A 2-week-old child had a slow-growing cystic cervical mass. The lesion had been diagnosed by ultrasound before the child was born.

Lymphangiomatous malformations occur in the cervical region as cystic masses (cystic hygroma). The vast majority are diagnosed in the first 2 years of life.

Lymphangiomatous malformations are rare congenital tumors that primarily affect the lymphovascular system, particularly in the head and neck region [1]. These malformations can manifest as lymphangiomatous polypoid lesions, which have histological differences compared to typical lymphatic malformations [1][6]. Lymphangiomatous polyps of the palatine tonsils are particularly rare, with less than 30 reported cases in the literature [2].

When diagnosing lymphangiomatous malformations, it is essential to consider the differential diagnosis. Some conditions that may need to be distinguished from lymphangiomatous malformations include lymphangiectasia, hemangioma, arteriovenous malformation, juvenile nasopharyngeal angiofibroma, fibroepithelial polyps, and papilloma [2]. In rare cases, lymphangiomatous malformations may also present as retroperitoneal cystic lesions or vesicular oral lesions [3][5]. These malformations should be differentiated from retroperitoneal cystic lymphangiomatous malformations, retroperitoneal abscesses, ovarian neoplasms, cystic or necrotic solid tumors, and seminal vesicle cysts [3]. In some cases, lymphangiomatous malformations may be misdiagnosed as other conditions, such as benign cystic mesothelioma [7].

Lymphangiomatous malformations can present with various symptoms depending on the location and size of the lesion. For instance, lymphangiomatous polyps of the tonsils may present with sore throat and dysphagia [10]. Lymphangiomatous macroglossia, on the other hand, is characterized by the chronic enlargement of the tongue and does not spontaneously regress [8]. In terms of management, the treatment options for lymphangiomatous malformations depend on factors such as the location, size, and symptoms of the lesion. Bipolar radiofrequency-induced interstitial thermoablation has been found to be effective for the treatment of oral cavity vascular malformations, including lymphangiomatous lesions [9].

In conclusion, lymphangiomatous malformations are rare, benign tumors that primarily affect the lymphovascular system in the head and neck region. They can manifest as lymphangiomatous polypoid lesions or macroglossia and may present with various symptoms. Diagnosing these malformations can be challenging due to the differential diagnosis with other conditions. The management of lymphangiomatous malformations depends on factors such as the location and symptoms of the lesion. Further research is needed to better understand the pathogenesis and optimal treatment strategies for these rare tumors.

REFERENCES

[1] Park, E., Pransky, S., Malicki, D., Hong, P. (2011). Unilateral Lymphangiomatous Polyp Of the Palatine Tonsil In A Very Young Child: A Clinicopathologic Case Report. Case Reports in Pediatrics, (2011), 1-3. https://doi.org/10.1155/2011/451542

[2] Chen, H., Lovell, M., Chan, K. (2010). Bilateral Lymphangiomatous Polyps Of the Palatine Tonsils. International Journal of Pediatric Otorhinolaryngology, 1(74), 87-88. https://doi.org/10.1016/j.ijporl.2009.08.017

[3] Khan, R., Wahab, S., Chana, R., Fareed, R. (2010). Isolated Retroperitoneal Hydatid Cyst In a Child: A Rare Cause Of Acute Scrotal Swelling?. Journal of Pediatric Surgery, 8(45), 1717-1719. https://doi.org/10.1016/j.jpedsurg.2010.04.019

[4] Andac, S. (2022). Silhouette Lymphangioma: An Unknown Macular Form Of Cutaneous Lymphangioma. Arch Iran Med, 7(25), 456-459. https://doi.org/10.34172/aim.2022.75

[5] (2021). Newborn With Vesicular Oral Lesions. J Paediatr Child Health, 5(57), 759-759. https://doi.org/10.1111/jpc.2_15225

[6] Günbey, E., Gunbey, H., Dölek, Y., Karabulut, Y. (2014). A Rare Cause Of Dysphagia In Children. Journal of Craniofacial Surgery, 4(25), e346-e348. https://doi.org/10.1097/scs.0000000000000773

