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Clinical Challenge
February 2017

Enlarging Floor of Mouth Mass

Author Affiliations
  • 1Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
JAMA Otolaryngol Head Neck Surg. 2017;143(2):189-190. doi:10.1001/jamaoto.2016.2240

A man in his 50s presented to the emergency department with a 10-day history of swelling in the sublingual area. The swelling had been progressively increasing over the first 3 days but had remained stable over the past week. He denied any history of similar symptoms, pain, fever, odynophagia, or difficulty breathing. He complained of some difficulty swallowing owing to the swelling. He had a history of hypertension and had been prescribed a blood pressure medication (the name of which he could not remember), but he had not been taking it for weeks. He had no other pertinent medical history. Physical examination revealed significant, soft, nontender swelling of the floor of mouth bilaterally causing elevation of the tongue (Figure, A). There was no edema of the tongue or lips. The neck was soft, nontender to palpation, and without palpable lymphadenopathy. Computed tomographic (CT) imaging of the soft tissues of the neck with intravenous contrast showed a 6.3-cm anteroposterior × 6.9-cm cranial caudal × 4.8-cm transverse cystic nonenhancing mass centered in the root of the tongue, with elevation of the oral aspect of the tongue and some downward displacement of the floor of mouth (Figure, B and C). The sublingual glands were compressed but otherwise appeared normal, and the sublingual spaces were effaced. Surgical excision via an intraoral approach yielded a smooth, well-circumscribed mass. Histologic examination showed keratinizing squamous epithelium.