Not every sublingual swelling is Ranula, a case report

Sublingual epidermoid cysts, rare benign lesions of ectodermal origin, are typically located beneath the tongue or in the floor of the mouth. Although typically asymptomatic, these cysts can grow and lead to discomfort, dysphagia, or complications such as obstructive sleep apnea (OSA). Since sublingual swellings might resemble other disorders, like Plunging ranulas, an accurate diagnosis and prompt treatment are crucial.

We describe a 22-year-old man with a persistent sublingual enlargement. It was associated with dysphagia, speech and chewing difficulties, and OSA episodes. The tongue was displaced upward and backward by a glossy, dark pink cyst that was discovered during physical examination. MRI confirmed a well-defined midline cystic mass above the mylohyoid muscle, measuring 5 × 3.5 cm, with no evidence of erosion or extension. The lesion was excised via a transoral approach. Histopathological examination verified the presence of a keratinized sublingual epidermoid cyst.

Less than 0.01 % of all oral cysts are epidermoid cysts, making them incredibly uncommon. They might be acquired as a result of trauma or obstruction of the sebaceous glands, or congenital as a result of ectodermal components trapped during development. Differential diagnosis for sublingual swellings includes ranula, lymphatic malformation, dermoid cyst, and other lesions. When it comes to defining cystic tumors and directing treatment, MRI is a vital tool. Surgical excision remains the definitive treatment, with intraoral approaches favored for accessible, smaller cysts like in this case.

The necessity of taking sublingual epidermoid cysts into account while making a differential diagnosis of sublingual swellings is highlighted by this specific case. This report highlights the clinical and diagnostic challenges of managing such rare lesions.