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    This case report describes a 34-year-old female patient who developed an iatrogenic infection in a dermoid cyst in the floor of her mouth following an aspiration biopsy. The cyst was surgically removed and found to contain hairs, keratin, and skin structures confirming it was a dermoid cyst. The report emphasizes that a careful physical exam is important to avoid unnecessary procedures for dermoid cysts which usually have distinct features when located in the floor of the mouth.

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    This case report describes a 34-year-old female patient who developed an iatrogenic infection in a dermoid cyst in the floor of her mouth following an aspiration biopsy. The cyst was surgically removed and found to contain hairs, keratin, and skin structures confirming it was a dermoid cyst. The report emphasizes that a careful physical exam is important to avoid unnecessary procedures for dermoid cysts which usually have distinct features when located in the floor of the mouth.

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    This case report describes a 34-year-old female patient who developed an iatrogenic infection in a dermoid cyst in the floor of her mouth following an aspiration biopsy. The cyst was surgically removed and found to contain hairs, keratin, and skin structures confirming it was a dermoid cyst. The report emphasizes that a careful physical exam is important to avoid unnecessary procedures for dermoid cysts which usually have distinct features when located in the floor of the mouth.

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    16 views1 page

    1 s2.0 S1808869415307175 Main PDF

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    KharismaNisa
    This case report describes a 34-year-old female patient who developed an iatrogenic infection in a dermoid cyst in the floor of her mouth following an aspiration biopsy. The cyst was surgically removed and found to contain hairs, keratin, and skin structures confirming it was a dermoid cyst. The report emphasizes that a careful physical exam is important to avoid unnecessary procedures for dermoid cysts which usually have distinct features when located in the floor of the mouth.

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    Braz J Otorhinolaryngol.

    2011;77(5):675.

    BJORL

    CASE REPORT

    .org

    Iatrogenic infection in dermoid cysts of the floor of the mouth


    Thiago de Santana Santos1, Ana Cludia Amorim Gomes2, Riedel Frota3, Emanuel Dias de Oliveira e Silva4,
    Paulo Ricardo Saquete Martins Filho5, Emanuel Svio de Souza Andrade6
    Keywords: dermoid cyst, iatrogenic disease, mouth floor, surgery, oral.
    INTRODUCTION

    evaluation, computed tomography, ultrasound, and biopsies may be used to clarify


    the diagnosis.1 Upon careful palpation, dermoid cysts fluctuate or feel similar to dough;
    ultrasound imaging adequately supplements
    the physical examination. Thus, aspiration
    biopsies, which are not recommended in the
    literature for the diagnosis of dermoid cysts,
    may be avoided, and may be considered an
    iatrogenic procedure in this situation. An
    altered physical status and the presence of
    poor dental health led to an initial diagnosis
    of odontogenic infection involving the primary
    fascial spaces.
    Therapy consists of surgical removal
    of lesions, either extra- or intraorally, depending on the site and number of tumors2,5. In
    the present case, removal was done through
    an intraoral approach as the lesion was located
    above the geniohyoid muscle.

    Dermoid cysts are infrequent cystic


    tumors with an epidermal epithelium lining
    and structures such as hair follicles, sweat
    glands, and sebaceous glands. These cysts
    are considered true teratomas, and their origin
    may be congenital or acquired. The incidence
    is highest in male or female individuals aged
    from 15 to 35 years1.
    CASE REPORT
    A female patients aged 34 years
    reported a progressive bilateral growth in
    the submentum and submandibular regions
    during the past 6 years. She added that it had
    worsened within the past seven days following
    needle aspiration biopsy in the floor of the
    mouth (Figure 1A). The physical examination revealed fever, dysphonia, dysphagia,
    and dyspnea. The patient was admitted into
    the hospital for surgical drainage through
    an intraoral approach; the drained material
    consisted of pus and a cyst containing hairs
    and a yellowish viscous material similar to
    keratin. A panoramic radiograph of the jaws
    revealed an extensive carious lesion with pulp
    involvement in unit 48, which suggested an
    odontogenic infection (Figure 1B). Ultrasound
    showed a well-defined regularly contoured
    ecogenic mass in the submentum, suggesting
    a cyst with viscous liquid content (Figure 1C).
    The hypothesis was a dermoid cyst. Under
    general anesthesia, the cyst was enucleated
    in an intraoral approach (Figure 1D). Histopathology confirmed the hypothesis (Figure
    1E). The tumor has not recurred 1 year and 6
    months after surgery (Figure 1F).
    DISCUSSION
    Dermoid cysts are generally asymptomatic slow-growing tumors of varying size.
    The anatomical site is critical for its clinical
    presentation. Lesions above the geniohyoid
    muscle may enlarge the sublingual region,

