiving either MRI or CT. Although MRI was the most likely to suggest the possibility of a dermoid/epidermoid cyst (2/4), ranula was the most common primary radiographic diagnosis (5/8). One patient underwent sclerotherapy for presumed LM one year prior to surgical excision of the cyst. Eleven patients (92%) underwent intraoral excision, one (8.3%) underwent a combined intraoral/extraoral approach.

CONCLUSIONS

To our knowledge, this review represents the largest case series of pediatric sublingual dermoid and epidermoid cysts to date. This series contained higher levels of epidermoid cysts and female patients than previously reported in the literature. Identifying more dermoid cysts in females and epidermoid cysts in males is also a new finding. MRI was superior to CT and US regarding the presence of a dermoid/epidermoid cyst. Frequently misdiagnosed, it is important to consider these relatively rare pathologies when treating children presenting with sublingual masses in order to avoid delayed and/or inappropriate treatment.

Two sequential surgeries in infant with multiple floor of the mouth dermoid cysts: A case report

BACKGROUND

Multiple intraoral dermoid cysts of large magnitude generally appear in the second or third decade of life. They are rare in infants and are usually solitary. In this case, a large mass was identified in utero during prenatal exams.

CASE SUMMARY

We introduce a rare case on multiple dermoid cysts in the floor of the mouth of an infant who underwent two surgeries for this. Preoperative magnetic resonance imaging confirmed a large well-circumscribed cystic lesion that originated at the former midline region in the floor of the mouth in which a suspicious lesion of minute size was likely compressed by the bulkier mass and overlooked. Therefore, the infant underwent two surgeries by an intraoral approach within 9 mo. At 5 mo after the second operation, a routine follow-up ultrasound showed evidence of an additional cyst. No further surgery was planned because the tumor had no immediate effect.

CONCLUSION

This report demonstrates the importance of carefully analyzing preoperative imaging to avoid multiple operations for a seemingly isolated oral cyst.