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Authors : Dr.Md.Asdullah , Dr. Arti .S. Sachdev, Dr. Jyoti Gupta.
 

Abstract

Mucoceles are benign, mucus containing cystic lesions of the minor salivary glands. Most dental literature reports a higher incidence of mucocele in young patients, with trauma being a leading cause. The Mucocele or Mucus retention phenomenon is formed when the main duct of a minor salivary gland is torn with subsequent extravasation of the mucus into the fibrous connective tissue so that a cyst like cavity is produced. The wall of this cavity is formed by compressed bundles of collagen fibrils and it is filled with mucin. Mucoceles are known to occur most commonly on the lower lip. The tentative diagnosis of a mucocele is made from the clinical history, clinical presentation and palpation, and the definitive diagnosis is made by histopathology. This paper reviews the Mucocele and presents one case report.

INTRODUCTION 

The term “Mucocele” (from Latin terms mucus, or mucus, and coele,or cavity) is used to define the accumulation of mucus secreted from salivary glands and their ducts in the oral cavity’s subepithelial tissue.1 Clinically, a mucocele is characterized by an increase in volume, with a bubble-like shape that contains saliva, and is similarly colored to that of the normal mucosa or it may present blue coloration, depending on whether it is deep or superficial,respectively2. By definition, they are not true cysts. The incidence is high, in the order of 2.5 lesions per 1000 individuals. Indeed, mucoceles are the most common minor salivary gland disorder, and represent the second most frequent benign soft tissue tumor of the oral cavity, following irritative fibromas3. The principle etiology of a mucocele is mechanical trauma, causing the rupture of a salivary duct and consequent mucus extravasation within the surrounding tissue. A second mechanism for mucus accumulation is obstruction or narrowing of the salivary duct walls, causing ductal expansion4. The tentative diagnosis of a mucocele is made from the clinical history, clinical presentation and palpation, and the definitive diagnosis is made by histopathology5. Histopathologically, retention mucoceles are true cysts, as the duct has an epithelial lining. Extravastion mucoceles are considered pseudocysts, as they have no epithelial lining and are covered by a pseudo capsule of fibrous connective tissue.6 Mucoceles are usually

asymptomatic, though in some patients they can cause discomfort by interfering with speech, chewing, or swallowing. Treatment options for mucoceles include surgical excision ,marsupialisation, , cryosurgery, laser vaporization, and laser excision. Conventional treatment of the mucocele is excision with the associated overlying mucosa and the glandular tissue down to the muscle layer7.

CASE REPORT:

A 19 year old male patient was reported in Department of Oral Medicine Radiology with chief complaint of swelling in lower lip. There was no significant medical history. The clinical examination revealed a round, sessile nodule on the lower lip nearly in middle 10 cm inside from vermllion border of lower lip. which was 6 mm in diameter, fluctuant, of an elastic consistency and the slightly bright in colour than adjacent mucosa (Fig- 1). No other oral anamolies were detected. This clinical examination led to a tentative diagnosis of a mucocele. After hematological and general medical evaluation of patient. An excisional

biopsy was performed, intraorally under local anesthesia and the wound was sutured(Fig-2,3&4).Specimen sent for histopathological examination.   

   
Fig-1 Pre- operative  Fig 2 Incised wound 
   
Fig-3 Excised Specimen   Fig-4 Wound Sutured  
   
Fig-5 Post operative   Fig-6 Histopathologic image H & E stain  

DISCUSSION:

The incidence of mucoceles in the general population is 0.4% to 0.8% with scant differences between males and females.8 As regards mucocele location in the oral cavity, most investigators consider

the lower lip to be the most frequently affected location (40% to 80% of all cases), followed by the cheek mucosa and floor of the mouth.9

Several techniques have been proposed for the treatment of a mucocele,

such as cryosurgery, micromarsupialization, marsupialisation, surgical excision and laser ablation.10 Marsupialization had resulted in considerably higher recurrence rates. Micromarsupialization had been suggested to have lower recurrence rates.11

CONCLUSION

Oral soft tissue reactive lesions, although a common entity, can cause diagnostic dilemma for an inexperienced clinician. Identification of any

reactive hyperplastic lesion requires the devising of a differential diagnosis to enable precise patient evaluation and there on its management. A correlation of clinical and histopathological findings is required to treat these patients.

ACKNOW LEDGEMENT

Authors of this article acknowledge the contribution and help of the following Dentists: Prof. K.Srinivas, Prof.P.Ratnakar Dr. Parvez Alam Khan, Dr. Payal Tripathi,& Dr. Vasu S.Saxena.

REFRENCES :

  1. Sukhtankar LV et al, Treatment of Lower lip Mucocele with Diode Laser – A Novel Approach,Annals of Dental Research (2013) Vol 2 Suppl 1: 102-108.
  2. 2. Baurmash HD. Mucoceles and ranulas. J Oral Maxillofac Surg 2003;61:369-78.
  3. 2. Baurmash H, The etiology of superficial oral mucoceles.J Oral Maxillofac Surg 2002;60:237-238.
  4. J Ata-Ali1, C Carrillo2 , C Bonet Oralmucocele: review of the literature J Clin Exp Dent. 2010;2(1):e18-21
  5. Tran TA,Parlette HL.Surgical pearl:Removal of a large labial mucocele. J Am Acad Dermatol 1999;40:760-762.
  6. 5. Kopp WK, St-Hilaire H. Mucosal preservation in the treatment of mucocele with CO2 laser. J Oral Maxillofac Surg 2004;62:1559-1561.
  7. Huang IY, Chen CM, Kao YH,Worthington P. Treatment of mucocele of the lower lip with carbon dioxide laser. J Oral Maxillofac Surg 2007;65:855-8.
  8. Knapp MJ. Oral Disease in 181,338 consecutive oral examination, J Am Dent Assoc 1971;83:1288-1293.
  9. Kirti Chawla, Arundeep Kaur Lamba et al. Treatment of Lower Lip Mucocele with Er,Cr:YSGG Laser – A Case Report, J Oral Laser Applications 2010;10:181-185.
  10. Marcushamer M, King DL, Ruano NS. Cryosurgery in the management of mucoceles in children. Pediatr Dent1997;19:292-3.
More refercences are available on request.

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