Tongue Cysts in Newborn: An Overview

Introduction

Tongue cysts in newborn infants can be a cause of concern for both parents and healthcare providers. These cysts, whether congenital or acquired, can lead to feeding difficulties and, in severe cases, even cause breathing difficulty. The article talks about the causes (etiology), different types (classification), how they are diagnosed, and effective management strategies.

What Are Tongue Cysts in an Infant?

Tongue cysts are unique and typically benign conditions that can occur in newborns and young children. These cysts may be either congenital (present from birth) or acquired over time, even in young adults. Congenital tongue cysts, in particular, can be distressing for both the infant and their parents, as they can affect feeding and even lead to respiratory issues.

According to medical reports, approximately 1.6 percent of benign cysts (a non-cancerous, fluid-filled sac or lump that can develop in various parts of the body) in the oral cavity of newborns are located on or under the tongue. These cysts can originate from various tissues, including:

• Thyroidal source related to the thyroid gland.

• Dermal source derived from skin tissues.

• The epidermal source consists of epidermal (skin) tissue.

• Venous source originates from blood vessels.

• The foregut source is related to the digestive tract's anterior part.

• Lymphatic source involves the lymphatic system.

Regardless of their origin, tongue cysts most commonly appear in the midline at the base of the tongue, often as a noticeable mass. In some cases, these cysts can interfere with breastfeeding and cause respiratory difficulties, including stridor, which is characterized by noisy breathing.

The root of the tongue is a region in the oral cavity that is generally resistant to primary cancers or neoplasms, primarily due to its high proportion of skeletal tissue and limited lymphatic tissue, especially in newborns. As a result, tongue cysts are relatively common in infants, and it is important to treat them, as untreated large cysts can potentially lead to malignant transformations.

How Are Tongue Cysts Classified and Differentiated Into Various Types?

• Two majorly occurring tongue cysts are the dermoid and the epidermoid cyst. To differentiate between dermoid and epidermoid tongue cysts, skin appendages are important. Dermoid cysts have skin appendages, while epidermoid cysts lack them.

• Epidermoid cysts can be further categorized as congenital or acquired, based on their origin as described in medical and oral pathology.

• A rarer type of cyst known as teratoid tongue cyst contains mesodermal cells from various tissues like bone, muscle, respiratory, or gastrointestinal, along with characteristic skin appendages.

• In clinical practice, oral surgeons and dentists often encounter these three major cyst types, primarily distinguished by their common squamous epithelium lining and the presence of keratinaceous (a substance or tissue that contains keratin, a tough, fibrous protein found in the skin, hair, and nails) material in the cyst lumen.

• While various terms exist in oral pathology literature for tongue cysts in children, such as tongue base cysts, epiglottic cysts, lingual cysts, vallecular cysts, and laryngeal cysts, these names typically refer to the location within the oral cavity where the cyst forms. Tongue cysts primarily fall into the three major histopathological variants mentioned above.

What Is the Etiology Of Tongue Cysts in Newborns?

One major hypothesis for explaining the formation of cysts in infants or young children involves researchers attempting to find the underlying pathogenesis of these cysts. According to medical studies, these cysts typically develop due to the obstruction of mucous or salivary gland ducts within the child's mouth. In some cases, this obstruction is congenital, resulting from embryological malformations that lead to the child being born with a tongue cyst. Also, the tongue cysts found in infants and children commonly exhibit features such as respiratory epithelium within mucous glands, along with an outer lining of squamous epithelium.

What Are the Clinical Features of Tongue Cysts in Newborns?

Clinical symptoms typically manifest within the first week of an infant's life. Most affected infants exhibit issues with breastfeeding during this early period. Clinical features of tongue cysts in infants:

• Upper airway obstruction, severity depends on cyst size and location.

• Inspiratory-related stridor (high-pitched breathing sound).

• Chest retraction.

• Apnea (temporary cessation of breathing).

• Cyanosis (bluish skin coloration due to lack of oxygen).

• Feeding difficulties exacerbated by stridor and airway obstruction.

• Infant stridor is the most common and should raise suspicion of tongue cysts, particularly when feeding problems are present.

How to Diagnose Tongue Cyst in Newborns?

Diagnosis methods for pre-operative planning by dentists or oral surgeons include:

• Fine Needle Aspiration Cytology (FNAC): It involves using a thin needle to extract tissue or fluid samples from a lesion for laboratory analysis, aiding in the diagnosis of tongue cysts.

• Ultrasound: This imaging method employs sound waves to visualize the tongue cyst and its surroundings, providing real-time information and helping with diagnosis.

• CT (Computed Tomography): CT scans use x-rays to create detailed cross-sectional images of the tongue cyst and adjacent structures, offering a more comprehensive view.

• MRI (Magnetic Resonance Imaging): MRI utilizes strong magnets and radio waves to generate highly detailed images of the cyst and surrounding tissues, aiding in precise diagnosis and treatment planning.

• Ultrasonography: Often preferred by pediatric dentists and healthcare providers, including pediatricians and neonatologists, due to its safety and reliability. While the image resolution may not match that of CT or MRI, ultrasonography is considered a dependable technique for analyzing lesions beneath the tongue or sublingual region.

What Are the Management Strategies for Tongue Cysts in Newborns?

• Initial Evaluation: Assess whether the cyst is self-limiting or causing feeding and respiratory issues in the newborn.

• Surgical Excision: For moderate to severe tongue cysts, the primary treatment is complete surgical removal.

• Exercise Caution: Surgeons must be careful during the procedure to avoid rupturing the cyst and causing postoperative inflammation.

• Low Recurrence: Recurrences are rare when the cyst is thoroughly removed by an oral and maxillofacial surgeon or pediatric dentist.

• Malignant Transformation: Untreated large tongue cysts may, in rare cases, undergo malignant transformation, leading to conditions like squamous carcinoma or basal cell carcinoma of the tongue. This underscores the importance of timely and appropriate management.

Conclusion

Watching over a newborn with a tongue cyst needs interdisciplinary care involving physicians, neonatologists, dentists, oral surgeons, and nurses. Consistent monitoring of cyst size, prompt diagnosis, and, when necessary, surgical excision without rupture constitute the primary treatment approach, effectively mitigating feeding difficulties in the infant. This collaborative and attentive care approach is essential to ensuring the well-being and proper development of the newborn.