A case of dermoid masquerading as a ranula.

1. A case of a ‘swelling’
Dr. Archan Khandekar
(PGY3, VSGH)

2. History
 A 22 year old female Hindu patient named XYZ coming
from low socioeconomic class residing at Amraiwadi,
Ahmedabad came to VSGH on the 22nd of July 2015 with
chief complaints of :-
 Swelling in right side of neck since the last 2 years.
 The patient was relatively asymptomatic before 2 yrs;
after which she noticed a single swelling in right side of
neck just below the jaw while being in front of the mirror.
The growth of the swelling was insidious; gradually
increasing in size from being barely noticeable to its
current size of that of a lemon.

4.  The swelling was not associated with pain.
 There was no associated fever.
 There was no difficulty in breathing, swallowing or change of
voice
 There were no similar other swellings present at any other
location or in the past.
 The skin over the swelling wass normal no redness or
blackening of the skin was noticed.
 There was no restriction in movement of the jaw.
 There was no history of trauma to the region.

5.  No associated history of loss of body weight was present.
 There was no history of any episodes of loss of consciousness.
 Patient has no past history of any major or minor surgical
procedure.
 Patient is not a known case of Diabetes Mellitus or
Tuberculosis.
 There is no past history of any blood transfusion or any
allergic reactions.
 Patient is on mixed diet with normal bowel and bladder
function with no addictions.
 The obstetric and gynecological history of the patient has no
findings of any significance.

6. General examination
 I have examined the patient in proper light and exposure.
 The patient is conscious, cooperative and well oriented with
person place and time.
 She is fairly built and fairly nourished with no specific
decubitus , gait or attitude.
 No signs of pallor, icterus, cyanosis, clubbing, edema or
generalized lymphadenopathy present.
 The Pulse is 88/min in right radial artery with normal force
tension and volume with bilateral symmetry. The is BP is
124/76 mm Hg in the right brachial artery.

7.  There is a single, ovoid swelling 4*3 cm in size, just below
the body and anterior to the angle of the mandible in
submandibular triangle on the right side.
 Surface over the the swelling is smooth with regular well-
defined edges.
 Skin over the swelling is is normal. No ulcer, scar sinus
fistula or venous engorgement seen over the skin.
 No impulse on coughing is seen over the swelling and
there are no visible pulsations.
Inspection

8.  There is no movement of the swelling with deglutition
and there is no movement of the swelling with
protrusion of the tongue.
 The oral cavity does not show any positive findings on
inspection.
 The cervical spine of the patient does not have any
visible deformity.

9. Palpation
 The skin over the swelling is non warm, non tender.
 The swelling is 4*3*3 cm in size with its superior border just
below and lateral to body of the mandible and and deep
to the platysma made evident by making the muscle taut.
 The surface of the swelling is smooth with well defined edges
on all aspects except the superomedial side where it
merges imperceptibly with the deep structures but can be
seperated from the mandible in its entire extent.
 The consistency of the swelling is cystic and fluctuation can
be illicited with no slip sign.
 Some amount of indentation is present in the entire extent
of the swelling.

10.  Transillumination is negative with no impulse on coughing
present.
 It is non reducible and non compressible.
 The swelling is non pulsatile.
 It is not fixed to the overlying skin and becomes less
evident on making the platysma taut on the right side
signifying its presence deep to it.
 The surrounding lymph nodes do not show any
enlargement.
 The cervical spine is normal.
 The oral cavity; including the floor of the mouth reveal no
abnormalities on bimanual digital examination of the
same.
 There are no positive findings on percussion or
auscultation.

11. Diagnosis
The swelling is a Inframylohyoid (cervical) dermoid of the
lateral variety.
D/D
Submandibular lymph node.
Submandibular gland swelling.
Plunging ranula.
Branchial cyst.

12. Investigations
 Complete blood hemogram.
 X-ray (Cervical spine/ local part/ chest)
 Ultrasonography.
 CT Scan.

13. Treatment
 The operative procedure for the above swelling would
be a complete excision with an incision kept in the
langer’s lines in the submandibular region.

14. CT pictures