ABSTRACT

The epidermal cyst is a rare, benign lesion, usually asymptomatic and slowly enlarging, more frequently located in the submandibular region. Its etiology is believed to be associated with the epithelial residual tissues retained in the midline during the closure of the first and second brachial arches, in the third and fourth weeks of intra-uterine life. Its clinical characteristics are of a rubbery consistency to palpation, well defined borders, with the absence of skin appendages within their squamous epithelium lined walls. The final diagnosis is confirmed through histopathological examination with stratified squamous epithelium findings in the cystic fluid lumen or keratin. The treatment is usually surgical and without recurrence and the final diagnosis is confirmed through histopathological examination. This paper aims to present a case report of a congenital epidermal cyst in a 5-month-old female patient located in the mouth floor near the sublingual gland duct. The case was treated with excisional biopsy and after follow-up, there was no recurrence.

Indexing terms
Surgery oral; Epidermal cyst; Nonodontogenic cysts; Diagnosis, oral; Pathology, oral

RESUMO

O cisto epidérmico é um cisto de desenvolvimento, benigno, raro, localizado com maior frequência na região submandibular, geralmente assintomático e de evolução lenta. Acredita-se que a sua etiologia esteja associada aos restos epiteliais retidos na linha média durante o fechamento do primeiro e segundo arcos braquiais, na terceira ou quarta semana de vida intrauterina. Suas características clínicas são de uma consistência borrachóide à palpação, bordas delimitadas e sem apêndices de pele no seu interior. O diagnóstico é confirmado através do exame histopatológico com achados de epitélio escamoso estratificado e no lúmen fluído cístico ou queratina. O tratamento é geralmente cirúrgico e sem recidivas. Este trabalho relata um caso de cisto epidérmico congênito de uma paciente pediátrica, do sexo feminino, de cinco meses de idade e localizado no assoalho de boca próximo ao ducto da glândula sublingual. O caso foi tratado com a enucleação cirúrgica e em seis meses de acompanhamento não apresentou recidiva.

Termos de indexação
Cirurgia oral; Cisto epidérmico; Cistos não odontogênicos; Diagnóstico bucal; Patologia bucal

INTRODUCTION

Epidermoid cysts are benign, painless lesions of congenital or acquired origin, slowly increasing in size [¹1 Verma S, Kushwaha JK, Sonkar AA, Kumar R, Gupta R. Giant sublingual epidermoid cyst resembling plunging ranula. Natl J Maxillofac Surg. 2012;3(2):211-3. http://dx.doi.org/10.4103/0975-5950.111386
https://doi.org/10.4103/0975-5950.111386... ,²2 Nasin VC, Perumal P. Oral epidermoid cyst. A case report. Eur J Paediatr Dent. 2014;15(2 Suppl):247-9.]. Epidermal and dermoid cysts are found throughout the body. Epidemiologically they represent 7% of the head and neck cysts [²2 Nasin VC, Perumal P. Oral epidermoid cyst. A case report. Eur J Paediatr Dent. 2014;15(2 Suppl):247-9.,³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2...

4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.-⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ] and 0.01% of those within the oral cavity [¹1 Verma S, Kushwaha JK, Sonkar AA, Kumar R, Gupta R. Giant sublingual epidermoid cyst resembling plunging ranula. Natl J Maxillofac Surg. 2012;3(2):211-3. http://dx.doi.org/10.4103/0975-5950.111386
https://doi.org/10.4103/0975-5950.111386... ,⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ,⁶6 Mohta A, Sharma M. Congenital oral cysts in neonates: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):e36-8. http://dx.doi.org/10.1016/j.tripleo.2006.03.024
https://doi.org/10.1016/j.tripleo.2006.0... ]. Although rare in the mouth, most of them occur in the midline, in the sublingual region [²2 Nasin VC, Perumal P. Oral epidermoid cyst. A case report. Eur J Paediatr Dent. 2014;15(2 Suppl):247-9.,⁷7 Anantanarayanan P, Manikandhan R, Bhargava D, Sivapathasundaram B. Sub-lingual epidermoid cyst. Head Neck Pathol. 2010;4(2):136-8. http://dx.doi.org/10.1007/s12105-010-0164-8
https://doi.org/10.1007/s12105-010-0164-... ], but may also appear in other parts of the oral cavity [⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ,⁸8 Hemaraju N, Nanda SK, Medikeri SB. Sub-lingual dermoid cyst. Indian J Otolaryngol Head Neck Surg. 2004;56(3):218-20. http://dx.doi.org/10.1007/BF02974355
https://doi.org/10.1007/BF02974355...

