Case of epidermoid cyst in mandible a rare entity and review.
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The document presents a case report of a rare epidermoid cyst in the mandible, detailing the patient’s demographics, symptoms, diagnostic processes, and treatment plan. The 52-year-old male patient experienced swelling and pain in the lower right back teeth region, leading to the diagnosis of an inflammatory epidermoid cyst after various examinations. The recommended treatment involved surgical resection and chemical cauterization, underscoring the uniqueness of the case and the rarity of such cysts in the oral cavity.
Case of epidermoid cyst in mandible a rare entity and review.
- 1. EPIDERMOID CYST IN MANDIBLE- A RARE ENTITY: A CASE REPORT AND REVIEW DR. BHAVIK MIYANI, POST- GRADUATE PART III
- 2. CONTENTS Introduction Case report Discussion Conclusion References 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 2
- 3. INTRODUCTION
- 4. Epidermoid cysts are rare, slow-growing, benign, developmental cysts that are derived from abnormally situated ectodermal tissue. It is defined as “A simple cyst lined with stratified squamous epithelium and lumen is filled with cystic fluid or keratin and no other specialized structure.” Shafer WG, Hine MK, Levy BM. A text book of Oral Pathology. 4th ed. Philadelphia These cysts are soft tissue tumors and are rarely seen in the head & neck region(7%). Only 1.6% are located within the oral cavity. Sinan Y Ertem, Sina Uckan, Hndan Ozdemir, 2014 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 4
- 5. An epidermal cyst is derived from epidermis, and is formed by cystic enclosure of epithelium within the dermis that becomes filled with keratin and lipid-rich debris. It occurs in young to middle-age adults. Men are affected more often than women in the ratio 3:1, with mean age 28 years. Al-Khateeb et al.; Smirniotopoulos & Chiechi; Koellaer et al., 1999; Som, 1987; Park, 1995 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 5
- 6. DEMOGRAPHIC DATA NAME : Ramanbhai Parmar AGE/SEX : 52 Years/ Male OCCUPATION : Police ADDRESS : Lanva (Village) OPD No. : 47536-G 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 6
- 7. CHIEF COMPLAINT Patient complaints of swelling in lower right back teeth region since 1 month and pain in same region since 15-20 days. 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 7
- 8. HISTORY OF PRESENTING ILLNESS… Patient was relatively asymptomatic before 1 month. He gradually developed swelling in lower right back teeth region of jaw which was asymptomatic for 15 days and later on it was associated with dull aching and continuous pain. There were no aggravating factors associated with pain. But as initially pain was dull aching, then it converted to continuous and sharp shooting that make patient to come our department with above mentioned complaint. 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 8
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- 10. GENERAL EXAMINATION: Patient is conscious, co-operative & well oriented to time, place & person. Moderately Built and Nourished Pallor, Icterus, Cyanosis, Clubbing – Absent VITALS: Temperature : Afebrile Pulse : 82 b.p.m. Respiratory Rate : 14 cycles/min Blood Pressure : 132/88 mm Hg 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 10
- 11. INSPECTION: Face : Gross Facial Asymmetry with Swelling present on lower third of face on Right side TMJ : Normal but Restricted Jaw Movements Skin & Soft Tissue : A diffused, roughly oval swelling present over the right lower border of the mandible, submandibular region, anterior to ear & right cheek extending… Anteroposteriorly 1 cm away from the right corner of the mouth to the posterior border of ramus of mandible approx. measuring 6cm LOCAL EXAMINATION (EXTRA- ORAL) 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 11
- 12. …EXTRA-ORAL EXAMINATION Mouth Opening : 13 mm INSPECTION: Colour: Same as the adjacent skin. Surface : Normal. Edge: Not well defined. Skin overlying the swelling: Normal. 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 12
- 13. …EXTRA-ORAL EXAMINATION PALPATION : All inspectory findings were confirmed on palpation. Temperature : Localized rise in temperature over swelling. Consistency: Swelling was firm, tender, non-fluctuant. Fluid Thrill : Absent Translucency: Not Assessed Reducibility: Swelling was non reducible on digital Pressure. Compressibility: Non Compressible Lymphnodes :Right Submandibular lymph nodes were Non Palpable. No regional lymphadenopathy. Fixity to Overlying Skin: No Pitting : Absent 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 13
