ISPUB.COM The Internet Journal of Otorhinolaryngology Volume 4 Number 2 1 of 5 Midline Submental Epidermoid Cyst: A Rare Case A Pancholi, S Raniga, P Vohra, V Vaidya Citation A Pancholi, S Raniga, P Vohra, V Vaidya. Midline Submental Epidermoid Cyst: A Rare Case. The Internet Journal of Otorhinolaryngology. 2005 Volume 4 Number 2. Abstract Epidermoid cysts of the neck are much less common than dermoid cysts in the head and neck, most often they are located in the submental region. Both are uncommon in the head & neck region. They present with midline, painless slow growing swelling. Imaging helps to determine the nature & contents of the lesion and the relationship of the lesion with the mylohyoid muscles which helps decide the surgical approach. Treatment is usually local excision. We will like to report a rare case of epidermoid cyst of the neck. The most striking point in the imaging was the presence of echogenic solid nodules in a cystic lesion on ultrasonography. INTRODUCTION The spectrum of teratoma includes true dermoid cyst, epidermoid cyst and teratoid cyst. Epidermoid and dermoid cysts are inclusion cysts lined by ectoderm. Epidermoids are devoid of skin appendages in their wall, while these are present in case of dermoids. Both are uncommon in the head & neck region and submental location of the dermoid represents 11.5% of head and neck dermoid [ 1 ]. Epidermoid cysts of the neck are much less common than dermoid cysts in the head and neck, most often they are located in the submental region [ 1 ]. They present with midline, painless slow growing swelling. Imaging helps to determine the nature & contents of the lesion and the relationship of the lesion with the myelohyoid muscles which helps decide the surgical approach. Treatment is usually local excision. We will like to report a rare case of epidermoid cyst of the neck. The most striking point in the imaging was the presence of echogenic solid nodules in a cystic lesion on ultrasonography- only once reported before in the literature. CASE REPORT A 28 year old male presented with a midline painless swelling in the submental region of the neck for 3-4 months. Examination of the neck revealed a non-tender, soft, mobile, non-transilluminant swelling of 3 X 4 cm in the midline submental region. The swelling was becoming prominent on contraction of the mylohyoid muscle, and was not moving with swallowing or protrusion of the tongue. There was no evidence of cervical lymphadenopathy. Laboratory investigations including hemogram & ESR were normal. Ultrasonography of the neck was done on AU-5 EPI, ESAOTE machine using 5-10 MHz linear probe. Ultrasonography through submental approach in coronal and sagittal planes revealed a 3 X 4 cm sized, well- circumscribed, encapsulated cystic lesion in the submental region (Between the anterior bellies of Diagastric muscles) [FIGRUE 1]; below the mylohyoid muscle [FIGURE 2], containing multiple echogenic coalescent nodules with central anechoic areas [FIGURE 1 AND 2]. The nodules were fixed in the lesion suggestive of thick cheesy fluid of the cyst. On ultrasonography, differential diagnoses of dermoid and epidermoid cyst were kept.