Dr Bhavik Miyani, Resident Doctor in Department of Oral & Maxillofacial Surgery, Narsinhbhai Patel Dental College & Hospital, SPU, Visnagar.

1. EPIDERMOID CYST IN MANDIBLE- A
RARE ENTITY:
A CASE REPORT AND REVIEW
DR. BHAVIK MIYANI,
POST- GRADUATE
PART III

2. CONTENTS
 Introduction
 Case report
 Discussion
 Conclusion
 References
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3. INTRODUCTION

4. Epidermoid cysts are rare, slow-growing, benign,
developmental cysts that are derived from abnormally
situated ectodermal tissue. It is defined as “A simple cyst
lined with stratified squamous epithelium and lumen is
filled with cystic fluid or keratin and no other specialized
structure.”
Shafer WG, Hine MK, Levy BM. A text book of Oral Pathology. 4th ed.
Philadelphia
These cysts are soft tissue tumors and are rarely
seen in the head & neck region(7%). Only 1.6% are
located within the oral cavity.
Sinan Y Ertem, Sina Uckan, Hndan Ozdemir, 2014
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5.  An epidermal cyst is derived from epidermis, and is
formed by cystic enclosure of epithelium within the
dermis that becomes filled with keratin and lipid-rich
debris.
 It occurs in young to middle-age adults.
 Men are affected more often than women in the ratio
3:1, with mean age 28 years.
Al-Khateeb et al.; Smirniotopoulos & Chiechi; Koellaer et al., 1999; Som,
1987; Park, 1995
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6. DEMOGRAPHIC DATA
NAME : Ramanbhai Parmar
AGE/SEX : 52 Years/ Male
OCCUPATION : Police
ADDRESS : Lanva (Village)
OPD No. : 47536-G
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7. CHIEF COMPLAINT
Patient complaints of swelling in lower
right back teeth region since 1 month and
pain in same region since 15-20 days.
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8. HISTORY OF PRESENTING
ILLNESS…
Patient was relatively asymptomatic before 1 month.
He gradually developed swelling in lower right back
teeth region of jaw which was asymptomatic for 15
days and later on it was associated with dull aching
and continuous pain.
There were no aggravating factors associated with
pain. But as initially pain was dull aching, then it
converted to continuous and sharp shooting that
make patient to come our department with above
mentioned complaint.
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9. 20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 9

10. GENERAL EXAMINATION:
Patient is conscious, co-operative & well
oriented to time, place & person.
Moderately Built and Nourished
Pallor, Icterus, Cyanosis, Clubbing – Absent
VITALS:
Temperature : Afebrile
Pulse : 82 b.p.m.
Respiratory Rate : 14 cycles/min
Blood Pressure : 132/88 mm Hg
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11. INSPECTION:
Face : Gross Facial Asymmetry with
Swelling present on lower third of
face on Right side
TMJ : Normal but Restricted Jaw
Movements
Skin & Soft Tissue : A diffused,
roughly oval swelling present over
the right lower border of the
mandible, submandibular region,
anterior to ear & right cheek
extending…
Anteroposteriorly 1 cm away from the
right corner of the mouth to the
posterior border of ramus of
mandible approx. measuring 6cm
LOCAL EXAMINATION (EXTRA-
ORAL)
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12. …EXTRA-ORAL EXAMINATION
Mouth Opening : 13
mm
INSPECTION:
Colour: Same as the adjacent skin.
Surface : Normal.
Edge: Not well defined.
Skin overlying the swelling: Normal.
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13. …EXTRA-ORAL EXAMINATION
 PALPATION :
All inspectory findings were
confirmed on palpation.
Temperature : Localized rise
in temperature over
swelling.
Consistency: Swelling was
firm, tender, non-fluctuant.
Fluid Thrill : Absent
Translucency: Not Assessed
Reducibility: Swelling was
non reducible on digital
Pressure.
Compressibility: Non
Compressible
Lymphnodes :Right
Submandibular lymph
nodes were Non Palpable.
No regional
lymphadenopathy.
Fixity to Overlying Skin: No
Pitting : Absent
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14. INTRA-ORAL EXAMINATION
INSPECTION:
TEETH PRESENT –
11-17, 21-27, 31-38, 41-
47
ALVEOLAR RIDGE –
Buccolingual Expansion Of
Cortical Plates Present irt
46,47
and the ascending ramus of
mandible on right side.
HARD PALATE –
NAD
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15. …INTRA-ORAL EXAMINATION
PALPATION:
GINGIVA - NAD
BUCCAL MUCOSA - NAD
LABIAL MUOSA - NAD
SOFT PALATE - NAD
VESTIBULE -
A firm, non fluctuant
Swelling Present on the lower
right vestibule irt 46, 47
region.
Tender on palpation
No bleeding on provocation
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16. …INTRA-ORAL EXAMINATION
PALPATION:
All inspectory findings were
confirmed on palpation.
Consistency: Swelling was firm,
tender, non-fluctuant.
Reducibility: Swelling was non
reducible on digital Pressure.
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18. PROVISIONAL DIAGNOSIS
Odontogenic keratocyst
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19. DIFFERENTIAL DIAGNOSIS
Central Giant Cell Granuloma
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20. INVESTIGATIONS
1. OPG
2. Pre-Op Blood Profile
3. CBCT
4. Chest X-ray
5. Incisional biopsy
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21. INVESTIGATIONS- OPG
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22. INVESTIGATIONS
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23. CBCT
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24. INVESTIGATIONS
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25. INCISIONAL BIOPSY
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26. FINAL DIAGNOSIS
Inflammatory Epidermoid Cyst
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27. TREATMENT PLAN
1. Resection with chemical cauterization
including a margin of 0.5-1 cm healthy bone
using modified ward’s incision under general
anesthesia.
2. Long term follow-up.
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28. Incision
Marking
Reflection and Exposure of
Site
Enucleation of Lesion
TREATMENT GIVEN
Chemical Cauterization Resected Closure 28