[7] Shakya, V., Agrawal, C., Karki, S., Sah, P., Poudel, P., Adhikary, S. (2011). Benign Cystic Mesothelioma Of the Peritoneum In A Child—case Report And Review Of The Literature. Journal of Pediatric Surgery, 4(46), e23-e26. https://doi.org/10.1016/j.jpedsurg.2011.01.004

[8] Kim, J., Kwon, H., Rhie, J. (2019). Reduction Glossectomy Of Congenital Macroglossia Due To Lymphangioma. Arch Craniofac Surg, 5(20), 314-318. https://doi.org/10.7181/acfs.2019.00220

[9] Civelek, S., Sayin, I., Ercan, I., Çakir, B., Turgut, S. (2012). Bipolar Radiofrequency-induced Interstitial Thermoablation For Oral Cavity Vascular Malformations: Preliminary Results In a Series Of 5 Children. Ear, Nose & Throat Journal, 11(91), 488-492. https://doi.org/10.1177/014556131209101111

[10] Bhat, S., Patla, S., Rent, N., Shetty, K. (2015). Lymphangiomatous Polyp Of the Tonsil: An Unusual Cause Of Snoring. Otorhinolaryngology Clinics – An International Journal, 2(7), 88-90. https://doi.org/10.5005/jp-journals-10003-1198

A 25-year-old man presented with an anterior midline cystic swelling in the neck. When he protruded his tongue the cyst elevated.

Thyroglossal tract cysts develop at any point from the foramen caecum to the thyroid along the line of the vestigal thyroglossal duct. Most occur below the level of the hyoid bone and in people under 30 years.

Thyroglossal tract cysts are abnormal fluid-filled sacs that develop along the path of a structure called the thyroglossal duct. To understand this, let’s break it down step by step.

1. Thyroglossal tract: During the early stages of fetal development, the thyroid gland (a butterfly-shaped gland located in the neck) forms at the base of the tongue in an area called the foramen caecum. As the fetus grows, the thyroid gland descends down the neck to its final position in front of the trachea (windpipe). The path it takes while descending is called the thyroglossal tract.
2. Vestigial thyroglossal duct: The thyroglossal tract is initially a duct-like structure that connects the thyroid gland to the base of the tongue. However, as the thyroid gland descends, the duct usually disappears, leaving only a remnant called the vestigial thyroglossal duct.
3. Development of cysts: In some cases, the vestigial thyroglossal duct may not completely disappear, and remnants of it can persist. These remnants can potentially develop into cysts. Thyroglossal tract cysts usually form anywhere along the path of the vestigial thyroglossal duct, from the foramen caecum (at the base of the tongue) to the final location of the thyroid gland in front of the trachea.
4. Location and age group: Most thyroglossal tract cysts occur below the level of the hyoid bone, which is a small U-shaped bone in the neck. They are commonly found in people who are under 30 years old. However, it’s important to note that thyroglossal tract cysts can occur at any age, including in adults.

In summary, thyroglossal tract cysts are fluid-filled sacs that develop along the vestigial thyroglossal duct, a remnant of the developmental path of the thyroid gland. They can occur anywhere from the base of the tongue to the final location of the thyroid gland. Most of these cysts are found below the level of the hyoid bone and are typically observed in individuals under 30 years of age.

A 44-year-old woman presented with a swelling in the midline floor of the mouth that elevated the floor of mouth and tongue. The mucosa over the cyst was yellowish in colour.

Dermoid cysts are cystic lesions that develop from abnormal inclusion of skin tissue during embryonic development. These cysts can occur along the midline of the body, including in the oral region. In the oral cavity, they can be found either above or below the mylohyoid muscle.

When a dermoid cyst is located above the mylohyoid muscle, it causes a bulge into the floor of the mouth. On the other hand, if it is located below the mylohyoid muscle, it expands into the submental soft tissue. The mylohyoid muscle is a muscle located in the floor of the mouth that separates the oral cavity from the submental region below the chin.

Histological examination refers to the microscopic analysis of the cyst’s tissue. When a dermoid cyst is examined under a microscope, the lining of the cyst resembles epidermis, which is the outermost layer of the skin. This means that the tissue inside the cyst looks similar to the surface of the skin.

