Sebaceous cyst in the oral cavity.

Sebaceous glands are reported to be normally located in the oral region in the vermilion of the upper lip and on the buccal mucosa. They are small yellowish bodies located immediately beneath the mucosa, and although numerous pathologies of these tissues have been described, very few clinical reports have been made. Pathologies such as ectopic location, hyperplasia, adenomas, carcinomas, and cysts have been described. If an excretory duct suffers a dilatation which does not regress of its own accord, it may originate a cyst. The purpose of this clinical report is to describe a free sebaceous cyst located in the upper lip.

INTRODUCTION

Gland tissues are normally located in the oral mucosa and contribute to normal environment of the mouth. One type is the sebaceous gland, whose function has not yet been established, although it has been associated with the production of lipase and cholesterol.[1] Sebaceous glands have been extensively reported as located normally in the oral region in 70%–95% of the adult population of both sexes.[1234] They are yellowish bodies located immediately beneath the mucosa, usually placed in the vermilion of the upper lip and on the buccal mucosa; however, other sites such as the retromolar region or palatal area have also been described.[15] They substantially increase in number and size as age increases as from puberty and appear to continue to do so throughout adult life, with no difference between sexes.[16] The earliest reported appearance of these glands was in a 3-year-old child.[1]

Numerous pathologies of these tissues, such as ectopic location, hyperplasia, adenomas, carcinomas, and cysts, have been described.[123456] Sebaceous cysts consist of the dilatation of the excretory duct of a gland and its consequent swelling. This pathology has been described but not many case reports have been made.[2346] The purpose of this clinical report is to describe a free sebaceous cyst located in the upper lip.

CASE REPORT

A 22-year-old male with a slowly enlarging painless swelling in the upper lip presented himself to the surgeon in November 2009. This lesion, with 12-month evolution, was not associated with trauma, previous surgery, or systemic disease. Clinically, it was a swelling in the upper lip, with disappearance of the nasolabial groove and elevation of the nasal wing [Figure 1]. This lesion was palpable immediately beneath the labial mucosa, well circumscribed, 2 cm in size, mobile, covered with normal mucosa, slightly depressible, and under pressure a light brownish area could be seen beneath the oral mucosa [Figure 2]. A panoramic and periapical radiograph confirmed no teeth or upper maxilla association with the pathology.

Figure 1

Extraoral view of the upper lip swelling

Figure 2

Intraoral view of the lesion before enucleation

The lesion was presumably diagnosed as nasolabial cyst, and differentially diagnosed as lipoma, neoplastic process of secondary salivary gland, and free sebaceous cyst. Surgery was performed under local anesthesia, and the lesion was totally enucleated, meticulously dissecting circumscriptive tissues [Figure 3]. The wound was closed with 3.0 silk sutures. The resected tissue was fixed in formalin to send to histopathological examination [Figure 4]. The postoperative period was uneventful. During the histological study, it was stained with hematoxylin and eosin, revealing lined keratinizing stratified squamous epithelium with attached sebaceous gland acini and inflammatory cells in the chorion. It was diagnosed as a free sebaceous cyst. No recurrence of the pathology was reported during a 3-year observation period.

Figure 3

Intrasurgical photograph of sebaceous cyst

Figure 4

Formalin-fixed resected tissue

DISCUSSION

Although sebaceous glands are normally found on the oral mucosa, sebaceous cysts are infrequent pathologies. These cysts are normally located on the skin of the genial and preauricular region. They usually appear as a solitary swelling yellowish mass with a slow growth rate not associated with pain or trauma. It is believed that if pain is associated with the cyst, the cause may be fixation to adjacent tissues as a consequence of reactional peripheral fibrosis. The etiology of the sebaceous cyst has not yet been established, and it does not appear to be caused by trauma. Age of appearance of this pathology has been reported as between 59 and 86 years, but in this clinical report, the patient was 22 years old when the cyst was diagnosed. Recurrence as a difficulty in the sebaceous cyst resection was not observed in this treatment. Differential diagnosis of this pathology with nasolabial cyst, oral lipoma, and pathologies of secondary salivary glands is recommended. Diagnosis is based on location, clinical presentation, and histological study.

There are ten clinical reports of this lesion in the literature, but none of them include clinical and surgical photographs, as this report does. Knowledge and divulgation of this pathology could help to diagnose this kind of lesion and to generate more information about its characteristics, evolution, and treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.