9 Janarthanam J, Mahadevan S. Epidermoid cyst of submandibular region. J Oral Maxillofac Pathol. 2012;16(3):435-7. http://dx.doi.org/10.4103/0973-029X.102511
https://doi.org/10.4103/0973-029X.102511...

10 Ozer E, Kanlikama M, Bayazit YA, Mumbuç S, Sari I, Gök A. A unique case of an epidermoid cyst of the pterygopalatine fossa and its management. Int J Pediatr Otorhinolaryngol. 2003;67(11):1259-61. http://dx.doi.org/10.1016/j.ijporl.2003.07.009
https://doi.org/10.1016/j.ijporl.2003.07...

11 Naik C, Prusty N. Epidermoid cyst of tongue. JNMA J Nepal Med Assoc. 2016; 54(201):43-5. http://dx.doi.org/10.31729/jnma.2817
https://doi.org/10.31729/jnma.2817... -¹²12 Daram S, Ulualp SO, Uddin N. Epidermoid cyst of the uvula in a child. SAGE Open Med Case Rep. 2016; 4: 1-3. http://dx.doi.org/10.1177/2050313X16683629
https://doi.org/10.1177/2050313X16683629... ].

The etiology is uncertain and may be associated with remains of the ectoderm retained in the first and second brachial arches [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2...

4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.

5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... -⁶6 Mohta A, Sharma M. Congenital oral cysts in neonates: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):e36-8. http://dx.doi.org/10.1016/j.tripleo.2006.03.024
https://doi.org/10.1016/j.tripleo.2006.0... ,¹¹11 Naik C, Prusty N. Epidermoid cyst of tongue. JNMA J Nepal Med Assoc. 2016; 54(201):43-5. http://dx.doi.org/10.31729/jnma.2817
https://doi.org/10.31729/jnma.2817...

12 Daram S, Ulualp SO, Uddin N. Epidermoid cyst of the uvula in a child. SAGE Open Med Case Rep. 2016; 4: 1-3. http://dx.doi.org/10.1177/2050313X16683629
https://doi.org/10.1177/2050313X16683629...

13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... -¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ] accidental or surgical events which lead to a traumatic implantation of the epithelium within deep structures [⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.,¹¹11 Naik C, Prusty N. Epidermoid cyst of tongue. JNMA J Nepal Med Assoc. 2016; 54(201):43-5. http://dx.doi.org/10.31729/jnma.2817
https://doi.org/10.31729/jnma.2817... ,¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ,¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ]; or a variation of the thyroglossal cyst [⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.,¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ,¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ].

Clinically, epidermoid cyst present rubbery consistency to palpation, defined borders and variable size. Depending on their location and size, it may cause dysphagia, dyspnea, and speech difficulty [⁹9 Janarthanam J, Mahadevan S. Epidermoid cyst of submandibular region. J Oral Maxillofac Pathol. 2012;16(3):435-7. http://dx.doi.org/10.4103/0973-029X.102511
https://doi.org/10.4103/0973-029X.102511... ]. However, the final diagnosis is only obtained through the histopathological examination.

The treatment is surgical excision and the location of the cyst, whether above or below the mylohyoid muscle, is a determining factor in the choice of the appropriate intra or extra-oral treatment [⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.] approach.

