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Cas e R e po r t

Management of Oral Mucocele: A Case Report


Namish Batra1,
Renu Batra2,
Dharmesh Vasavada3,
Rashmi G S Phulari4

Senior Lecturer, Department of Oral and Maxillofacial Surgery, Manubhai Patel Dental College
and Hospital, Mujmahuda, Vadodara, Gujarat, India, 2Senior Lecturer, Department of Conservative
Dentistry and Endodontics, Manubhai Patel Dental College and Hospital, Mujmahuda, Vadodara,
Gujarat, India, 3Senior Lecturer, Department of Oral Pathology, Manubhai Patel Dental College,
Vadodara, Gujarat, India, 4Reader, Department of Oral and Maxillofacial Surgery, Manubhai Patel
Dental College and Hospital, Mujmahuda, Vadodara, Gujarat, India
1

Corresponding Author: Dr. Namish Batra, Manubhai Patel Dental College, Munjmahuda,
Vadodara - 390 011, Gujarat, India. Phone: +91-9537508008. E-mail: drnamish_mds@yahoo.com

Abstract
Mucocele is benign painless swelling of minor salivary gland, which most commonly involves lower lip and is characterized
as diffuse and fluctuant. It is characterized by accumulation of mucin with spherical, well-circumscribed transparent, bluish
colored lesion. Most of the time mococele is smaller than 1 cm extravasation cyst is mostly seen in association minor salivary
gland whereas retention cyst in association with major salivary gland. Many treatment modalities have been mentioned in
the literature, and surgical excision is advocated. The aim of this article is to emphasize on different treatment modalities and
present a case report of complete excision of mucocele.
Keywords: Extravesation, Mucocele, Retention, Salivary gland

INTRODUCTION
Mucocele is a common lesion of the oral mucosa that
results from an alteration of minor salivary glands due
to a mucous accumulation. Mucocele involves heavily
glycosylated proteins accumulation causing limited
swelling.1 Two different variants of mucocele can appear:
Extravasation and retention. Extravasation type is due to
the leaking of fluid from the salivary gland ducts and acini
to surrounding soft tissues. Retention mucocele appears
due to decrease or absence of glandular secretion produced
by blockage of salivary gland ducts.2 Clinically, there is no
difference between extravasation and retention type of
mucocele.
Etiopathogenesis

Trauma and obstruction of the gland are considered to be


the most common pathologies.3 Extravasation mucoceles
undergo three evolutionary phases. In the first phase,
mucous spills from the excretory duct into surrounding
tissues where some leukocytes and histiocytes are found.
Granulomas become visible during the resorption phase
due to histiocytes, macrophages and multi-nucleated
giant cells associated with a foreign body reaction. In
the final phase, connective cells form a pseudo capsule
without epithelium around the mucosa. 1 Retention

mucoceles are formed by dilation of the duct secondary


to its obstruction caused by a sialolith. The majority of
retention cysts develop in the ducts of the major salivary
glands.4,5
Clinical Characteristics

Mucocele is the common salivary gland disorder, and it


is the second common benign soft tissue tumor in the
oral cavity. It is characterized by accumulation of mucoid
material with rounded, well circumscribed transparent,
bluish colored lesion of variable size. It is a soft, fluctuant
painless swelling with rapid onset that frequently resolves
spontaneously. It is common in first three decades of life
with equal gender prevalence.

CASE REPORT
A 36-year-old male patient reported with a chief complaint
of solitaire diffuse swelling in lower lip since 3 days. Patient
also gave history of previous swelling 2 months in the
same region which resolved on its own. Medical and dental
history was not contributory. Patient is habituated to lower
lip biting. Extraorally no gross asymmetry was detected.
Intraorally a single diffuse swelling of 1 cm2 1 cm2 is
seen which was round in shape, with a smooth surface

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Batra, et al.: Extravesation Mucocele

and a bluish translucent hue (Figure 1). The swelling was


soft in consistency, fluctuant, non-tender, non-reducible,
compressible, afebrile and non-pulsatile, A differential
diagnosis of mucocele, lipoma, oral hemangioma, and oral

lympangioma, was made. Since the swelling was small it was


decided to surgically remove under local anesthesia. Using
blunt dissection cystic cavity was removed intact along with
excision of accessory salivary glands (Figure 2). Closure is
done with 4-0 vicryl.

DISCUSSION
The appearance of mucocele is pathognomonic, therefore,
the knowledge concerning the lesion location, history of
trauma, infection, variations in size, blue color and also
the consistency helps in the diagnosis of such lesions.6,7
The history and clinical findings help in diagnosing of a
superficial mucocele. Radiographic evaluation is considered
to be a diagnostic factor in the formation of oral ranulas
to rule outsialoliths.
Removal of the accessory salivary glands has been
urged as the treatment. Marsupialization can solely lead
to recurrence, but large lesions are best treated with
marsupialization. Laser, cryosurgery, and electro cautery
have also been used for treatment of the conventional
mucoceles.8,9 Intralesional corticosteroid injection are also
considered in the management of oral mucocele, but some
studies suggested that the initial cryosurgery or intralesional
corticosteroid injection relapse is more often.10 Removal of
surrounding glandular acini, excision or dissection of lesion
down to the muscle layer and avoiding damage to adjacent
gland and duct are some strategies to reduce recurrence.11
Histopathological report presented it as extravasation
mucocele and accessary minor salivary glands (Figure 3).
Microscopically, mucoceles appear as granulation tissue,
neutrophils, and histiocytes.

Figure 1: Clinical presentation of mucocele

Figure 2: Grossing image of intact mucocele with accessory


salivary glands

CONCLUSION
Mucocele is the most common benign lesion of the oral
cavity. Majority of these cases can be diagnosed clinically.
Management of mucocele is done surgically by excision
or marsuplization depending on the size of the lesion.
Recurrence is rare if managed accurately.

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Figure 3: Photomicrograph of mucocele

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How to cite this article: Batra N, Batra R, Vasavada D, Phulari RGS. Management of oral mucocele: A Case Report. Int J Sci Stud
2014;2(7):202-204.
Source of Support: Nil, Conflict of Interest: None declared.

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