An Adolescent with Recurrent Sublingual Cysts

John Chin, MD, MBChB
Volume 55 - Issue 7 - July 2015

A 19-year-old African-American male with a history of frenectomy and recurrent sublingual cysts presented to the emergency department for sublingual swelling. He underwent aspiration of a sublingual cystic mass by otolaryngology 2 weeks prior. The swelling was causing mild pain and making it difficult for him to move his tongue. He denied dyspnea, difficulty lying flat, hoarseness, and dysphagia.  

 

Physical examination. The tongue showed sublingual fluctuance, but was otherwise normal. 

Laboratory tests. Otolaryngology aspirated 30 mL of turbid fluid without marsupulization; subsequent culture was negative for speciation. Previous cytology was negative for malignancy.

The patient was diagnosed with sublingual mucocele. 

Differential diagnosis. This includes true cysts (epidermoid and dermoid cysts) and pseudocysts (mucoceles and ranulas). The difference between the 2 categories is that true cysts have a wall composed of keratinized, stratified squamous epithelium and pseudocysts do not.1 Mucoceles are the most common lesions of the minor salivary glands and typically appear as a fluctuant, bluish, nontender, submucosal swelling with a normal overlying mucosa. The glands of Blandin-Nuhn can be damaged during frenectomy and allow the extravasation of mucus to the submucosa, thus causing a mucocele.2 

Treatment. In the emergency room, addressing possible airway occlusion is paramount prior to any further evaluation. Treatment for sublingual cysts generally consists of surgical excision. Given the patient’s surgical history, the cyst most likely represents a mucocele; however, histology after surgical excision is necessary to confirm this diagnosis. 

Outcome of the case. The patient was scheduled for excision by otolaryngology at a later date.  

REFERENCES:

  1. Mueller DT, Callanan VP. Congenital malformations of the oral cavity. Otolaryng Clin N Am. 2007;40(1):141-160.
  2. Santos Tde S, Filho PR, Piva MR, Khalil Karam F. Mucocele of the glands of Blandin-Nuhn after lingual frenectomy. J Craniofac Surg. 2012;23(6):e657–e658.