Giant sublingual epidermoid cyst resembling plunging ranula
A 16-year-old female presented with complaints of a mass in oral cavity beneath the tongue and difficulty in chewing and swallowing of solid foods for the past 5 months. The patient had no dyspnea or pain, no previous history of surgery or trauma to the oral cavity or neck. On examination, there was 7 cm × 5 cm sublingual mass that was non-tender, fluctuant, soft, non-mobile, with overlying mucosa showing no secondary changes []. There were no inflammatory signs or lymphadenopathy associated with the swelling. Mass was displacing the tongue superiorly and posteriorly [].\nOn examination, a soft swelling was also noticed in the submental area, extending down to the thyroid notch. Fine needle aspiration cytology showed keratin flakes and proteinaceous material. Contrast-enhanced CT was done and showed 7.0 × 5 × 4.5 cm well-circumscribed non-enhancing cystic mass extending into the floor of the mouth. Anteriorly, the lesion is abutting to mandible. Posteriorly, the lesion is abutting the base of tongue and causing compression over anterior wall of the oropharynx. CT features and extension suggested possibility of plunging ranula and thyroglossal cyst [].\nUnder general anesthesia, intraoral incision was given in the floor of the mouth from base of tongue to mandible. Sharp and blunt dissection was done to free the cyst from fibers of mylohyoid muscle. Cyst was removed per oral in toto []. The resultant defect was closed in layers after ensuring hemostasis.\nThe postoperative period was uneventful and the tongue went back to its normal position. On histological examination, acidophilic stratum corneum and basophilic dot like staining of stratum granulosum were seen. Stratum granulosum is the hallmark of epidermoid cyst. It confirmed the diagnosis of an epidermoid cyst []. The patient did well postoperatively, and no recurrence was noticed at the two-month follow-up.