CASE REPORT

Oral Mucocele : A Case Report

Nitin Singh*, Pratik Chandra**, Sugandha Agarwal***

Abstract
The Mucocele or Mucus retention phenomenon is a salivary gland lesion of traumatic origin,
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, followed by the floor of mouth and buccal mucosa being
the next most frequent sites.
(Singh N, Chandra P, Agarwal S. Oral Mucocele : A Case Report. www.journalofdentofacialsciences.com,
2014; 3(1): 47-50.

Key words: Mucocele, Cyst, Salivary gland, Mucus, Extravasation, Retention phenomenon

Introduction occur more frequently in children, adolescents and

Mucoceles (Mouco-mucus and coele-cavity),
are cavities filled with mucus1.They are one of the
most common benign soft tissue masses that occur
in the oral cavity. Mucoceles are traumatic in
origin. They are most commonly found on the
lower lip, lateral to the midline2. They are rarely
seen on the upper lip, retro molar pad or palate.
They may occur at any age, but are seen most
frequently in the second and third decade of
life3.These lesions have no sex predilection and
*Senior Lecturer, Department of Pediatric & Preventive
Dentistry, Saraswati Dental College, Lucknow
**Senior Lecturer, Department of Orthodontics,
Saraswati Dental College, Lucknow
***Senior Lecturer, Department of Public Health
Dentistry, BBDCODS, Lucknow, U.P.
Address for Correspondence:
*Dr. Nitin Singh
e-mail: drsinghnitin@gmail.com
young adults. Mucoceles can be single or multiple
often rupturing and leaving slightly painful
erosions that usually heal within few days4.They
are either the extravasation type or the retention
type. The mucous extravasation phenomenon is
the term used when there is spillage of mucin into
the connective tissue around the gland. The term
mucous retention cyst is used to describe a cyst
with retained mucin which is lined by ductal
epithelium5.
Case report
A 10 year old female child reported to the
Department of Pediatric and Preventive Dentistry
in Saraswati Dental College Lucknow, U.P India.
She came with a chief complaint of painless
swelling on right side of lower lip (Fig.1). The
history of present illness consisted of swelling in
inner aspect of lower lip in relation to right central
incisor region since 2 to 3 months. A detailed
history elicited from the accompanying parent
showed etiology to be trauma from lip biting. The
48 Singh et al.

child was observed nonchalantly to see whether lip sutures were placed (Fig 4). Regular recall and
biting or sucking is present as a habit. Examination checkup for the reoccurrence of the lesion was
of swelling showed it to be oval in shape, soft, done.
fluctuant, palpable with no increase in
temperature. It was blue in color and symptomless.
The lesion was 1cm in diameter and superficially
placed in the inner aspect of labial mucosa of the Fig. 3:
lower lip (Fig.1). Mucocele

Fig. 1:
Mucocele
swelling

Fig. 4:
Sutures
placed
The patient did not have any difficulty in
speech. The child had mixed dentition with
calculus and no obvious malocclusion. The lab
investigations like HB, TLC and DLC were
conducted and the values were found to be Histopathology
normal. The differential diagnoses were Oral Microscopically Mucocele showed a cystic
ranula, Oral lymphangioma Oral haemangioma cavity containing eosinophilic mucinous material
and Minor aphthous ulcers. The Final diagnosis and was lined by compressed fibrous tissue as well
was formulated as a Mucocele on the basis of the as granulation tissue with fibroblasts, few blood
history of the Lip biting habit, clinical features and vessels and acute and chronic inflammatory cells.
histopathological findings. The treatment planning Minor salivary gland ducts were also present in the
consisted of the surgical removal of the lesion. proximity to the cavity; few of them were filled
EMLA was applied for 5 minutes to attain with mucinous material. (Fig. 5)
psychological and pharmacological benefits which
were followed by local anesthesia. An incision was
placed vertically (Fig 2); therefore splitting the
overlying mucosa and separating the lesion from Fig. 5: Cystic
the mucosa. cavity with
granulation
tissue &
surface
epithelium
Fig. 2: Removal
of lesion

Discussion
Mucoceles may be located either as a fluid
filled vesicle or blister in the superficial mucosa or
The Mucocele was resected (Fig 3) from the
as a fluctuant nodule deep within the connective
base so that chances of reoccurrence are less,
tissue3. Mucoceles appear as discrete, small,