These cysts are rarely seen in the first years of life [¹⁵15 da Silva LP, Gonzaga AK, Severo ML, Barros CC, de Medeiros AM, de Souza LB, da Silveira ÉJ. Epidemiologic study of odontogenic and non-odontogenic cysts in children and adolescents of a Brazilian population. Med Oral Patol Oral Cir Bucal. 2018;23(1):e49-53. http://dx.doi.org/10.4317/medoral.22138
https://doi.org/10.4317/medoral.22138... ] and can often be seen in young adults [¹1 Verma S, Kushwaha JK, Sonkar AA, Kumar R, Gupta R. Giant sublingual epidermoid cyst resembling plunging ranula. Natl J Maxillofac Surg. 2012;3(2):211-3. http://dx.doi.org/10.4103/0975-5950.111386
https://doi.org/10.4103/0975-5950.111386... ] or in the third or fourth decade of life [¹⁶16 Mammen S, Korulla A, Paul MJ. An epidermal cyst in the floor of the mouth: a rare presentation. J Clin Diagn Res. 2013;7(2):381-2. http://dx.doi.org/10.7860/JCDR/2013/4165.2776
https://doi.org/10.7860/JCDR/2013/4165.2... ]. Therefore, the objective of this study is to report a rare case of epidermoid cyst in a 5-month-old patient focusing the clinical and histopathological aspects.

CASE REPORT

Approval of the Ethics Committee of Faculdade Educacional de Francisco Beltrão: 2.162.971

A five-month-old female patient was taken by the parents to a dental pediatric appointment when the parents complained of a “ball” on the floor of the mouth floor, which had been present since the baby was born. According to the parents, the pediatrician believed that the lesion was not malignant and referred the patient to the dentist. The first dental appointment was performed at the health clinic, where the dentist suggested, as a diagnostic hypothesis, the presence of a ranula and referred the patient to a pediatric dentist. Anamnese showed the baby’s good health condition and breastfeeding was maternal.

The clinical examination revealed the presence of a circular-shaped smooth, whitish surface of fibrous consistency on the left side, near the sublingual gland duct, measuring 0.3 x 0.3 x 0.2 cm, sessile base (figures 1). The parents were advised of a possible cystic lesion diagnosis which should be confirmed by a histopathological examination after excision.

Figure 1
Papule on the mouth floor.

Three days after the first appointment intraosseous antisepsis was performed with a gauze soaked in 0.12% chlorhexidine solution and the child was anesthetized with one third of the anesthetic tube containing 2% Lidocaine solution with Epinephrine 1: 100,000 (DFL - Brazil) by the infiltrative technique, on the floor of the mouth. Clamping was performed using a 15C scalpel blade and the lesion was nucleated (figure 2). Once the lesion was superficial with little bleeding there was no need for suturing, and the specimen was stored in 10% formalin solution. The child was medicated with analgesic after the procedure and was scheduled for another appointment.

Figure 2
Nucleated lesion.

The histopathological analysis revealed fragment of oral mucosa constituted by parakeratinized epithelial showing areas of acanthosis and atrophy. In the lamina propria, constituted by dense connective tissue, it can be observed a cystic capsule coated by parakeratinized stratified squamous epithelial tissue presenting remnants of keratin in its lumen (figure 3 A, B, C and D).

Figure 3
Histopathological exam image.

Several scaly cells were observed in the cystic lumen. Presence of salivary duct and small blood vessels led to an epidermal cyst diagnosis.

The case was reassessed in one week and 45 days when the parents were informed of the diagnosis (figure 4). At the six-month follow-up the child did not present a recurrence and the case has been under follow up since then.

Figure 4
Healing after 45 days.

DISCUSSION

The epidermoid cyst, a part of the cystic teratoma spectrum3, can be according to Meyer (1955) histologically differentiated into three types, as follows: epidermoid (simple): when it presents stratified squamous epithelium and no skin appendages; dermoid (compound): besides the typical squamous epithelium it also encloses skin appendages such as hair, hair follicle as well as sebaceous and sweat glands; terathoid (complex): a cavity lined with epithelium containing mesodermal and endodermal origin such as muscles, intestinal mucosa, respiratory mucosa, fibrous tissue, bone tissue, blood vessels and skin appendages which are typical of dermoid cysts [¹1 Verma S, Kushwaha JK, Sonkar AA, Kumar R, Gupta R. Giant sublingual epidermoid cyst resembling plunging ranula. Natl J Maxillofac Surg. 2012;3(2):211-3. http://dx.doi.org/10.4103/0975-5950.111386
https://doi.org/10.4103/0975-5950.111386... ,⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.,⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ,¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ].

