Mucocele

Mucoceles are painless, asymptomatic swellings that have a relatively rapid onset and fluctuate in size(2 to 10 mm in diameter). They may rapidly enlarge and then appear to involute because of the rupture of the contents into the oral cavity or resorption of the extravasated mucus. The patient may relate a history of recent or remote trauma to the mouth or face, or the patient may have a habit of biting the lip. However, in many cases no insult can be identified. When lesions occur on the anterior ventral surface of the tongue, tongue thrusting may be the aggravating habit, in addition to trauma. The duration of the lesion is usually 3-6 weeks; however, it may vary from a few days to several years in exceptional instances.

Patients with superficial mucoceles report small fluid-filled vesicles on the soft palate, the retromolar pad, the posterior buccal mucosa, and, occasionally, the lower labial mucosa. These vesicles spontaneously rupture and leave an ulcerated mucosal surface that heals within a few days. Several lesions may be present, and they range from being nontender to painful. Some individuals note a pattern of development during mealtime. Often, an individual may rupture or unroof the vesicles by creating a suction pressure. Typically, affected individuals report a chronic and recurrent history.

Mucoceles often show up on the inside of lower lips, gums, the roof of mouth, or under tongue. Those on the floor of the mouth are called ranulas. Mucoceles may have these characteristics:

  • Moveable, painless, tense,
  • Soft, round, dome-shaped,
  • Pearly or semi-clear surface or straw-colored(or bluish) in color,
  • 2 to 10 millimeters in diameter.

The frequently injured glands are the minor salivary glands of the lower lip. The mechanism of injury is mechanical, with the tissue of the lower lip becoming caught between the maxillary anterior teeth and the mandibular anterior teeth during mastication or with the habit of biting one’s lip. This trauma results in a crush-type injury and severance of the excretory duct of the minor salivary gland. In the palate, low-grade chronic irritation (eg, from heat and noxious tobacco products) may cause these lesions to develop.

Mucoceles occur when injury to the minor salivary glands occurs usually secondary to trauma; biting one’s lip; chronic inflammation with periductal scarring; excretory duct fibrosis; prior surgery; trauma from oral intubation; or rarely, minor salivary gland sialolithiasis. Most mucoceles occur because of severance of the excretory duct and extravasation of mucus into the adjacent tissue.

Getting hit in the face could also disrupt the duct. Mucus seeps out, pools, becomes walled off, and causes a cyst-like swelling. A similar buildup happens when the duct has become blocked.

Mucoceles often go away without treatment. Surgical excision with the submission of the tissue for histopathologic examination is the treatment of choice for persistent oral mucoceles.

Medical Care

Examples of treating multiple superficial mucoceles with clobetasol 0.05%, a high-potency topical steroid, or with gamma-linolenic acid (oil of evening primrose), which is a prostaglandin E precursor, have some degree of success in limited patients. The lesions recur within a few months when gamma-linolenic acid is discontinued, while periodic use of the topical steroids is used to control flare-ups.

Mucoceles may spontaneously resolve, especially in infants and young children. Mucoceles in children spontaneously resolved after an average of 3 months.If symptoms are minimal in this young age group, aspiration of the lesions and periodic follow-up for 6 months have been suggested as an alternative to surgery. There is use of intralesional steroids for the management of oral mucoceles, this treatment option may be an alternative when surgery cannot be performed.

Surgical Care

Surgical excision of the mucocele along with the adjacent associated minor salivary glands is recommended. Aspiration only of the mucocele’s contents often results in recurrence and is not appropriate therapy, except to exclude other entities prior to surgical excision. If this surgical approach is used, the adjacent minor salivary glands must be removed.

Micromarsupialization technique for mucoceles is used for pediatric patients. This technique involves the placement of a 4.0 silk suture through the widest diameter of the lesion (dome of the lesion) without engaging the underlying tissue. A surgical knot is made, and the suture is left in place for 7 days. Patients need to be educated about suture replacement.

Laser ablation, cryosurgery, and electrocautery are approaches that have also been used for the treatment of the conventional mucocele with variable success.

Superficial mucoceles

No surgical treatment is necessary unless the lesion frequently recurs and is problematic to the patient. If treatment is desired, the options include surgical excision, cryotherapy, and laser vaporization.

Mucoceles often go away without treatment. But sometimes they enlarge. Need to see a doctor for proper diagnosis. Before Start medication, must consult with a doctor, especially for children’s. No surgical treatment is necessary unless the lesion frequently recurs and is problematic to the patient.

  • Andrew’s Diseases of the skin

Mucocele

TUI - Tibot Urgency Index

Mucoceles are painless, asymptomatic swellings that have a relatively rapid onset and fluctuate in size(2 to 10 mm in diameter). They may rapidly enlarge and then appear to involute because of the rupture of the contents into the oral cavity or resorption of the extravasated mucus. The patient may relate a history of recent or remote trauma to the mouth or face, or the patient may have a habit of biting the lip. However, in many cases no insult can be identified. When lesions occur on the anterior ventral surface of the tongue, tongue thrusting may be the aggravating habit, in addition to trauma. The duration of the lesion is usually 3-6 weeks; however, it may vary from a few days to several years in exceptional instances.

Patients with superficial mucoceles report small fluid-filled vesicles on the soft palate, the retromolar pad, the posterior buccal mucosa, and, occasionally, the lower labial mucosa. These vesicles spontaneously rupture and leave an ulcerated mucosal surface that heals within a few days. Several lesions may be present, and they range from being nontender to painful. Some individuals note a pattern of development during mealtime. Often, an individual may rupture or unroof the vesicles by creating a suction pressure. Typically, affected individuals report a chronic and recurrent history.

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Dr. Lora Smith

MBBS (Dhaka), DGO (DU) Ex SR. Gynaecologist & Obstetrician

09 606 111 222

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