Available Online at http://www.recentscientific.com International Journal of CODEN: IJRSFP (USA) Recent Scientific

International Journal of Recent Scientific Research Research Vol. 11, Issue, 01(E), pp. 36963-36966, January, 2020 ISSN: 0976-3031 DOI: 10.24327/IJRSR RESEARCH ARTICLE

ORAL MUCOCELE- AN ENIGMA

Dr.Thasneem AA, Dr.ManjushreeKadam, Dr.Shreerashmi Nambiar P Dr.MeghaVanasi, Dr.Missriya and Dr. Nidha Begum

Postgraduate A.J Institute of Dental Sciences Mangalore

DOI: http://dx.doi.org/10.24327/ijrsr.2020.1101.5033

ARTICLE INFO ABSTRACT

Article History: Mucocele is defined as a mucus filled that can appear in the oral cavity, appendix, gall bladder, paranasal sinuses or lacrimal sac. They are formed either as a result of trauma or obstruction of a Received 6th October, 2019 th . This case report presents a 16 year old male patient who reported with the chief Received in revised form 15 complaint of painless swelling since 3 months .A complete successful excision of the was November, 2019 performed using a diode laser. Biopsy reports confirmed the diagnosis as extravasation mucocele. Accepted 12th December, 2019 th Among all the available treatment options, CO2 laser treatment has shown more benefits with less Published online 28 January, 2020 relapse.

Key Words:

They are formed either as a result of trauma or obstruction of a salivary gland duct.

Copyright © Dr.Thasneem AA et al, 2020, this is an open-access article distributed under the terms of the Creative Commons

Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is

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INTRODUCTION Etiopathogenesis

Mucocele is defined as a mucus filled cyst that can appear in The two important etiological factors are (Yamasoba et al., (5) the oral cavity, appendix, gall bladder, paranasal sinuses or 1990) 1 lacrimal sac. The term mucocele is derived from a latin word, 1. Trauma and mucus and cocele means cavity. It is seventeenth most common 2. Obstruction of salivary gland duct. salivary gland seen in the oral cavity. They are formed secondary to rupture of an excretory duct of a salivary gland, Extravasation mucoceles are commonly found on the minor which results in an outpouring of saliva into the surrounding salivary glands and is caused due to the leaking of fluid from and the accumulation of mucus causes limited swelling. surrounding tissue ducts or acini. Pooling of saliva in the adjacent submucosal tissue can occur due to physical trauma Types too, that finally leads to (4).

Two types of mucocele can appear - Extravasation and A study done by Bagan et al (6) showed a higher incidence of Retention mucocele. extravasation cyst (95%) compared to retention cyst (5%).

Extravasation mucocele - results from a broken salivary glands The three evolutionary phases of extravasation mucoceles: 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 (2) .

Mucocele is referred as as it resembles the ‘cheeks of a frog’ when appeared in the floor of the oral cavity(3).A ranula manifests as a cup-shaped fluctuant bluish swelling on the floor of the oral cavity and generally tends to be larger than mucoele in other regions of the (4).

*Corresponding author: Dr.Thasneem AA Postgraduate A.J Institute of Dental Sciences Mangalore Dr.Thasneem AA et al., Oral Mucocele- an Enigma

Pathogenesis of retention cyst: complete excision was performed using soft diode laser in wavelength of 940nm,400µm diameter tip at 1.5W in continuous mode . (Fig 2) The tissue was sent for biopsy. Based on the clinical features, a provisional diagnosis of Traumatic Cyst was done.The patient was recalled for re evaluation after a week.Healing was satisfactory(Fig 4) and no recurrence was observed after 15 days.

Clinical Characteristics

Mucocele is one of the most common salivary gland disorders and is the second most common benign soft tissue tumor in the (4) oral cavity . It commonly occurs in lower , followed by the (9) and is also seen in other locations. It is generally seen Fig 2 Immediate post operative equally in males and females in first, second and third decade of life but rarely among children under one of year of age. The lesion is seen unilaterally and rarely bilateral and is more common in white subjects(9). Mucoceles in general appears as a bluish, soft and transparent cystic swelling that frequently resolves spontaneously.The bluish discoloration is due to the vascular congestion, cyanosis of the tissue above and the accumulation of fluid below. Coloration also depends on the size of the lesion, its proximity to the surface and upper tissue elasticity (4,7).Sizes may vary between millimetres to centimeters .

