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British Journal of Oral and Maxillofacial Surgery 46 (2008) 131–132
Short communication
Lateral dermoid cyst Richard M. Graham a,∗ , Ewen F. Thomson a , Robert T.M. Woodwards a , Philip Sloan b a b
Department of Oral and Maxillofacial Surgery, North Manchester General Hospital, Crumpsall M8 5RB, United Kingdom Oral Pathology Unit, University Dental Hospital of Manchester, Manchester M15 6FH, United Kingdom
Accepted 29 October 2006 Available online 22 December 2006
Abstract This is an unusual case of a lateral dermoid cyst that caused some diagnostic confusion. © 2006 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Lateral dermoid cyst; Computed tomogram
A 31-year-old man had, in total, a 17-year history of intermittent swelling of the right submandibular triangle and floor of the mouth. The presentation and ultrasound investigation suggested sialadenitis of the right submandibular salivary gland. The patient was reluctant to attend for regular reviews, so it was not until during the last 2 years that he presented with repeated episodes of swelling of this region, caused by an acute infection that required intravenous antibiotics and a number of admissions to hospital. Despite the size of the lesion, he had no functional impairment of swallowing or speech. During one admission, because of the repeated swelling and questionable initial diagnosis, a computed tomogram (Fig. 1) was done, which showed fluid in the floor of the mouth lateral to the styloglossal complex extending to the submandibular salivary gland; the possible diagnoses were a ranula or cystic hygroma, but the exact diagnosis was still not clear. The lesion was excised by a neck dissection. Histopathological examination confirmed a complex lateral dermoid cyst that contained epithelium and appendages of skin. Later radiological and histopathological investigations suggested that the fluid contained a mixture of pus, exudates, and keratin. Dermoid cysts are thought to comprise about 34% of developmental cysts in the head and neck region,1 and these ∗
Corresponding author. Tel.: +44 7977579170. E-mail address:
[email protected] (R.M. Graham).
occur mostly in the midline of the floor of the mouth.2 However, it is possible that this was a midline dermoid cyst that had migrated laterally by expansion.
Fig. 1. Axial computed tomogram showing an extensive cystic mass causing compression and displacement of the lobes of the right submandibular salivary gland.
0266-4356/$ – see front matter © 2006 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2006.10.015
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R.M. Graham et al. / British Journal of Oral and Maxillofacial Surgery 46 (2008) 131–132
This case shows that repeated episodes of infection can change the presentation and appearance of a well-known entity such as a dermoid cyst, and that sophisticated investigations may only confound their diagnosis.
References 1. Taylor BW, Erich JB, Dockerty MB. Dermoids of the head and neck. Minn Med 1966;49:1535–40. 2. Mandel L, Surattanont F. Lateral dermoid cyst. J Oral Maxillofac Surg 2005;63:137–40.