www.journalofdentofacialsciences.com Vol. 3 Issue 1

Singh et al.
translucent, soft, painless swelling of the mucosa
ranging from normal pink to deep blue in
color4.The development of Mucoceles usually
depends on the disruption of the flow of saliva
from the secretory apparatus of the salivary glands.
The lesions are most often associated with mucus
extravasation into the adjacent soft tissues caused
by a traumatic ductal insult, which may include a
crush-type injury and severance of the excretory
duct of the minor salivary gland6, 7.
Mucoceles have no age predilection but mainly
occur in the children and young adults due to
more chances of trauma2. The lower lip is reported
to be the most common site where the maxillary
canine impinges on it. Less common sites for the
occurrence are buccal mucosa, anterior lateral
tongue, floor of mouth. In our case the site of the
lesion is lower lip6. The patient may relate a history
of trauma or a habit of lip biting. These vesicles
rupture spontaneously and leave ulcerated surface
that heals within a few days. Their deep blue color
results from tissue cyanosis and vascular
congestion associated with the stretched overlying
tissue and translucent character of the
accumulated mucin beneath. The variation of the
color depends upon the size of the lesion, its
proximity to the mucosal surface and the elasticity
of the overlying tissue.5 Histologically, mucocele
are of two types mucous extravasation and
mucous retention phenomena, depending on
presence of epithelial lining. In children prevalence
of mucous retention phenomena is low due to
inability of ductal structure to contain an
exaggerated accumulation of secretion8, 9. Whereas
as mucous extravasation is common in children
because extravasated saliva is first surrounded by
inflammatory cell followed by granulation tissue
composed mainly of fibroblast due to absence of
epithelial lining, this phenomenon is categorized as
a pseudocyst or false cyst10. The various
differential diagnosis are Blandin and Nuhn
mucocele, Benign or malignant salivary gland
neoplasm, Oral Hemangioma, Oral
Lymphangioma, Venous varix, Soft irritation
fibroma, Gingival cyst , Soft tissue abscess.
Superficial mucoceles may be confused with
Cicatricial pemphigoid, Bullous lichen planus and
Minor aphthous ulcers5. The history, clinical
www.journalofdentofacialsciences.com
49
findings and histopathological evaluation lead to
the diagnosis of a Superficial Mucocele. The
localization and determination of the origin of the
lesion can be done by Computed tomography
scanning and magnetic resonance imaging.11, 12.
Surgical excision with removal of the involved
accessory salivary gland has been suggested as the
treatment both the Mucocele are treated in same
manner. Acc to Pedron et al, mucocele can be
treated by conventional surgery, cryo therapy,
carbon dioxide laser surgery or Nd:Yag laser
vaporisation13. The diode laser can be useful if the
lesion contains a vascular area which could result
in post treatment hemorrhage. Fibrotic lesions or
lesions which do not contain any pigment may be
more effectively removed using the Erbium laser14.
Small mucocele can be removed with marginal
glandular tissue but in case of large mucocele
marsupilization can be done prevent vital
structures primarily labial extension of mental
nerve8. EMLA is effective as a Pediatric local
anesthesia and for minor soft tissue surgical
procedures15. Reoccurrence can be avoided by
removing adjacent surrounding glandular acini
and removing the lesion down to the muscle
layer16,17. Special care should be taken to avoid
injury to adjacent glands and ducts while placing
sutures as this also causes reappreance8.
Conclusion
Mucocele are one of the most common soft
tissue lesions of the oral cavity which cause distress
and discomfort to the patient. Out of many
advanced treatment modalities simple surgical
excision with care is the treatment of choice that
can relieve the patient fear and anxiety.
References
1. Gupta Bhavna, Anegundi R., Sudha P., Gupta
Mohit Mucocele: Two case reports J Oral Health
Comm Dent2007; 1(3): 56-58
2. Yamasoba T, Tayama N., Syoji M., Fukuta M.,
Clinicostatastical study of lower lip mucoceles.
Head Neck. 1990; 12:316-20
3. Mc Donald, Avery &Dean: Dentistry for the child
and adolescent, Eighth edition, Mosby, 2004.
4. Kheur Supriya, Desai Rajiv, Kelkar Chintamani
Mucocele of lingual salivary glands (Glands of
Blandin & Nunh)
Vol. 3 Issue 1
50
5. Ata-Ali J, Carrillo C, Bonet C et al Oral mucocele:
Review of the literature J Clin Exp. Dent 2010; 2
(1):10-13
6. Baurmash HD. Mucoceles and ranulas. J Oral
Maxillofac Surg. 2003;61:369-78.
7. Guimares MS, Hebling J, Filho VA, Santos LL,
Vita TM, Costa CA. Extravasation mucocele
involving the ventral surface of the tongue (glands
of Blandin-Nuhn). Int J Paediatr Dent. 2006;
16:435-9.
8. Layfield LJ, Gopez EV. Cystic lesions of Salivary
glands; Cytologic features in fine needle aspiration
biopsies: Diagn Cytopathol 2002; 27: 197-204
9. Marcushmar m, king DL, Ruano NS. Cryosurgery
in management of Mucocele in children. Pediatr
Dent. 1997;19:292-293
10. Martin PS, Santos T, Piva MR, Andrade EA
Clinicopathologic review of 138 cases in pedtric
population. Quint Int 2001; 42(8):679-85
11. Anastassov GE, Haiavy J, Solodnik P, et al.
Submandibular gland mucocele: diagnosis and
www.journalofdentofacialsciences.com
Singh et al.
management. Oral Surg Oral Med OralPathol Oral
Radiol Endod 2000;89(2):159-63.
12. Yamasoba T, Tayama N, Syoji M, Fukuta M
Clinicostatistical study of lower lip mucoceles. Head
Neck 1990;12(4):316-20.
13. Tanure NP, Silvia PD, Primo LG, Maia LC.
Management o oral Mucocele in 6 month old child.
Braz J Health 2010; 1: 210-214
14. Singh N, Chandra P, Agarwal S. Therapeutic Uses
of Laser in Pedodontics. Journal of dento facial
sciences, 2013; 2(3): 41-46
15. Singh N, Agarwal S, Bhagchandani J, Chandra P,
Gaur A. Painless Anesthesia: A New Approach.
Journal of dento facial sciences, 2013; 2(2): 49-55
16. De Camargo Moraes P, Bonecker M, Feruse C,
Thomez LA, Teixeria RG, De Arujovc. Mucocele of
the gland of blandin- Nuhn. Histological and
clinical findings. Clin Oral Investig 2009;13: 351-53
17. Tran TA, Parlette HL iii. Surgical pearl: removal of
a large labial Mucocele. J Am Acad Dermatol
1999;40: 760-62
Vol. 3 Issue 1