The etiology of this case is probably related to the entrapment of ectodermal tissue of the first (mandibular) and second (hyoid) brachial arches remanants during fetal development [¹1 Verma S, Kushwaha JK, Sonkar AA, Kumar R, Gupta R. Giant sublingual epidermoid cyst resembling plunging ranula. Natl J Maxillofac Surg. 2012;3(2):211-3. http://dx.doi.org/10.4103/0975-5950.111386
https://doi.org/10.4103/0975-5950.111386... ,³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ,⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ,¹¹11 Naik C, Prusty N. Epidermoid cyst of tongue. JNMA J Nepal Med Assoc. 2016; 54(201):43-5. http://dx.doi.org/10.31729/jnma.2817
https://doi.org/10.31729/jnma.2817... ,¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.] during the third and fourth week of intrauterine life. It is a congenital cyst. once it was present since birth. The development of these cysts in the oral cavity is extremely rare [⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.,⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ,¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ,¹⁵15 da Silva LP, Gonzaga AK, Severo ML, Barros CC, de Medeiros AM, de Souza LB, da Silveira ÉJ. Epidemiologic study of odontogenic and non-odontogenic cysts in children and adolescents of a Brazilian population. Med Oral Patol Oral Cir Bucal. 2018;23(1):e49-53. http://dx.doi.org/10.4317/medoral.22138
https://doi.org/10.4317/medoral.22138... ], although they have been reported in the mouth floor [²2 Nasin VC, Perumal P. Oral epidermoid cyst. A case report. Eur J Paediatr Dent. 2014;15(2 Suppl):247-9.,⁷7 Anantanarayanan P, Manikandhan R, Bhargava D, Sivapathasundaram B. Sub-lingual epidermoid cyst. Head Neck Pathol. 2010;4(2):136-8. http://dx.doi.org/10.1007/s12105-010-0164-8
https://doi.org/10.1007/s12105-010-0164-... ,¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ], on the tongue11, lips, oral mucosa [¹⁸18 Costa FW, Carvalho FS, Chaves FN, de Almeida S, Alves AP, Patrocínio RM, Sousa FB, Pereira KM. Epidermoid Cyst Arising in the Buccal Mucosa: Case Report and Literature Review. Acta Stomatol Croat. 2015;49(1):65-73. http://dx.doi.org/10.15644/asc49/1/9
https://doi.org/10.15644/asc49/1/9... ], pharynx, soft palate [¹⁹19 Montebugnoli L, Tiberio C, Venturi M. A rare case of congenital epidermoid cyst of the hard palate. BMJ Case Rep. 2011;2011:bcr0720114485. http://dx.doi.org/10.1136/bcr.07.2011.4485
https://doi.org/10.1136/bcr.07.2011.4485... ] and uvula [¹²12 Daram S, Ulualp SO, Uddin N. Epidermoid cyst of the uvula in a child. SAGE Open Med Case Rep. 2016; 4: 1-3. http://dx.doi.org/10.1177/2050313X16683629
https://doi.org/10.1177/2050313X16683629... ].

