SOFT TISSUE CYSTS

GHADA YAACOUB 202001340

[Date] [Course title]

 CYSTS OF THE ORAL CAVITY

A cyst is a pathologic cavity, this cavity is either lined wholly or partly by epithelium, and its
content is either fluid or semi-fluid that is not created by puss, otherwise it would be an abscess.

Classifiaction

Odontogenic
Non-
Pseudocysts
Soft tissue
odontogenic cysts

Developmental Inflammatory

Soft tissue cysts are cysts that occur in soft tissues of gingiva or lips, and have no radiographic
image, where all other cysts appear as dark areas of radiolucency in the bone resembling bone
resorption. Types of soft tissue cysts:
1. Lymphoepithelial cyst
2. Thyroglossal cyst
3. Dermoid cyst
4. Mucocele:
a. Mucous retention cyst
b. Mucous extravasation cyst
c. Ranula
 1- Branchial lymphoepithelial cyst (cervical or intraoral):

It is a very rare congenital cyst.

Current theory of its etiology: is that due to entrapment of epithelium within the cervical lymph
nodes during embryogenesis, and this is then followed by cystic degeneration ( formation of
cavity). They arise from incomplete involution of the branchial clefts.

Clinical features:
o Occurs mostly in the late childhood or adulthood.
o Site is either:
lateral aspect of the neck anterior to the sternomastoid muscle
or intraoral predominantly in the floor of the mouth, ventral and posterior lateral
tongue or palatine tonsils.
o Appear as soft, fluctuant yellowish mass.
o It causes pain if secondary infection occurs causing an abscess and drains along the
anterior margin of sternomastoid muscle.

Types of branchial cysts:

• First branchial cyst: it represents 5 to 25% of the branchial
cysts, this cyst is located between the ear and the
submandibular area. So, an otologic examination is
essential in these patients.
 This cyst might affect the ear, parotid gland, and the facial
nerve.
• Second branchial cyst: this cyst is the most common
branchial cyst and contributes to 40 to 95% of the branchial
cysts. These cysts are seen under the skin of the neck
muscles, and the discovery of these cysts occur mostly
when the patient develops an upper respiratory tract
infection, since upon infection they might compromise the
airway.
This cyst might approximate the glossopharyngeal and the
hypoglossal nerve.
• Third and fourth branchial cysts: rarest branchial cysts,
occur on the bottom left side of the neck.
As such the thyroid gland might be affected.

Diagnosis:
A typical physical examination is enough to diagnose this cyst. Clinically, this cyst is smooth,
round, fluctuant and not-tender at the lateral aspect of the neck, and the patient is presented with
no pain when there is no secondary infection.
No specific laboratory test is required for identification of this cyst. However, some imaging can
be helpful:
- Contrast- enhanced CT scan will show a cystic mass.
 - The cyst can be characterized by an ultrasonography.
- To obtain a better resolution, an MRI can be taken.

- In case of a secondary infection, a sinus tract is present, in this case a

radiopaque dye can be injected to determine the size and course of the
cyst.
- In case of confusion between a malignant neoplasm and a branchial cleft
cyst, fine needle aspiration can be made to determine the contents of the
mass.
Differential Diagnosis:
- Epidermoid cyst
- Thyroglossal duct cyst
- Lymphatic malformation
- lipoma

Treatment:
Complete Surgical excision under general anesthesia is the treatment of choice for this cyst.
 2- Thyroglossal Tract Cyst:

This cyst is a common developmental cyst of the neck.

Etiology: it arises from the residues of the embryonic
thyroglossal duct anywhere from the foramen cecum area
of the tongue to the location of the thyroid gland midline
of the neck
- It can occur at any age but 50% of
these cysts occur before 20 years
old.
Site: it can occur in two locations:
a. At the midline of the
neck in the region of
the hyoid bone
b. When the cyst arises at a position high in the thyroglossal
duct, it arises then in the tongue substance at the posterior
portion.

Diagnosis:
This cyst is asymptomatic but can result in:
- Dysphagia
- An essential clinical manifestation is
that this cyst moves with the
movement of the tongue and might
retract upon swallowing.

- Blood tests to assess the thyroid

function.
 - Fine needle aspiration can be made.

- Ultrasound is the ideal choice.

- CT scan and MRI.

Differential Diagnosis:
1- Cystic metastatic lymph nodes
2- Dermoid or epidermoid cyst
3- Second branchial cleft cyst
The close relation of the thyroglossal duct cyst is a key feature in identifying this cyst

Treatment:
Complete surgical excision is done
by Sistrunk procedure under general
anesthesia, but before excision of
the lingual thyroid mass it is
important to make sure that the
patient has a functioning thyroid
tissue in the neck.

