An Unusual Case of Bilateral Upper and Lower Oral Cavity Cysts in a Newborn.

Background: Oral mucosal lesions in newborns have a broad differential diagnosis, ranging from benign, transient conditions to potential early signs of systemic disease. Most of these lesions are resolved without intervention, but delayed recognition can lead to complications, such as airway obstruction. Early identification is crucial for appropriate management. This case report discusses an unusual presentation of multiple oral mucosal cysts in a newborn, emphasizing the challenges of diagnosis and management. Case Presentation: A 1-day-old male was evaluated at Boston Medical Center for cystic oral lesions identified during newborn screening. The infant was born at 36 weeks and 2 days' gestational age via vaginal delivery. His mother reported no feeding, breathing, or crying issues. On exam, there were 4 small cysts on the left lateral hard palate consistent with Epstein pearls. There were also 1 cm pedunculated cystic lesions on the lingual surface of the mandibular gingiva and on the lateral hard palate. Although unclear, the cysts were diagnosed as congenital gingival cysts and close follow up was recommended. At 4 months, lesions were asymptomatic and reduced significantly in size.The differential diagnosis for neonatal oral cysts is broad. Epstein's are common, self-limiting lesions, while gingival cysts may present as larger, keratin-filled cysts that also typically resolve spontaneously. Congenital epulis, though rare, are pedunculated masses requiring surgical removal. Given the uncertain diagnosis of this patient's lesions, the optimal choice of management was unclear. Although biopsy or surgery could provide definitive diagnosis, given that the lesions were asymptomatic, observation was continued. Conclusion: Oral mucosal lesions in newborns may raise parental concern, but most are benign and self-limiting; however, variabilities in presentation can make proper diagnoses difficult without histopathological confirmation. This case highlights the importance of observation, careful monitoring, and avoiding unnecessary surgical interventions.