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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 81-84

Laser-assisted surgical removal of mucocele in a 12-Year-Old female patient


1 Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Deemed University Dental College and Hospital, Pune, Maharashtra, India
2 Department of Oral Pathology, Bharati Vidyapeeth Deemed University Dental College and Hospital, Pune, Maharashtra, India

Date of Web Publication25-Jan-2018

Correspondence Address:
Dr. Preetam Shah
Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Deemed University Dental College and Hospital, Dhankawadi, Katraj, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohr.ijohr_29_17

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  Abstract 


Mucoceles are common salivary gland disorders which can be seen in the oral cavity. They occur most commonly in the lower lip region followed by the tongue, buccal mucosa, and the soft palate region. Two histological types are seen: extravasation and retention. Retentive types of mucoceles are found less commonly in children. Several treatment modalities have been put forth for excision of such cysts including the use of a scalpel, CO2laser, and cryosurgery. The present case report depicts a combination of surgical and laser-assisted approaches adapted for the excision of a small retentive type of mucocele in a 12-year-old female child.

Keywords: Lip biting, mucocele, mucous extravasation, retention cysts


How to cite this article:
Shah P, Velani PR, Lakade L, Deshmukh AA. Laser-assisted surgical removal of mucocele in a 12-Year-Old female patient. Indian J Oral Health Res 2017;3:81-4

How to cite this URL:
Shah P, Velani PR, Lakade L, Deshmukh AA. Laser-assisted surgical removal of mucocele in a 12-Year-Old female patient. Indian J Oral Health Res [serial online] 2017 [cited 2019 Aug 22];3:81-4. Available from: http://www.ijohr.org/text.asp?2017/3/2/81/223926




  Introduction Top


Mucocele is one of the most common lesions of the oral cavity resulting from an alteration of minor salivary glands on account of mucous accumulation. Mucus is produced exclusively by the minor salivary glands and is also the most important substance secreted by the major sublingual salivary glands. Mucocele involves accumulation of mucin causing swelling. Mucoceles can appear by an extravasation or a retention mechanism. Extravasation mucocele results from a broken salivary gland duct and the consequent spillage into the soft tissues around this gland. Retention mucocele appears due to a decrease or absence of glandular secretion produced by blockage of the salivary gland ducts.[1] Physical trauma can cause a leakage of salivary secretion into the surrounding submucosal tissue. Inflammation becomes obvious due to stagnant mucous resulting from extravasation.[2] The incidence of mucoceles is generally high, 2.5 lesions per 1000 patients, frequently in the second decade of life and in children and young adults and rarely among children under 1 year of age.[3],[4] According to many studies, there is no difference between genders.[5],[6] Their prevalence in the oral cavity varies depending on its specific location, and it is seen in cheek, tongue, or lips.[7]

On clinical presentation, mucocele presents itself as a bluish, soft, and transparent cystic swelling which frequently resolves spontaneously. The blue color is caused by vascular congestion and tissue cyanosis above followed by accumulation of fluid below. Mucoceles of the minor salivary glands are rarely >1.5 cm in diameter and are always superficial. Mucoceles found in deeper areas are usually larger. Mucoceles can cause a convex swelling depending on the size and location as well as difficulties in speaking or chewing.[2]

Various treatment modalities have been taken up for the removal of the mucocele. These mainly include surgical excision, electrocautery, cryosurgery, and use of lasers. They are less commonly found in children and mostly of extravasation type. The present case report in a 12-year-old child is retention type and depicts an effective method for laser-assisted surgical removal of the mucocele, thereby combining two different treatment modalities which help in painless and early healing of lesion.


  Case Report Top


A 12-year-old female patient reported to the Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Pune, with a chief complaint of swelling in relation to the lower lip. No significant medical or family history was recorded. However, the patient had a chronic habit of lip biting for 5–6 years.