    FINAL COMMENTS
    Figure 1. Dermoid cyst - A. Bilaterally enlarged submentual and
    submandibular mass resulting in a double chin, limited opening
    of the mouth, and elevated floor of the mouth; B. Panoramic
    radiograph of the jaws; C. Ultrasound - arrows show a suggested
    cyst with a semiliquid content within the fascial spaces of the
    muscles in the floor of the mouth; D. Surgical removal of the lesion
    through an intraoral approach; E. Histopathology. Note the wall
    of the cyst consisting of fibrous connective tissue, skin elements
    such as a hair follicle (PF), and sweat glands (SG) (H.E. 100x); F.
    Postoperative aspect after 1 year and 6 months.

    while those below this muscle may enlarge


    the submentual region and generate a double
    chin aspect2-4. In the present case, although
    the lesion was above the geniohyoid muscle,
    the initial infection and concomitant obesity
    of the patient resulted in a double chin, which
    made for an atypical presentation of a tumor
    located sublingually.
    The differential diagnosis of dermoid
    cysts in the floor of the mouth is made with several other lesions, such as ranula, obstructed
    submandibular/sublingual ducts, thyroglossal
    duct cysts, odontogenic infection, benign and
    malignant tumors, and even excessive fat in
    the submentual region. Besides the clinical

    A careful physical examination may


    avoid iatrogenic procedures when a dermoid
    cyst is suspected; these lesions generally have
    well-defined features when located in the floor
    of the mouth.
    REFERENCES
    1. King RC, Smith BR, Burk JL. Dermoid cyst in
    the floor of mouth: review of the literature and
    case reports. Oral Surg Oral Med Oral Pathol.
    1994;78(5):567-76.
    2. El-Hakim IE, Alyamani A. Alternative surgical
    approaches for excision of dermoid cyst of
    the floor of mouth. Int J Oral Maxillofac Surg.
    2008;37(5):497-9.
    3. 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(12):1825-30.
    4. Kim IK, Kwak HJ, Choi J, Han JY, Park SW. Coexisting sublingual and submental dermoid cyst
    in an infant. Oral Surg Oral Med Oral Pathol Oral
    Radiol Endod. 2006;102(6):778-81.
    5. Shaari C, Ho BT, Shah K, Biller HF. Lingual dermoid cyst. Otolaryngol Head Neck
    Surg.1995;112(3):476-8.

    Specialist in buccomaxillofacial surgery and trauma, Brazilian College of Buccomaxillofacial Surgery and Traumatology. Masters degree in buccomaxillofacial surgery and trauma, Pernambuco
    Dentistry School (FOP), UPE.
    2
    Doctoral degree in buccomaxillofacial surgery and trauma, Pernambuco Dentistry School (FOP), UPE. Adjunct professor, Pernambuco Dentistry School (FOP), UPE.
    3
    Doctoral degree in buccomaxillofacial surgery and trauma, Pernambuco Dentistry School (FOP), UPE. Staff of the residency program in buccomaxillofacial surgery and trauma, Oswaldo Cruz
    University Hospital (HUOC), UPE.
    4
    Specialist in buccomaxillofacial surgery and trauma. Head of the residency and specialization program in buccomaxillofacial surgery and trauma, Oswaldo Cruz University Hospital (HUOC), UPE.
    5
    Masters degree in health sciences, Graduate Nucleus in Medicine, Sergipe Federal University (UFS). Substitute professor of oral pathology, Sergipe Federal University (UFS).
    6
    Doctoral degree in oral pathology, Rio Grande do Norte Federal University (UFRN). Adjunct professor of oral pathology, Pernambuco Dentistry School (FOP), UPE.
    Pernambuco Dentistry School (Faculdade de Odontologia de Pernambuco - FOP).
    Pernambuco University (Universidade de Pernambuco - UPE).
    Send correspondence to: Thiago de Santana Santos - Faculdade de Odontologia, Universidade de Pernambuco - Av. General Newton Cavalcanti, 1650. CEP: 54753-220. Camaragibe, PE, Brazil.
    Phone: (+55 81) 345828 - Fax: (+55 81) 34582867 - E-mail: thiago.ctbmf@yahoo.com.br
    Paper submitted to the BJORL-SGP (Publishing Management System Brazilian Journal of Otorhinolaryngology) on May 4, 2010;
    and accepted on July 20, 2010. cod. 7063
    1

    Brazilian Journal of Otorhinolaryngology 77 (5) September/October 2011


    http://www.bjorl.org / e-mail: revista@aborlccf.org.br

    675

    77(5)-Ingles.indb 675

    03/10/2011 09:18:40

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