MANAGEMENT AND FOLLOW-UP OF EXTENSIVE TERATOID CYST IN MOUTH FLOOR

INTRODUCTION

Dysontogenetic cysts, commonly referred as dermoid cysts or teratoid cysts, are hamartomas which may contain various derivatives of endoderm, mesoderm and ectoderm⁷. The majority of cases is reported in the midline of the body and especially in testes and ovaries. The most common site in the head and neck region is the lateral eyebrow, the so-called angular dermoid, and approximately 6.5% of the cases occur in the oral cavity. The teratoid cyst of the floor of the mouth is distinctly uncommon, with only a few cases reported, usually in the anterior portion^8,14.

Three theories with regard to the origin of cysts in the floor of the mouth were found in literature. According to the 1^st and most prevalent theory, these cysts originate from embryonic cells of the 1^st and 2^nd branchial arches during the 3^rd/4^th week of embryonic life. The 2^nd theory explains the pathogenic mechanism of the acquired form, which may be due to the implantation of epithelial cells subsequent to accidental or surgical injury (traumatic causes, iatrogenic antecedents, or an occlusion of a sebaceous gland duct). Lastly, the 3^rd theory maintains that these cysts are considered a variation of the cyst of the thyroglossal pore⁶. With regard to the etiology of dermoid and teratoid cysts in this site, there is much theory, but the most accepted is a possible sequestration of ectodermal tissue in the midline at the time of fusion of the first (mandibular) and second (hyoid) brachial arches^2,10.

Histologically, the dermoid cyst differs from epidermoid cyst only in the presence of normal or dysmorphic adnexal appendages within its walls, usually sebaceous glands or abortive hair follicles. The teratoid cyst is considered if the cyst wall contains other elements, such as muscle or bone¹¹. Surgical approaches for excision have been the treatment of choice for dermoid or teratoid cyst, including intraoral and extraoral skin incisions¹². Most of the authors recommend conservative surgical removal, trying not to rupture the cyst, as the luminal contents may act as irritants to fibrovascular tissues, producing postoperative inflammation. Recurrence and malignant transformation of oral cysts are unlikely after treatment^8,9.

This paper presents a case of teratoid cyst in a child with emphasis on the management and follow-up of six months.