Although presenting with dysarthia and dysphagia the patient was clinically well with no local or systemic signs or symptoms of infection or signs of upper airway obstruction. Clinical examination revealed a soft but oedematous floor of mouth bilaterally with superior displacement of the tongue and a large soft submental swelling. A flexible nasendoscope revealed a patent airway despite displacement of the tongue.
An attempt to aspirate the swelling through the floor of mouth yielded only a small amount of sebaceous like material. A subsequent CT Neck and MRI revealed a 5x5x6cm unilocular low density cystic mass occurring in the sublingual space between the two genioglossus muscles with the possibility of a dermoid cyst.
Consideration for an intraoral, external or combined surgical approach was made, and the patient subsequently proceeded to an external approach given the large submental component whereby an intact cyst was resected. Histopathology revealed an epithelial lined cyst with sebaceous glands and hair follicular structures consistent with a dermoid cyst. The patient subsequently made a full recovery.