Transoral approach to excision of massive dermoid cysts in pediatric patients: A case series

Abstract

Floor of mouth (FOM) dermoid cysts are a rare but clinically significant lesion of the head and neck. Classically, large cysts have been excised via a transcervical approach, although the limits of the transoral approach are expanding. The majority of FOM dermoid cysts present in the midline, but true lateral cysts have been reported. In this case series, we describe 3 pediatric patients who all underwent successful transoral excision of massive dermoid cysts, along with a literature review. Massive cystic lesions were identified on preoperative imaging. The dermoid cysts averaged 6 × 4.3 × 5 cm and were successfully removed via a transoral approach. Two were removed via a median ventral FOM incision and one via a lateral trans-sublingual approach to the FOM. When needed, the geniohyoid muscle was divided to gain access to the cyst. All cysts were removed intact, although partial, controlled decompression was performed to aid in dissection. There were no post-operative complications. FOM dermoid cysts are a rare but important cause of pediatric neck masses that present a challenging but satisfying surgical opportunity. The transoral approach is a viable option for massive dermoid cysts superior to the mylohyoid.

Keywords

• Pediatric otolaryngology
• Dermoid cysts
• Oral surgery