Case report
A 56-year-old man in a good heath was referred to the Oral Medecine and
Oral Surgery department at the university clinic of dental medecine,
Monastir, Tunisia, with the chief complaint of a painless swelling in
the left buccal mucosa for about 5 years. The patient had neither known
drug allergies, or history of surgery and/or trauma related to the
lesion area.
Extraoral examination revealed the presence of a solitary swelling in
the left cheek covered by normal looking skin in color and texture, as
well. The swelling was nontender and freely mobile to the skin, on
palpation (figure 1). No submental nor submandibular lymphadenopathy
were detected.
Intraoral examination showed a poor oral hygien and a nodule in the left
buccal mucosa covered by a healthy mucosa (figure 2). The mass was soft
and non mobile on palpation.
Due to these clinical findings, the initial diagnosis was benign tumor
of either the oral mucosa (including vascular lesions) or the salivary
gland.
An ultrasonography was required. It revealed a well defined walled
hyperechoic heterogenous lesion measuring 34×31×21 mm with posterior
ultrasound reinforcement in the left buccal mucosa (figure 3). Vascular
lesions were excluded on Colour Doppler analysis. At this stage, the
diagnosis of epidermoid cyst of the left buccal mucosa was evoked.
Under local anesthesia and with intraoral access, the lesion was
completely removed.
An horizontal incision in the buccal mucosa was conducted exposing a
cyst immediately underlying the mucosa.
The enucleation was carefully done. Accidentally, when a partial rupture
of the wall was happened, a yellow liquid was observed (figure 4).
The surgical wound was closed using a 4.0 silk suture, and the specimen
was stored in 10% formol for further anatomopathological study (figure
5).
The postoperative period was uneventful and healing was good.
Histopathological examination of the surgical specimen revealed a cystic
cavity. The cyst wall is composed of keratinized stratified squamous
epithelium with keratin debris and no skin appendages (figure 6). This
wall contains a foreign-body giant-cell reaction (figure 7).
These finding were suggestive of epidermoid cyst of the buccal mucosa.