PMC5502507_01
Submental swelling with "double chin" appearance (a), sublingual swelling (b). Ultrasonography of submental swelling shows thick walled unilocular cystic swelling with fluid content and floating nonshadowing echogenic nodules like "stack of marbles" (c) and sublingual swelling shows unilocular cystic lesion with internal homogeneous particulate component (d)
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F1
Local examination revealed cystic, nonpulsatile, noncompressible, nontender, and nontranslucent sublingual and submental swellings [Figure 1a and b]. Ultrasound examination of the sublingual swelling showed cystic swelling with uniform low-level echogenicity, internal particulate content with no internal vascularity on the color Doppler study [Figure 1d]. The submental lesion revealed particulate internal content with multiple floating echogenic lobules (like stalk of marble) inside the cystic swelling with no posterior acoustic shadow and no evidence of internal vascularity on color Doppler study [Figure 1c].
Hypodense cystic sublingual and submental swelling (a) which on magnetic resonance imaging images shows T1-weighted hyperintense (b), T2-weighted/short tau inversion recovery hyperintense signal (c and d), diffusion restriction in diffusion weighted image/apparent diffusion coefficient (e and f). The submental lesion shows T1-weighted/T2-weighted/short tau inversion recovery hypointense nodules within the fluid content
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F2
Noncontrast-enhanced computed tomography (CT) of the face shows hypodense cystic lesion in the sublingual and submental region [Figure 2a]. T1-weighted hyperintense, T2-weighted/short tau inversion recovery (STIR) hyperintense signal and diffusion restriction in diffusion weighted image (DWI), and apparent diffusion coefficient (ADC) sequences [Figure 2b-f]. The submental swelling shows T1-/T2-weighted hypointense discrete nodular structures within the fluid content.
Intraoperative picture of sublingual mass dissection and enucleation of epidermoid cyst (a) and excised epidermoid cysts with intact capsule on the table (b). The postoperative picture (c) shows postoperative scar underneath the tongue and disappearance of sublingual swelling
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F3
Both cystic lesions were enucleated by intraoral sublingual dissection with intact capsules, and the opening in the floor of the mouth was marsupialized [Figure 3a-c].
Microscopic examination of the lesions showing stratified squamous epithelial lining with accumulated keratin and underlying fibrous tissue with small blood vessels in low and high magnification (a and b)
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F4
The cystic lesions were pearly white and revealed epidermoid cyst on histopathological examination [Figure 4a and b].