They may occur during childhood [¹⁵15 da Silva LP, Gonzaga AK, Severo ML, Barros CC, de Medeiros AM, de Souza LB, da Silveira ÉJ. Epidemiologic study of odontogenic and non-odontogenic cysts in children and adolescents of a Brazilian population. Med Oral Patol Oral Cir Bucal. 2018;23(1):e49-53. http://dx.doi.org/10.4317/medoral.22138
https://doi.org/10.4317/medoral.22138... ,¹⁶16 Mammen S, Korulla A, Paul MJ. An epidermal cyst in the floor of the mouth: a rare presentation. J Clin Diagn Res. 2013;7(2):381-2. http://dx.doi.org/10.7860/JCDR/2013/4165.2776
https://doi.org/10.7860/JCDR/2013/4165.2... ] and in young adult patients, with age preponderance in patients between 35 and 45 years of age [¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ]. In the literature, cases of epidermal cyst in childhood (0-10 years) have been reported in the floor of the mouth [²2 Nasin VC, Perumal P. Oral epidermoid cyst. A case report. Eur J Paediatr Dent. 2014;15(2 Suppl):247-9.,⁶6 Mohta A, Sharma M. Congenital oral cysts in neonates: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):e36-8. http://dx.doi.org/10.1016/j.tripleo.2006.03.024
https://doi.org/10.1016/j.tripleo.2006.0... ,⁷7 Anantanarayanan P, Manikandhan R, Bhargava D, Sivapathasundaram B. Sub-lingual epidermoid cyst. Head Neck Pathol. 2010;4(2):136-8. http://dx.doi.org/10.1007/s12105-010-0164-8
https://doi.org/10.1007/s12105-010-0164-... ], on the tongue [⁶6 Mohta A, Sharma M. Congenital oral cysts in neonates: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):e36-8. http://dx.doi.org/10.1016/j.tripleo.2006.03.024
https://doi.org/10.1016/j.tripleo.2006.0... ,¹¹11 Naik C, Prusty N. Epidermoid cyst of tongue. JNMA J Nepal Med Assoc. 2016; 54(201):43-5. http://dx.doi.org/10.31729/jnma.2817
https://doi.org/10.31729/jnma.2817... ], on the uvula [¹²12 Daram S, Ulualp SO, Uddin N. Epidermoid cyst of the uvula in a child. SAGE Open Med Case Rep. 2016; 4: 1-3. http://dx.doi.org/10.1177/2050313X16683629
https://doi.org/10.1177/2050313X16683629... ], in the soft palate [¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ] and in the pterygopalatine fossa [¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ]. Studies have shown that few cases occurred in early childhood (0-3 years) [⁶6 Mohta A, Sharma M. Congenital oral cysts in neonates: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):e36-8. http://dx.doi.org/10.1016/j.tripleo.2006.03.024
https://doi.org/10.1016/j.tripleo.2006.0... ,¹⁵15 da Silva LP, Gonzaga AK, Severo ML, Barros CC, de Medeiros AM, de Souza LB, da Silveira ÉJ. Epidemiologic study of odontogenic and non-odontogenic cysts in children and adolescents of a Brazilian population. Med Oral Patol Oral Cir Bucal. 2018;23(1):e49-53. http://dx.doi.org/10.4317/medoral.22138
https://doi.org/10.4317/medoral.22138... ], on the floor of the mouth5, on the tongue [⁶6 Mohta A, Sharma M. Congenital oral cysts in neonates: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):e36-8. http://dx.doi.org/10.1016/j.tripleo.2006.03.024
https://doi.org/10.1016/j.tripleo.2006.0... ], on the uvula and in the soft palate [¹⁵15 da Silva LP, Gonzaga AK, Severo ML, Barros CC, de Medeiros AM, de Souza LB, da Silveira ÉJ. Epidemiologic study of odontogenic and non-odontogenic cysts in children and adolescents of a Brazilian population. Med Oral Patol Oral Cir Bucal. 2018;23(1):e49-53. http://dx.doi.org/10.4317/medoral.22138
https://doi.org/10.4317/medoral.22138... ].

Some authors have found no gender predilection [⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ,¹⁶16 Mammen S, Korulla A, Paul MJ. An epidermal cyst in the floor of the mouth: a rare presentation. J Clin Diagn Res. 2013;7(2):381-2. http://dx.doi.org/10.7860/JCDR/2013/4165.2776
https://doi.org/10.7860/JCDR/2013/4165.2... ], others however state either male predilection [¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.,¹⁸18 Costa FW, Carvalho FS, Chaves FN, de Almeida S, Alves AP, Patrocínio RM, Sousa FB, Pereira KM. Epidermoid Cyst Arising in the Buccal Mucosa: Case Report and Literature Review. Acta Stomatol Croat. 2015;49(1):65-73. http://dx.doi.org/10.15644/asc49/1/9
https://doi.org/10.15644/asc49/1/9... ] or female [¹⁸18 Costa FW, Carvalho FS, Chaves FN, de Almeida S, Alves AP, Patrocínio RM, Sousa FB, Pereira KM. Epidermoid Cyst Arising in the Buccal Mucosa: Case Report and Literature Review. Acta Stomatol Croat. 2015;49(1):65-73. http://dx.doi.org/10.15644/asc49/1/9
https://doi.org/10.15644/asc49/1/9... ].

