Case report
Giant Submental Dermoid Cysts With Near Total Obstruction of the Oral Cavity: Report of 2 Cases

https://doi.org/10.1016/j.joms.2010.05.064Get rights and content

Dermoid cysts in the head and neck are a relatively uncommon entity with only 6.9% occurring in this site. They most commonly occur in the lateral third of the eyebrow with 26% found in the floor of the mouth.1 They are believed to arise from failure of the overlying surface ectoderm to separate from underlying structures. Typically, dermoid cysts present as slow-growing nontender midline floor of the mouth or submental swellings that can develop to significant dimensions before producing symptoms.2 We report 2 such cases where large dermoid cysts produced progressive dysphagia and breathing difficulty, resulting in acute presentation to our service.

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Case 1

A 30-yr-old male presented acutely to the maxillofacial surgery service with a history of progressively worsening dysphagia and neck swelling. The patient also complained of difficulty sleeping secondary to airway compromise, recent weight loss, and speech disturbance. Physical examination showed a thin male with a significant submental swelling (Fig 1). There was no obvious respiratory distress, although breathing at rest appeared labored. The mass was soft, nonpulsatile, nontender, and free

Case 2

An otherwise healthy 34-yr-old Sudanese male immigrant presented to the emergency department with acute onset of floor of the mouth and submental pain and increased swelling. He described a long history of slowly progressive, painless sublingual/submental swelling causing retro displacement of the tongue and dysphagia. He noticed sudden onset pain, tenderness, and odynophagia over the prior 24 hours. Subjective complaints of a globus sensation and difficulty breathing were also noted. Emergency

Discussion

Dermoid cysts of the head and neck, particularly the floor of the mouth, although rare, have historically been documented since 1778 as referenced in Jourdain's book.3 Histologically, dermoid cysts are distinguished from epidermoid cysts by the presence of an epidermoid lining containing adnexal structures such as sweat glands, sebaceous glands, hair, and hair follicles.4, 5 Clinically, these lesions are benign, painless, and slow-growing; however, malignant transformation when longstanding has

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Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.