An epidermoid cyst of the uvula causing dyspnea in an infant
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Epidermoid cysts are aberrant epithelial components of ectodermal tissues; they develop during the fetal period or are acquired via trauma or surgery. Uvular cysts are rare.

A 10-month-old infant developed aggravated dyspnea during an upper respiratory tract infection. The patient appeared to have developed normally and had no history of feeding difficulty, dyspnea, or congenital abnormalities. Severe rhinorrhea and nasal obstruction allowed oral breathing only. Inspiration was poorer than expiration; he exhibited intermittent cyanosis. His symptoms were aggravated when lying down.

Oral cavity examination using a tongue depressor revealed a well-circumscribed, round yellowish mass at the tip of an elongated uvula. On flexible laryngoscopy, the epiglottis was compressed by the mass; the uvular soft tissue became elongated during inspiration. A neck soft tissue X-ray revealed a thumbprint sign and diffuse thickening of the prevertebral soft tissue. Although the epiglottis was not swollen, the airway was obstructed by the cyst. Diagnosis was uvular epidermoid cyst.

The cyst was removed with the child under general anesthesia induced by oral intubation; intubation was very difficult because the cyst covered the vocal cords. Doctors pulled the uvula to expose the cyst and removed it. The specimen was a 2 ×1 × 0.5 cm, well-circumscribed, yellowish, submucosal cystic mass. The histopathological diagnosis was a benign keratinous cyst. The patient recovered immediately after the operation and was discharged 1 day later. The patient is under follow-up and the uvula is healing; no recurrence has been noted 6 months postoperatively.

Cysts can arise anywhere in the body; the incidence in the head-and-neck region is 7.0%. Only a few cases of epidermoid uvular cysts have been reported; such cysts are extremely rare.

Source: https://journals.lww.com/md-journal/Fulltext/2020/11130/An_epidermoid_cyst_of_the_uvula_causing_dyspnea_in.13.aspx
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