The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

A Sublingual Epidermoid Cyst

A
73-year-old woman presented to the emergency department François Thibouw, M.D.
with difficulty in speaking, which had progressively worsened over a period Antoine Schein, M.D.
of 4 days. Her medical history was notable only for a dental procedure Centre Hospitalier Universitaire Dijon
2 months earlier that had involved the insertion of a bridge because of a missing Bourgogne
tooth. Physical examination showed a large, fluctuant, painless swelling of the Dijon, France
francois.thibouw@gmail.com
anterior floor of the mouth. There were no palpable cervical lymph nodes and no
purulent drainage at the orifices of the submandibular and sublingual ducts. Com-
puted tomography of the neck with the use of contrast material revealed a well-
defined, midline, and suprahyoid cyst, measuring 7 cm by 4 cm by 3.5 cm, located
above the geniohyoid and mylohyoid muscles (the image on the left shows the
axial view, and the image on the right the sagittal view). The lesion had peripheral
enhancement with multiple discrete foci of hypoattenuation indicating a coales-
cence of small, fatty nodules — features consistent with an epidermoid cyst.
Epidermoid cysts are benign cysts filled with keratin. Although most commonly
located on the face, neck, and trunk, they can be present within the floor of the
mouth, as in this case. This patient’s cyst was surgically excised with an intraoral
approach, and she had complete resolution of her symptoms.
DOI: 10.1056/NEJMicm1908237
Copyright © 2020 Massachusetts Medical Society.

n engl j med 382;7 nejm.org February 13, 2020 655

The New England Journal of Medicine
Downloaded from nejm.org at UNIVERSITE DE PARIS on February 13, 2020. For personal use only. No other uses without permission.
Copyright © 2020 Massachusetts Medical Society. All rights reserved.