On clinical examination, it was revealed that the patient had Ellis Class III fracture with the upper permanent central incisors and multiple carious lesions in the mouth. There was a soft swelling on the labial mucosa opposite to the lower left premolars. It was sessile, translucent in appearance, approximately 1 cm × 1 cm in size, and was not painful on palpation [Figure 1]. The clinical picture suggested the swelling to be a mucocele.
Figure 1: Extraoral view of mucocele

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After explaining the condition to the patient, various options for the removal of the mucocele were put forth. Subsequent to obtaining a written informed consent from the patient, excision of the mucocele was planned surgically assisted by diode laser. The mucocele was excised using a #15 blade. Hemostasis was achieved using the diode laser followed by placement of sutures [Figure 2] and [Figure 3]. The lesion was sent to the oral pathology laboratory for tissue sectioning and diagnosis, and a diagnosis of a mucous retention cyst was confirmed [Figure 4]. Histopathological finding showed Pale, homogenous, eosinophilic fluid suggestive of mucin surrounded by inflammatory cells [Figure 5].
Figure 2: Surgical excision of the mucocele

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Figure 3: Hemostasis using diode laser

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Figure 4: Specimen collection for histopathological examination

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Figure 5: Pale, homogenous, eosinophilic fluid suggestive of mucin surrounded by inflammatory cells (×40)

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  Discussion Top


Mucocele is an accumulation of mucus within minor salivary glands, resulting in benign cystic lesion. The most common etiological factor for mucocele may be of traumatic origin. The most common site of occurrence of mucocele is the lower lip, followed by the ventral part of the tongue, the vestibule, and buccal mucosa in children.[8] Although mucoceles are benign and simple in their presentation, their differential diagnosis becomes important due to their clinical resemblance with many other benign or malignant swellings and vesiculobullous and ulcerative lesions of the oral cavity.[9] Histopathologically, retention mucoceles are true cysts as the duct has an epithelial lining. Extravasation mucocele is a pseudocyst containing pool of spilled mucin, surrounded by granulation tissue which undergoes fibrosis with time forming a pseudocapsule.[10],[11]

Several studies have been performed to find the prevalence and etiopathogenesis of mucoceles in children, and varied results have been obtained. In a study by Martins-Filho et al. in 2010, they evaluated the clinicopathologic features of pediatric mucoceles diagnosed in two public institutions in Brazil during an 18-year period. Clinical data (age, sex, history of trauma, location, and size) of 138 cases of mucoceles in children 0–16 years of age were obtained from medical records. The results showed that mucoceles made up 24.5% of the oral pediatric lesions diagnosed in the period of study. Age at diagnosis ranged from 0.4 to 16.0 years. The lower lip was the most commonly affected site, and a history of trauma was related by 87% of the patients. Histologically, 96.4% of mucoceles were diagnosed as mucus extravasation phenomenon. Cases of mucus retention phenomenon were relatively more common in the floor of the mouth.[12]

In another study by Bodner et al. in 2015, they characterized the clinicopathologic features of mucoceles in 56 pediatric patients. The age range was 1.5–16 with a male: female ratio of 1:1.33. The intraoral sites were the lower lip (38 [68%]), tongue (10 [18%]), and floor of the mouth (8 [14%]). Of the 56 patients, 44 (79%) were exravasation mucocele (EM) and 12 (21%) were ranulas. No mucous retention types of mucocele were found. Mucoceles ranged from 0.3 to 3.8 cm in diameter. They concluded that in contrast to adults, where both types of mucoceles can be found, among children, most of the cases are of the extravasation type.[13]

Mucoceles are painless, asymptomatic swellings that have a relatively rapid onset and fluctuate in size. In general, small and superficial mucoceles do not require treatment because they often heal after spontaneous rupture. However, in most cases, the treatment of choice is excision. Surgical excision with removal of the involved accessory salivary gland has been suggested as the treatment of choice in many cases since it is an economical procedure. Marsupialization will only result in recurrence.[14] Large lesions are best treated with an unroofing procedure and may be marsupialized to prevent significant loss of tissue or to decrease the risk for significantly traumatizing the labial branch of the mental nerve. If the fibrous wall is thick, moderate-sized lesions may be treated by dissection.[15]

The excision by scalpel is one of the most-often used methods to treat mucocele. It does not require extensive equipment, has negligible cost, and can be performed by most trained dentists. However, the potential for postoperative bleeding is greater than with certain other treatment modalities such as the laser and electrocautery as is the possibility of a more ulcerative appearance and possibly a longer healing period.[16],[17] Hence, in the present case report, after surgical excision procedure of mucocele, hemostasis was achieved using the diode laser.

