Khalefa Mahmoud, Yassin Marwa Saeed, Abdelmohsen Sarah Magdy
Otorhinolaryngology department, faculty of medicine, Aswan university, Aswan, Egypt.
MBBCH, Faculty of medicine, Aswan university, Otorhinolaryngology department, Aswan, Egypt.
Int J Surg Case Rep. 2025 Jun;131:111330. doi: 10.1016/j.ijscr.2025.111330. Epub 2025 Apr 21.
Sublingual epidermoid cysts, rare benign lesions of ectodermal origin, are typically located beneath the tongue or in the floor of the mouth. Although typically asymptomatic, these cysts can grow and lead to discomfort, dysphagia, or complications such as obstructive sleep apnea (OSA). Since sublingual swellings might resemble other disorders, like Plunging ranulas, an accurate diagnosis and prompt treatment are crucial.
We describe a 22-year-old man with a persistent sublingual enlargement. It was associated with dysphagia, speech and chewing difficulties, and OSA episodes. The tongue was displaced upward and backward by a glossy, dark pink cyst that was discovered during physical examination. MRI confirmed a well-defined midline cystic mass above the mylohyoid muscle, measuring 5 × 3.5 cm, with no evidence of erosion or extension. The lesion was excised via a transoral approach. Histopathological examination verified the presence of a keratinized sublingual epidermoid cyst.
Less than 0.01 % of all oral cysts are epidermoid cysts, making them incredibly uncommon. They might be acquired as a result of trauma or obstruction of the sebaceous glands, or congenital as a result of ectodermal components trapped during development. Differential diagnosis for sublingual swellings includes ranula, lymphatic malformation, dermoid cyst, and other lesions. When it comes to defining cystic tumors and directing treatment, MRI is a vital tool. Surgical excision remains the definitive treatment, with intraoral approaches favored for accessible, smaller cysts like in this case.
The necessity of taking sublingual epidermoid cysts into account while making a differential diagnosis of sublingual swellings is highlighted by this specific case. This report highlights the clinical and diagnostic challenges of managing such rare lesions.
舌下表皮样囊肿是起源于外胚层的罕见良性病变，通常位于舌下方或口腔底部。虽然这些囊肿通常无症状，但可生长并导致不适、吞咽困难或诸如阻塞性睡眠呼吸暂停（OSA）等并发症。由于舌下肿胀可能类似于其他疾病，如舌下腺囊肿，准确的诊断和及时的治疗至关重要。
我们描述了一名22岁的男性，其舌下持续肿大。伴有吞咽困难、言语和咀嚼困难以及OSA发作。体格检查发现一个光滑、暗粉色的囊肿将舌头向上和向后推移。MRI证实了一个边界清晰的位于下颌舌骨肌上方的中线囊性肿块，大小为5×3.5厘米，没有侵蚀或扩展的迹象。通过经口入路切除了病变。组织病理学检查证实存在角化的舌下表皮样囊肿。
在所有口腔囊肿中，表皮样囊肿占比不到0.01%，使其极为罕见。它们可能是由于创伤或皮脂腺阻塞而获得性的，或者是由于发育过程中被困的外胚层成分而先天性的。舌下肿胀的鉴别诊断包括舌下腺囊肿、淋巴管畸形、皮样囊肿和其他病变。在确定囊性肿瘤和指导治疗方面，MRI是一种重要工具。手术切除仍然是确定性治疗方法，对于像本病例中这样易于触及的较小囊肿，倾向于采用口内入路。
该特定病例突出了在对舌下肿胀进行鉴别诊断时考虑舌下表皮样囊肿的必要性。本报告强调了管理此类罕见病变的临床和诊断挑战。
