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Case Report
Epidermoid cyst arising in the mandibular ramus: A case report
1 Department of Dentistry and Oral Surgery, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan
2 Department of Dentistry and Oral Surgery, Keio University School of Medicine, Tokyo, Japan
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Seiji Asoda
DDS, PhD, Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-0016,
Japan
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Article ID: 101271Z01FH2021
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Homma F, Karube T, Usuda S, Endo T, Asoda S, Kizu H. Epidermoid cyst arising in the mandibular ramus: A case report. Int J Case Rep Images 2021;12:101271Z01FH2021.ABSTRACT
Introduction: Dermoid and epidermoid cysts are developmental lesions derived from the ectoderm. In acquired elements, trauma and inflammation are hypothesized mechanisms of onset. In the oral region, these cysts mainly develop in the soft tissues such as floor of the mouth, moreover, it is relatively rare in the mandible. Among them, it is extremely rare in the ramus.
Case Report: A 48-year-old woman visited dental clinic because of occlusal pain of the left wisdom tooth. The panoramic X-ray film showed an oval-shaped radiolucent area in the left mandibular ramus. Computed tomography revealed radiolucent area in the left mandibular ramus, moreover, there was no bone destruction. Magnetic resonance imaging revealed a lesion measuring 18×17×21 mm in size with mixed moderate and high signal intensity on fat-suppressed T2-weighted imaging in the left mandibular ramus. Gadolinium contrast-enhanced T1-weighted imaging showed no clear enhancement. On the basis of imaging findings, cystic lesion was diagnosed. We performed cystectomy and extraction of the lower wisdom teeth under general anesthesia. Histopathologic examination of the resected specimen revealed the unilocular cyst lined keratinized squamous epithelium. There were no adnexal skin structures such as sweat grand, sebaceous glands, and hair follicles. In addition, the lesions were not associated with teeth and were found only in the mandibular ramus. From these results, it was finally diagnosed as the epidermoid cyst. Three years and six months have passed, but there is no recurrence and a radiolucent area in the panoramic X-ray film shows increased radiopaque. Computed tomography revealed that the defect of the bone is reduced. The postoperative course was uneventful.
Conclusion: There is a large amount of literature on jaw diseases; however, we may still come across unique and unclear cases. Clinical examinations, conventional radiography, and surgical experience are not sufficient for the diagnosis of all pathologies. Our case is very rare and is a unique case in the relevant literature because the lesion was limited to the mandibular ramus above the mandibular foramen and was not associated with teeth.
Keywords: Epidermoid cyst, Mandibular ramus
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Author Contributions
Fuka Homma - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Takeshi Karube - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Shin Usuda - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tomoki Endo - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Seiji Asoda - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hideki Kizu - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Fuka Homma et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
