Two sequential surgeries in infant with multiple floor of the mouth dermoid cysts: A case report

Figure 1 Status of infant prior to first surgery. A: Large-sized cystic mass protruding from mouth (white arrow: raised tongue in retracted position; orange arrow: cystic mass); B: Magnetic resonance imaging in axial plane showing large (orange arrow) and small suspect (white arrow) lesions; C: View in coronal plane of well-circumscribed cystic lesion (4.0 cm × 3.8 cm × 3.9 cm) with high signal; D: View in sagittal plane of large (orange arrow) and tiny suspect (white arrow) lesions.

Figure 2 Infant during first surgery. A: Contracted lesion and lowered tongue after clear fluid (10 mL) aspirated, enabling oral intubation (white arrow at shrunken mass); B: Clear fluid withdrawn; C: Horizontal incision made; D: Careful blunt dissection of cyst from surrounding tissues; E: Resected cyst, roughly 2.0 cm × 2.0 cm with wall intact; F: Histologic section of cyst wall [note keratinizing stratified squamous epithelial lining (white arrows) and sebaceous glands (orange arrows)].

Figure 3 Infant after first surgery (day 3). A: Slight edema at the floor of the mouth incision; B: Postoperative magnetic resonance imaging showing two cystic lesions (orange arrows) under tongue (0.8 cm × 1.0 cm × 0.5 cm and 1.2 cm × 0.5 cm × 0.5 cm); C and D: View of each lesion in coronal plane (orange arrow); E: Both lesions in sagittal plane (orange arrows).

Figure 4 Infant during second surgery. A: Second preoperative magnetic resonance imaging of large mass (orange arrow, 2.0 cm × 1.5 cm) midline floor of the mouth with high signal intensity and tiny suspect lesion (white arrow); B: Magnetic resonance imaging (sagittal plane) showing large high-signal (wide arrow) and tiny suspect (narrow arrow) lesions; C: Magnetic resonance imaging (coronal plane) of one lesion only; D: Completely encapsulated mass; E: Fully excised lesion (2.0 cm × 1.0 cm); F: Cross section with keratin content.