Well-circumscribed mass of the lateral floor of the mouth

Abstract

In June 1990. a 67-year-old woman was referred to the Oral and Maxillofacial Surgery Clinic for evaluation and treatment of an asymptomatic, firm swelling in the right anterior floor of the mouth. The patient’s chief complaint was an ill-fitting maxillary full denture and mandibular partial denture. The patient had been unaware of the mass. The patient’s medical history was significant for bilateral acoustic neuromas, which were removed surgically, one in 1981. the other in 1986. The patient was left with total bilateral deafness and mild seventh cranial nerve weakness bilaterally. The patient also had bilateral cataracts that were treated surgically 4 years previously. The patient’s health and family history were otherwise noncontributory. She was not taking medications and denied a history of drug allergies. On clinical examination, the patient appeared to be a thin. elderly woman without acute distress. She was afebrile and her vital signs were stable. Examination of the head and neck revealed a soft. discrete swelling of the right submental area. without any other significant findings. The floor of the mouth on the right was slightly elevated above the partially edentulous atrophic mandibular alveolar ridge (Fig 1). A nonpainful, ill-defined, freely movable, rubbery mass measuring 3.0 by 2.5 cm in diameter was palpable above the mylohyoid muscle. The overlying mucosa was nonulcerated and appeared normal. The mass did not appear to contribute to the ill fit of the lower partial denture. Salivary flow from Wharton’s ducts was clear and abundant bilaterally. A mandibular occlusal radiograph failed to disclose any abnormalities. Magnetic resonance imaging (Tz-weighted) revealed a 2.7 X 2.2-cm area of increased signal intensity in the right floor of the mouth (Fig 2). Patient movement limited the diagnostic value ofthe study. She was scheduled for an incisional biopsy in the outpatient oral surgery clinic under local anesthesia.