Clinically, the lesions are of a rubbery, soft, palpable consistency, mobile and well- defined borders, separated from the underlying skin [¹⁶16 Mammen S, Korulla A, Paul MJ. An epidermal cyst in the floor of the mouth: a rare presentation. J Clin Diagn Res. 2013;7(2):381-2. http://dx.doi.org/10.7860/JCDR/2013/4165.2776
https://doi.org/10.7860/JCDR/2013/4165.2... ], asymptomatic, presenting a slow and progressive growth [⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.,¹⁶16 Mammen S, Korulla A, Paul MJ. An epidermal cyst in the floor of the mouth: a rare presentation. J Clin Diagn Res. 2013;7(2):381-2. http://dx.doi.org/10.7860/JCDR/2013/4165.2776
https://doi.org/10.7860/JCDR/2013/4165.2... ,¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.], without lymphadenopathy or signs of infection [¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ]. If large they can interfere with feeding or speech and tongue displacement (up or behind) [⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.,¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.].

Some cases in the literature have used ultrasound [²2 Nasin VC, Perumal P. Oral epidermoid cyst. A case report. Eur J Paediatr Dent. 2014;15(2 Suppl):247-9.,⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ,⁷7 Anantanarayanan P, Manikandhan R, Bhargava D, Sivapathasundaram B. Sub-lingual epidermoid cyst. Head Neck Pathol. 2010;4(2):136-8. http://dx.doi.org/10.1007/s12105-010-0164-8
https://doi.org/10.1007/s12105-010-0164-... ,¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ,¹⁶16 Mammen S, Korulla A, Paul MJ. An epidermal cyst in the floor of the mouth: a rare presentation. J Clin Diagn Res. 2013;7(2):381-2. http://dx.doi.org/10.7860/JCDR/2013/4165.2776
https://doi.org/10.7860/JCDR/2013/4165.2... ,¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.], computerized tomography scan [¹1 Verma S, Kushwaha JK, Sonkar AA, Kumar R, Gupta R. Giant sublingual epidermoid cyst resembling plunging ranula. Natl J Maxillofac Surg. 2012;3(2):211-3. http://dx.doi.org/10.4103/0975-5950.111386
https://doi.org/10.4103/0975-5950.111386... ,¹⁰10 Ozer E, Kanlikama M, Bayazit YA, Mumbuç S, Sari I, Gök A. A unique case of an epidermoid cyst of the pterygopalatine fossa and its management. Int J Pediatr Otorhinolaryngol. 2003;67(11):1259-61. http://dx.doi.org/10.1016/j.ijporl.2003.07.009
https://doi.org/10.1016/j.ijporl.2003.07... ,¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ,¹⁶16 Mammen S, Korulla A, Paul MJ. An epidermal cyst in the floor of the mouth: a rare presentation. J Clin Diagn Res. 2013;7(2):381-2. http://dx.doi.org/10.7860/JCDR/2013/4165.2776
https://doi.org/10.7860/JCDR/2013/4165.2... ] and magnetic resonance imaging [¹1 Verma S, Kushwaha JK, Sonkar AA, Kumar R, Gupta R. Giant sublingual epidermoid cyst resembling plunging ranula. Natl J Maxillofac Surg. 2012;3(2):211-3. http://dx.doi.org/10.4103/0975-5950.111386
https://doi.org/10.4103/0975-5950.111386... ,³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ,¹⁰10 Ozer E, Kanlikama M, Bayazit YA, Mumbuç S, Sari I, Gök A. A unique case of an epidermoid cyst of the pterygopalatine fossa and its management. Int J Pediatr Otorhinolaryngol. 2003;67(11):1259-61. http://dx.doi.org/10.1016/j.ijporl.2003.07.009
https://doi.org/10.1016/j.ijporl.2003.07... ,¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ,¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.] for the diagnosis and treatment planning.

