Is this an airway emergency? How would you handle it?

A 50 y.o. male comes to the ED with difficulty speaking.  You notice a submandibular swelling and when you look in his mouth he has a large mass under the tongue.

 This patient had an 8 cm.  epidermoid cyst in the floor of the mouth.  

Epidermoid cysts that appear in the midline floor of the mouth are, usually, a result of entrapped ectodermal tissue of the first and second branchial arches, which fuse during the third and fourth weeks in utero. The incidence in the floor of the mouth of the oral cavity is rare and development sites are the sublingual, submaxillary and submandibular spaces.

However. kudos to Dr. Docherty who thought it was a ranula.  A ranula is a type of mucocele of the salivary glands sometimes caused by minor trauma. It is usually in the floor of the mouth but can also be cervical . If it is cervical it is called a plunging ranula.  Ranula can also refer tosalivary duct cysts, ermoid cysts and cystic hygromas.  The word ranulacomes from rana which means frog .  It is thought the mucocele is reminiscent of a croaking frogs throat. 

Teaching point: this was NOT an airway emergency because the pt had this cyst for ten years.  He was Hispanic and when asked why he was not concerned about his inability to speak clearly; he said he assumed it was because English was his second language. If he had any airway distress a nasal trumpet would have created a sufficient airway.

Patients course:

The patient underwent resection of the 8 cm mass and recovered without complications.


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Zachariades N, Skoura-Kafoussia C. A life threatening epidermoid cyst of the floor of the mouth: Report of a case. J Oral Maxillofac Surg 1990:48:400.