The key point in avoiding recurrence is to eliminate the adjacent surrounding glandular acini and removing the lesion down to the muscle layer.[6] Special care should be taken to avoid injury to the adjacent glands and ducts while placing sutures as this is also a cause for reappearance.[2] In our report, no recurrence was observed over a period of 9 months along with the absence of any scar tissue post suture removal.


  Conclusion Top


The case report presents a small mucocele lesion on the lower lip which was successfully treated with scalpel excision with added hemostasis achieved by a diode laser. The excision exhibited uneventful healing with no postoperative complications along with the absence of any recurrence. Thus, a simple and easy technique as described here can be applied in the removal of mucoceles in children.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Boneu-Bonet F, Vidal-Homs E, Maizcurrana-Tornil A, González-Lagunas J. Submaxillary gland mucocele: Presentation of a case. Med Oral Patol Oral Cir Bucal 2005;10:180-4.  Back to cited text no. 1
    
2.
Baurmash HD. Mucoceles and ranulas. J Oral Maxillofac Surg 2003;61:369-78.  Back to cited text no. 2
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3.
Guimarães MS, Hebling J, Filho VA, Santos LL, Vita TM, Costa CA, et al. Extravasation mucocele involving the ventral surface of the tongue (glands of Blandin-Nuhn). Int J Paediatr Dent 2006;16:435-9.  Back to cited text no. 3
    
4.
Bentley JM, Barankin B, Guenther LC. A review of common pediatric lip lesions: Herpes simplex/recurrent herpes labialis, impetigo, mucoceles, and hemangiomas. Clin Pediatr (Phila) 2003;42:475-82.  Back to cited text no. 4
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5.
de Camargo Moraes P, Bönecker M, Furuse C, Thomaz LA, Teixeira RG, de Araújo VC, et al. Mucocele of the gland of Blandin-Nuhn: Histological and clinical findings. Clin Oral Investig 2009;13:351-3.  Back to cited text no. 5
    
6.
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.  Back to cited text no. 6
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7.
Gatti AF, Moreti MM, Cardoso SV, Loyola AM. Mucus extravasation phenomenon in newborn babies: Report of two cases. Int J Paediatr Dent 2001;11:74-7.  Back to cited text no. 7
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8.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 3rd ed. Philadelphia: WB Saunders; 2008.  Back to cited text no. 8
    
9.
Bermejo A, Aguirre JM, López P, Saez MR. Superficial mucocele: Report of 4 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:469-72.  Back to cited text no. 9
    
10.
Tran TA, Parlette HL 3rd. Surgical pearl: Removal of a large labial mucocele. J Am Acad Dermatol 1999;40:760-2.  Back to cited text no. 10
    
11.
Kopp WK, St-Hilaire H. Mucosal preservation in the treatment of mucocele with CO2 laser. J Oral Maxillofac Surg 2004;62:1559-61.  Back to cited text no. 11
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12.
Martins-Filho PR, Santos Tde S, da Silva HF, Piva MR, Andrade ES, da Silva LC, et al. Aclinicopathologic review of 138 cases of mucoceles in a pediatric population. Quintessence Int 2011;42:679-85.  Back to cited text no. 12
    
13.
Bodner L, Manor E, Joshua BZ, Shaco-Levy R. Oral mucoceles in children – Analysis of 56 new cases. Pediatr Dermatol 2015;32:647-50.  Back to cited text no. 13
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14.
Ralph E. McDonald, David R. Avery, Jeffrey A, Dean. Dentistry for the Child and Adolescent. 8th ed. Elsevier, A Divisionof Reed Elsevier India Pvt. Limited; 2004.  Back to cited text no. 14
    
15.
Senthilkumar B, Mahabob MN. Mucocele: An unusual presentation of the minor salivary gland lesion. J Pharm Bioallied Sci 2012;4:S180-2.  Back to cited text no. 15
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16.
Harris DM, Gregg RH 2nd, McCarthy DK, Colby LE, Tilt LV. Laser-assisted new attachment procedure in private practice. Gen Dent 2004;52:396-403.  Back to cited text no. 16
    
17.
Cobb CM. Lasers in periodontics: A review of the literature. J Periodontol 2006;77:545-64.  Back to cited text no. 17
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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