Depending on the location, the differential diagnosis can lead to a dermoid cyst, epidermoid [¹1 Verma S, Kushwaha JK, Sonkar AA, Kumar R, Gupta R. Giant sublingual epidermoid cyst resembling plunging ranula. Natl J Maxillofac Surg. 2012;3(2):211-3. http://dx.doi.org/10.4103/0975-5950.111386
https://doi.org/10.4103/0975-5950.111386... ,¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ], infectious processes, ranula [¹1 Verma S, Kushwaha JK, Sonkar AA, Kumar R, Gupta R. Giant sublingual epidermoid cyst resembling plunging ranula. Natl J Maxillofac Surg. 2012;3(2):211-3. http://dx.doi.org/10.4103/0975-5950.111386
https://doi.org/10.4103/0975-5950.111386... ,³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2...

4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.

5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... -⁶6 Mohta A, Sharma M. Congenital oral cysts in neonates: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):e36-8. http://dx.doi.org/10.1016/j.tripleo.2006.03.024
https://doi.org/10.1016/j.tripleo.2006.0... ,¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ,¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ,¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.], cyst of the thyroglossal duct, cystic hygroma [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ,⁶6 Mohta A, Sharma M. Congenital oral cysts in neonates: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):e36-8. http://dx.doi.org/10.1016/j.tripleo.2006.03.024
https://doi.org/10.1016/j.tripleo.2006.0... ,¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ,¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.], accumulation of adipose tissue, unilateral or bilateral blockage of the Wharton ducts, cyst of the branchial cleft, submandibular and sublingual gland infection, benign and malignant tumors of the mouth floor and adjacent salivary glands [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2...

4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.-⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ,¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.], hemangioma [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ], lymphoepithelial cyst [⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.,¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ,¹⁴14 De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13(2):308-10. http://dx.doi.org/10.1097/00001665-200203000-00024
https://doi.org/10.1097/00001665-2002030... ], lipoma [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ,¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ,¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.], neurofibroma and lymphangioma [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ]. In newborns, it is essential that professionals are able to identify the differences in transient cysts such as Epstein’s Pearls, Bohn’s Nodules and dental sheet cysts in order to avoid unnecessary therapeutic procedures.

The anatomical classification is based on its relation with the geniohyoid, milo-hyoid and genioglossus muscles, determining whether the lesion is sublingual (located above the geniohyoid muscle); submental (located between geniohyoid) or milo-hyoid or submandibular (located on the lateral aspect of the floor of the mouth). When the lesion is above the geniohyoid muscle, intra-oral swelling may cause tongue elevation and retraction, making it difficult to speak, chew, swallow [²2 Nasin VC, Perumal P. Oral epidermoid cyst. A case report. Eur J Paediatr Dent. 2014;15(2 Suppl):247-9.], causing dysphagia, dysphonia and dyspnea [⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.,⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ]. If the location is between or below the geniohyoid and milohyoid muscles, swelling may give the patient the appearance of a double chin [⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.,⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ]. Most reports of cysts in the oral cavity describe cysts in the submental region.

The epidermoid cyst treatment is surgical without rupture of the cyst, since its content may irritate the surrounding fibrovascular tissue producing postoperative [¹1 Verma S, Kushwaha JK, Sonkar AA, Kumar R, Gupta R. Giant sublingual epidermoid cyst resembling plunging ranula. Natl J Maxillofac Surg. 2012;3(2):211-3. http://dx.doi.org/10.4103/0975-5950.111386
https://doi.org/10.4103/0975-5950.111386... ,³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ,⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ,¹⁶16 Mammen S, Korulla A, Paul MJ. An epidermal cyst in the floor of the mouth: a rare presentation. J Clin Diagn Res. 2013;7(2):381-2. http://dx.doi.org/10.7860/JCDR/2013/4165.2776
https://doi.org/10.7860/JCDR/2013/4165.2...

17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.