Additionally, adnexal structures are often found within dermoid cysts. These structures include hair follicles, sebaceous glands (oil glands), and smooth muscle. Hair follicles are responsible for hair growth, while sebaceous glands produce oil to moisturize the skin and hair. Smooth muscle is a type of muscle tissue that is not under voluntary control and is typically found in the walls of organs.

The presence of these adnexal structures within the lining of the cyst helps to confirm the diagnosis of a dermoid cyst. The combination of the epidermis-like lining and the presence of hair follicles, sebaceous glands, and smooth muscle is characteristic of dermoid cysts.

It’s important for dental students to be aware of dermoid cysts because they can present in the oral region and may require surgical intervention for removal. Proper diagnosis and treatment planning are crucial to ensure optimal patient care.

A radiolucent lesion was found incidentally on a dental panoramic radiograph in a 30-year-old man. The cyst was located in the mandible below the inferior alveolar canal. It was roughly oval in outline.

A Stafne cavity is a developmental depression or concavity that occurs in the border of the mandible, which is the lower jaw. It is important to note that Stafne cavities are not true cysts but can sometimes be mistaken for cysts on imaging studies like dental X-rays.

Stafne cavities are typically found in the posterior region of the mandible, near the angle of the jaw. They are more commonly seen in adult males and are considered to be a normal anatomical variation rather than a pathological condition.

These cavities are usually asymptomatic, which means they don’t cause any symptoms or problems for the patient. They are often discovered accidentally during routine dental X-rays or radiographic examinations.

The appearance of a Stafne cavity on an X-ray can resemble that of a cyst, but there are some differences. Unlike cysts, Stafne cavities do not cause expansion or erosion of the surrounding bone. They usually have a well-defined and smooth appearance. It’s also important to note that Stafne cavities are typically found on one side of the mandible and are usually symmetrical.

In most cases, treatment is not necessary for Stafne cavities because they are harmless and don’t cause any issues. However, if there is uncertainty about the diagnosis or if the lesion shows unusual features, further evaluation may be recommended. This can include additional imaging studies like a CT scan or even a biopsy to rule out any other potential pathological conditions.

It’s essential for dental professionals to be aware of Stafne cavities and their characteristic appearance on X-rays. This knowledge helps prevent confusion with other conditions and ensures appropriate management for the patient.

A well-circumscribed radiolucent lesion with a corticated outline was found on a radiograph related to the root of an upper lateral incisor. The tooth was not restored but was slightly discoloured.

A radicular cyst, also known as a periapical, apical, or dental cyst, is a type of cyst that develops around the root of a tooth. It is typically caused by chronic inflammation in the area, which is usually due to an infection or irritation of the dental pulp.

The development of a radicular cyst is influenced by osmotic pressure. Osmotic pressure refers to the movement of fluid from an area of lower solute concentration (inside the cyst) to an area of higher solute concentration (outside the cyst). This movement of fluid leads to the growth of the cyst, causing it to expand over time. As a result, radicular cysts are often rounded in shape and have a well-defined border or margin.

One of the common signs of a radicular cyst is tooth discoloration. The affected tooth may appear darker or grayer than the surrounding teeth. This discoloration is an indication that the tooth has lost its vitality or blood supply, which can occur when the cyst puts pressure on the nerves and blood vessels in the tooth’s pulp.

The development of a radicular cyst is usually triggered by periapical inflammation. Periapical inflammation refers to inflammation that occurs in the tissues around the apex (tip) of a tooth’s root. This inflammation can result from untreated dental caries (cavities), tooth fractures, or other factors that allow bacteria to enter the pulp and cause an infection.

It’s important to note that while radicular cysts can occur around any tooth, they are most commonly found in relation to the upper lateral incisor teeth. The exact reasons for this predilection are not entirely understood, but it may be due to the unique anatomy and susceptibility of these teeth to inflammation and infection.

Treatment of a radicular cyst typically involves removing the cyst surgically and addressing the underlying cause, such as root canal treatment or tooth extraction if necessary. It’s important for dental professionals to diagnose and manage radicular cysts promptly to prevent complications and maintain oral health.

I hope this explanation helps clarify the concept of a radicular cyst for you. If you have any further questions, feel free to ask!