Management of congenital lingual dermoid cysts

Lingual dermoid cysts are squamous epithelial-lined cavities with variable numbers of skin adnexae in the capsule and are rare entities in the head and neck. We discuss the presentation, possible aetiologies and the surgical management of these lesions and report on the ninth lingual dermoid cyst as an illustrative example, the first to be excised by laser. An extensive literature search was undertaken. We present the case of a 4-month-old di-zygotic twin girl with a firm midline anterior tongue dermoid cyst. Its extent was defined by magnetic resonance imaging. The cyst was excised using the CO2 laser via an extended median sagittal glossotomy approach. Lingual dermoid cysts most commonly present in early childhood or adolescence and are located in the anterior two thirds of the tongue. Eight lingual dermoid cysts have been reported, all of which were surgically excised, using varying techniques, and no recurrences have been reported. Our patient recovered well and was extubated immediately post-operatively. However, feeding was delayed for 48 h post-operatively due to pain, requiring opiate analgesia. The tongue healed completely with only a small indent in the tip. Treatment of these lesions consists of complete surgical excision. We propose that the midline sagittal glossotomy incision using the CO2 laser offers surgical precision, superior haemostasis and wound healing and minimal post-operative oedema. The involvement of the sensitive tongue tip in this approach may be its one drawback, however this may be compensated for with appropriate post-operative analgesia.