- 14. INTRA-ORAL EXAMINATION INSPECTION: TEETH PRESENT – 11-17, 21-27, 31-38, 41- 47 ALVEOLAR RIDGE – Buccolingual Expansion Of Cortical Plates Present irt 46,47 and the ascending ramus of mandible on right side. HARD PALATE – NAD 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 14
- 15. …INTRA-ORAL EXAMINATION PALPATION: GINGIVA - NAD BUCCAL MUCOSA - NAD LABIAL MUOSA - NAD SOFT PALATE - NAD VESTIBULE - A firm, non fluctuant Swelling Present on the lower right vestibule irt 46, 47 region. Tender on palpation No bleeding on provocation 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 15
- 16. …INTRA-ORAL EXAMINATION PALPATION: All inspectory findings were confirmed on palpation. Consistency: Swelling was firm, tender, non-fluctuant. Reducibility: Swelling was non reducible on digital Pressure. 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 16
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- 18. PROVISIONAL DIAGNOSIS Odontogenic keratocyst 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 18
- 19. DIFFERENTIAL DIAGNOSIS Central Giant Cell Granuloma 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 19
- 20. INVESTIGATIONS 1. OPG 2. Pre-Op Blood Profile 3. CBCT 4. Chest X-ray 5. Incisional biopsy 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 20
- 21. INVESTIGATIONS- OPG 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 21
- 22. INVESTIGATIONS 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 22
- 23. CBCT 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 23
- 25. INCISIONAL BIOPSY 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 25
- 26. FINAL DIAGNOSIS Inflammatory Epidermoid Cyst 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 26
- 27. TREATMENT PLAN 1. Resection with chemical cauterization including a margin of 0.5-1 cm healthy bone using modified ward’s incision under general anesthesia. 2. Long term follow-up. 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 27
- 28. Incision Marking Reflection and Exposure of Site Enucleation of Lesion TREATMENT GIVEN Chemical Cauterization Resected Closure 28
- 29. FIRST FOLLOW-UP OPG 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 29
- 30. SECOND FOLLOW-UP OPG 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 30
- 31. DISCUSSION 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 31
- 33. DISCUSSION DEPARTMENT OF OMFS, NPDCH, SPU 3320 June 2020
- 34. CONCLUSION The lesion enucleated by intraoral approach which is suitable and suggested technique for IECs. The aspiration biopsy and further radiological investigations like ultrasonography, computed tomography or magnetic resonance imaging should be considered for cystic lesions of the jaws. Although, we have a large literature of jaw pathologies, we may still come across unique and unclear cases. Clinical examination, conventional radiographs and surgical experience is not enough for diagnosis of all pathologies. Our case is very rare and second case in the literature because of unilateral placement and being relationship20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 34
- 35. REFERENCES 1. Thomas et al., Epidermal cyst of the mandible: a case report. The British Association of Oral Surgeons and John Wiley and Sons Ltd. Oral Surgery 2016:1-3 2. Loxha M P et al., Epidermoid Cyst of Mandible Ramus: Case Report, Med Arch. 2016 Jun; 70(3): 238-240. 3. Orcun Toptas et al., Intra Osseous Epidermoid Cyst Associated with Impacted Mandibular Wisdom Teeth: An Uncommon Entity. Journal of Clinical and Diagnostic Research. 2014 Jul, Vol-8(7): ZD31-ZD32. 4. Ertem et al. An unusual presentation of an intraosseous epidermoid cyst of the anterior maxilla: a case report Journal of Medical Case Reports 2014, 8:262. 5. Alimoğlu et al Mandibular Ramus Epidermal Inclusion Cyst. The Journal of Craniofacial Surgery & Volume 21, Number 5, September 2010. 6. Sunil et al. Epidermoid cysts of head and neck region – case series and review of literature. Int J Odontostomat 2014; 8:165–9. 7. Ohn BH, Koh SW, Park SJ, Chee YD, Epidermoid Cyst of the Mandible: Case Report, J Korean Assoc Maxillofac Plast Reconstr Surg. 2011; 33: 535-9 8. Janarthanam J, Mahadevan S. Epidermoid cyst of submandibular region, Oral Maxillofac Pathol. 2012 Sep-Dec; 16(3): 435-7., doi: 10.4103/0973-029X.102511 9. Jayade BV, Upadya VH, Goplakrishnan K, Shirganvi MS. Epidermal inclusion cyst of the mandible after extraction of a third molar: case report. Br J Oral Maxillofac Surg 2012; 50:e72–4. 10. Debaize S, Gebhart M, Fourrez T, Rahier I, Baillon JM. Squamous cell carcinoma arising in a giant epidermal cyst: a case report. Acta Chir Belg 2002; 102:196–8. 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 35
- 36. 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 36 THANK YOU