29. FIRST FOLLOW-UP OPG
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30. SECOND FOLLOW-UP OPG
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31. DISCUSSION
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32. DISCUSSION
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33. DISCUSSION
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34. CONCLUSION
 The lesion enucleated by intraoral approach which is
suitable and suggested technique for IECs.
 The aspiration biopsy and further radiological
investigations like ultrasonography, computed
tomography or magnetic resonance imaging should be
considered for cystic lesions of the jaws.
 Although, we have a large literature of jaw pathologies,
we may still come across unique and unclear cases.
 Clinical examination, conventional radiographs and
surgical experience is not enough for diagnosis of all
pathologies.
 Our case is very rare and second case in the literature
because of unilateral placement and being relationship20 June 2020 DEPARTMENT OF OMFS, NPDCH, SPU 34

35. REFERENCES
1. Thomas et al., Epidermal cyst of the mandible: a case report. The British Association of Oral
Surgeons and John Wiley and Sons Ltd. Oral Surgery 2016:1-3
2. Loxha M P et al., Epidermoid Cyst of Mandible Ramus: Case Report, Med Arch. 2016 Jun; 70(3):
238-240.
3. Orcun Toptas et al., Intra Osseous Epidermoid Cyst Associated with Impacted Mandibular Wisdom
Teeth: An Uncommon Entity. Journal of Clinical and Diagnostic Research. 2014 Jul, Vol-8(7):
ZD31-ZD32.
4. Ertem et al. An unusual presentation of an intraosseous epidermoid cyst of the anterior maxilla: a
case report Journal of Medical Case Reports 2014, 8:262.
5. Alimoğlu et al Mandibular Ramus Epidermal Inclusion Cyst. The Journal of Craniofacial Surgery &
Volume 21, Number 5, September 2010.
6. Sunil et al. Epidermoid cysts of head and neck region – case series and review of literature. Int J
Odontostomat 2014; 8:165–9.
7. Ohn BH, Koh SW, Park SJ, Chee YD, Epidermoid Cyst of the Mandible: Case Report, J Korean Assoc
Maxillofac Plast Reconstr Surg. 2011; 33: 535-9
8. Janarthanam J, Mahadevan S. Epidermoid cyst of submandibular region, Oral Maxillofac Pathol.
2012 Sep-Dec; 16(3): 435-7., doi: 10.4103/0973-029X.102511
9. Jayade BV, Upadya VH, Goplakrishnan K, Shirganvi MS. Epidermal inclusion cyst of the mandible
after extraction of a third molar: case report. Br J Oral Maxillofac Surg 2012; 50:e72–4.
10. Debaize S, Gebhart M, Fourrez T, Rahier I, Baillon JM. Squamous cell carcinoma arising in a giant
epidermal cyst: a case report. Acta Chir Belg 2002; 102:196–8.
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THANK
YOU