Floor of the mouth swelling

Abstract

In October 1984, a 31-year-old white man reported to the University Hospital of Jacksonville, Division of Oral and Maxillofacial Surgery outpatient clinic complaining of a slowly enlarging mass in the floor of the mouth present for about one year. The mass had approximately doubled in size over the past two months with extension into the right submandibular region, but had then slightly regressed. He complained of only slight dysphagia during the time that the mass had reached maximum size, and denied pain at rest or with eating, xerostomia, fever, paresthesia or paresis. He knew of no past injury to the area and denied any oral habits. The patient had previously been in good health. His past medical history was significant only for treatment of gonorrhea at age 19 years. His past surgical history included tonsillectomy at age six, removal of a palatal “cyst” at age 23 and removal of his impacted third molars under general anesthesia at 30 years. He denied the use of tobacco products and was only an occasional alcohol user. He had no known allergies and was not under any medications. Clinical examination revealed a slightly obese, well developed man in no acute distress and with an obvious right submandibular swelling (Fig. 1). His vital signs were stable and he was afebrile. The head, neck and oral examination revealed a normocephalic individual without obvious deficits. A large, soft, slightly tender swelling of the right submandibular region was present, but there was no cervical adenopathy. The trachea was in the midline and the thyroid gland was not palpable. The intraoral mass measured approximately 6 cm in diameter, causing moderate elevation of the floor of the mouth (Fig. 2). It was centered in the right sublingual area and crossed the midline slightly to the left. The mass had a doughy consistency to palpation and was covered with normal-appearing pink mucosa. Salivary flow was normal bilaterally. The remainder of the oral examination was within normal limits. Panoramic and occlusal radiographic examination showed no obvious foci of infection or calcification. The impression was of a benign process involving the floor of the mouth, and admission was planned for excisional biopsy.