3- Dermoid Cyst:
This cyst is uncommon and can occur at a variety of sites ranging between the hyoid bone and the
mandible. It is a developmental cyst where 15% of the reported case were congenital and occurs mostly in
children and young adults.

Etiology:
During embryogenesis, there occurs incomplete fusion of the mandibular
and hyoid branchial arches, that result in the entrapment of epithelial cells
at the midline.
Site:
It occurs as a midline swelling, and its position depends on whether it occurs above or below mylohyoid
muscle.
1- Intraoral: when it occurs above the mylohyoid muscle. It causes
displacement of the tongue superiorly and posteriorly, and as it
increases in size in interferes with speech and eating.

2- Submental: when it occurs below the mylohyoid muscle, it gives

a double-chin appearance

Diagnosis:
This cyst is painless, and slowly growing appearing as yellowish-pink
The contents of this cyst are sebum and keratin, as such the mass is soft and doughy.
- An MRI can be helpful to confirm the location of the
cyst.
- CT scan can determine the nature of the cyst
contents. A dermoid cyst appears on the Ct having
intracystic floating corpuscles giving the sack of
marbles feature.

Treatment:
Complete surgical excision is the treatment of choice.
 3- Salivary Gland Cyst (Mucocele):

Mucocele is a term that includes both mucous extravasation cyst and mucous retention cyst.

mucous mucous retention

extravasation
cyst

a- Mucous extravasation cyst:

It is the most common cyst of the minor salivary glands.
Occurs due to trauma to the minor salivary gland duct that causes the
mucous to escape into the surrounding connective tissue. The mucous
then induces an inflammatory reaction and a granulation tissue forms a
wall around the mucin pool.
Occur most commonly in the lower lip, buccal mucosa, floor of the
mouth and ventral surface of the tongue. Occurs predominantly around the
2nd decade of age.
Diagnosis:
1- It is painless and ranges from few mm to 2cm in size.
2- Appears as a bluish submucosal swelling.
3- Has a history of rupture and refilling.
Histopathology of the mucocele helps determine its type, mucous
extravasation cyst shows:
1- It’s a pseudocyst not lined by true epithelium.
2- Inflammatory cells and granulation tissue is seen.
Differential diagnosis:
Although bluish translucency of the lower lip is characteristics of
mucous retention cyst other lesions might be considered when a
typical history is absent

• Mucoepidermoid carcinoma
• Vascular malformation
• Soft tissue neoplasm
 b- Mucous retention cyst:
It is caused due to obstruction of the duct by sialolith, as such mucin doesn’t escape that causes cystic
dilation of the duct, so this cyst is lined by true epithelium.
Occurs predominantly at the floor of the mouth and almost never found at the lower lip.

Diagnosis:
• It is asymptomatic and ranges from 3 to 10mm in size.
• Is seen mobile and not tender.
• Has a normal color overlying the mucosa.
Histopathological appearance:

• It appears lined by ductal epithelium as a double layer of columnar or cuboidal epithelium.

• Mucin is inside the cavity.
• Surrounding connective tissue shows no inflammation.
Treatment:
Mucoceles that are generally small don’t require surgical
intervention, they usually resolve on their own, if they become
larger in size and interfere with speech and mastication, then
surgical excision in performed.

c- Ranula:
It is the mucocele that occurs at the floor of the mouth.
The swelling has a frog’s belly appearance.
It arises from the submandibular or sublingual salivary glands.
Has soft bluish and fluctuant appearance.
Painless but might interfere with mastication.
Differential diagnosis:
1. Salivary glands tumors.
2. Dermoid cyst is doughy in consistency & more towards the
midline.
3. Mesenchymal tumors

Treatment:
Complete surgical removal
References:
Coste AH, Lofgren DH, Shermetaro C. Branchial Cleft Cyst. [Updated 2022 Sep 12]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK499914/
Hayashida, A.M. et al. (2010) Mucus extravasation and retention phenomena: A 24-year study, BMC oral
health. U.S. National Library of Medicine. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894742/
Menditti, D. et al. (2018) Cysts and pseudocysts of the oral cavity: Revision of the literature and a new
proposed classification, In vivo (Athens, Greece). U.S. National Library of Medicine. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/
East J Med 26(1): 47-52, 2021 CT and MRI findings of ... - journalagent (no date). Available at:
https://jag.journalagent.com/ejm/pdfs/EJM_26_1_47_52.pdf
Amos J, Shermetaro C. Thyroglossal Duct Cyst. [Updated 2022 Aug 19]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK519057/

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