18 Costa FW, Carvalho FS, Chaves FN, de Almeida S, Alves AP, Patrocínio RM, Sousa FB, Pereira KM. Epidermoid Cyst Arising in the Buccal Mucosa: Case Report and Literature Review. Acta Stomatol Croat. 2015;49(1):65-73. http://dx.doi.org/10.15644/asc49/1/9
https://doi.org/10.15644/asc49/1/9... -¹⁹19 Montebugnoli L, Tiberio C, Venturi M. A rare case of congenital epidermoid cyst of the hard palate. BMJ Case Rep. 2011;2011:bcr0720114485. http://dx.doi.org/10.1136/bcr.07.2011.4485
https://doi.org/10.1136/bcr.07.2011.4485... ] inflammation [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ]. Surgery can be performed by transcutaneous approach in the upper neck or by intraoral access1. The choice of the type of surgical approach will depend on the location of the cyst in relation to the muscles of the mouth floor [²2 Nasin VC, Perumal P. Oral epidermoid cyst. A case report. Eur J Paediatr Dent. 2014;15(2 Suppl):247-9.,⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.] and the size of the mass [²2 Nasin VC, Perumal P. Oral epidermoid cyst. A case report. Eur J Paediatr Dent. 2014;15(2 Suppl):247-9.]. Intraoral access should be chosen whenever the lesion is above the geniohyoid and milohyoid muscle, due to its lower morbidity, absence of dermal scar [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ] and faster recovery [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ,⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.]. Large cysts should receive an extraoral approach, due to better visualization of surrounding structures, control of bleeding and intrabuccal contamination [¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ]. However, the treatment of choice should be the one allowing better visualization of the operative field in order to faciliate the removal of the lesion [¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.]. Due to the age of our patient, size and location of the lesion, the intrabuccal access was the choice for surgical excision. For larger lesions marsupialization can be performed [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ]. Recurrence rarely occurs and it has been reported in less than 3% of cases [¹⁹19 Montebugnoli L, Tiberio C, Venturi M. A rare case of congenital epidermoid cyst of the hard palate. BMJ Case Rep. 2011;2011:bcr0720114485. http://dx.doi.org/10.1136/bcr.07.2011.4485
https://doi.org/10.1136/bcr.07.2011.4485... ], however it may occur if the cyst is not completely removed [⁴4 Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int. 2007; 38 (6): 473-7.,¹³13 Lima SM Jr, Chrcanovic BR, de Paula AM, Freire-Maia B, Souza LN. Dermoid cyst of the floor of the mouth. Sci. 2003;3:156-62. http://dx.doi.org/10.1100/tsw.2003.04
https://doi.org/10.1100/tsw.2003.04... ,¹⁷17 Nishar C-C, Ambulgekar VK, Gujrathi A-B, Chavan P-T. Unusually Giant Sublingual Epidermoid Cyst: A Case Report. Iran J Otorhinolaryngol. 2016;28(87):291-6.,¹⁸18 Costa FW, Carvalho FS, Chaves FN, de Almeida S, Alves AP, Patrocínio RM, Sousa FB, Pereira KM. Epidermoid Cyst Arising in the Buccal Mucosa: Case Report and Literature Review. Acta Stomatol Croat. 2015;49(1):65-73. http://dx.doi.org/10.15644/asc49/1/9
https://doi.org/10.15644/asc49/1/9... ]. Malignant alterations are also rare [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ,¹⁸18 Costa FW, Carvalho FS, Chaves FN, de Almeida S, Alves AP, Patrocínio RM, Sousa FB, Pereira KM. Epidermoid Cyst Arising in the Buccal Mucosa: Case Report and Literature Review. Acta Stomatol Croat. 2015;49(1):65-73. http://dx.doi.org/10.15644/asc49/1/9
https://doi.org/10.15644/asc49/1/9... ,¹⁹19 Montebugnoli L, Tiberio C, Venturi M. A rare case of congenital epidermoid cyst of the hard palate. BMJ Case Rep. 2011;2011:bcr0720114485. http://dx.doi.org/10.1136/bcr.07.2011.4485
https://doi.org/10.1136/bcr.07.2011.4485... ], in a proportion of 5% [³3 Mirza S, Fadl S, Napaki S, Abualruz A. Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation. Qatar Med J. 2014;2014(1):12-6. http://dx.doi.org/10.5339/qmj.2014.2
https://doi.org/10.5339/qmj.2014.2... ,⁵5 Patil K, Mahima VG, Malleshi SN. Sublingual epidermoid cyst: a case report. Cases J. 2009;2:8848. http://dx.doi.org/10.4076/1757-1626-2-8848
https://doi.org/10.4076/1757-1626-2-8848... ].

CONCLUSION

A diagnosis of Epidermal cyst was made based on clinical and histopathologeatures. The six-month follow-up the child did not present a recurrence. This case report also highlights the importance of differential diagnosis and management of oral benign lesions in children.

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