A case of giant epidermoid cyst of the submandibular region with tracheal deviation

Abstract

We report the case of a giant epidermoid cyst of the submandibular region with tracheal deviation.
The patient was a 24-year-old man with an asymmetric face caused by enlargement of the left side of the neck.　Magnetic resonance imaging （MRI） showed a high-signal intensity, clear-bordered mass （greatest dimension, 210 × 160 mm） on T2-weighted images, displacing the trachea. Needle aspiration yielded a bean-curd, refuseshaped, keratinized substance and yellowish white viscous fluid. A dermoid cyst or epidermoid cyst was suspected. A cystectomy was performed via a submandibular incision under general anesthesia . Although the cyst had a thick capsule surrounded by mild adhesions, it was extirpated after aspiration and reduction of the contents of the cyst because its major axis was 230 mm, making en bloc removal difficult. The cystic wall was composed of keratinizing stratified squamous epithelium, and did not include a dermal appendage. The pathological diagnosis was an epidermoid cyst.
The postoperative course has been good, and respiratory discomfort has also improved. About 1 year postoperatively, the face is symmetric, and there has been no evidence of recurrence.