Case Report

A 16- year old male patient reported with the chief complaint of a painless swelling in the lower lip region since 3 months. Fig 3 Excised tissue On examination a nodular overgrowth measuring 3mm x1.5mm was seen in the lower lip irt 42 and 43. (Fig 1) was present. Trauma from occlusion was elicited. It was Non fluctuant on palpation. There were no systemic conditions present.

Fig 4 1 week post operative

Histopathologic Evaluation

A histopathologic study is crucial to confirm the diagnosis. Extravasation mucoceles are pseudocysts without defined Fig 1 walls. Surgical Procedure The H & E stained section showed an overlying and In the Phase I Therapy, Complete ultrasonic scaling was done. . A large space pooled with mucinous material A local infiltration of 1:2,00,000 lignocaine was given. The was seen in the connective tissue with focal mucinophages and incision was placed on the uppermost site of the lesion and a chronic inflammatory cells. The surrounding connective tissue was fibrosed. (Fig 5) 36964 | P a g e International Journal of Recent Scientific Research Vol. 11, Issue, 01(E), pp. 36963-36966, January, 2020

The lip comprises of adipose tissue, blood vessels, nerves, In the case of retention mucoceles a cyst cavity can be found, connective tissue and salivary gland. Thus considerations this is generally well defined with an epithelial wall covered should be given to pathosis or swelling of any of these tissues with a row of cuboidal or flat cells produced from the excretory as seen in benign or malignant salivary gland neoplasms,Oral duct of the salivary glands. Compared to extravasation Hemangioma, Oral Lymphangioma, Venous varix or venous mucoceles, retention mucoceles show no inflammatory reaction lake, , Soft irritation ,Oral lymphoepithelial and are true with an epithelial covering. Hence the final cyst, in adults, Soft tissue abscess or diagnosis of extravasation mucocele was made. (7) Cysticercosis (parasitic infection) .

Differential diagnosis for superficialmucoceles are most commonly Cicatricialpemphigoid, Bullous and Minor aphthous ulcers. These can be differentiated from mucocele on lower lip, based on various clinical, radiographic examination.

Treatment

Conventional treatment is the most commonly used to treat this lesion. It involves surgical extirpation of the surrounding mucosa and glandular tissue down to the muscle layer. A simple incision of the mucocele drains out the lesion but reappears as soon as the wound heals(13).Superficial extravasation mucoceles doesn’t require any treatment as it resolves spontaneously.

Small mucoceles can be removed completely with the marginal glandular tissue before suture. Marsupialization is done for

large mucoceles to avoid damage to vital structures. Both the Fig 5 types of mucoceles are treated in the same manner as there is (1,2) DISCUSSION no clinical difference in each . When an obstruction of retention mucoceles is detected ,treatment involves the The appearance of mucoceles is pathognomonic and the introduction of a lacrimal catheter into the duct to dilate it(4,14) . following data are crucial: lesion location, history of trauma, It is important to remove the surrounding glandular acini while rapid appearance, variations in size, bluish colour and the removing the mucocele surgically. Its important to avoid the consistency. They are mobile lesions with soft and elastic adjacent gland and any damage to duct while placing the consistency depending on how much tissue is present over the suture. This reduces the chances of recurrence of mucocele. If lesion. Despite this fluctuation, a drained mucocele would not the fibrous wall of the mucocele is thick, its necessary to rule fluctuate and a chronic mucocele with a developed fibrosis out any salivary gland neoplasms using histopathological would have less fluctuation. examination of the excised tissue. Cryosurgery, CO2 laser

Diagnosis ablation, intralesional corticosteroid injection, marsupialization and electrocautery are the other treatment options. The The location of the lesion, history of trauma, rapid appearance, advantage of CO2 laser is, it allows rapid, simple mucocele variations in size, bluish colour and the consistency helps in the ablation. It also minimizes the recurences and further diagnosis of such pathognomonic lesions(7,10,11).Mucoceles are complications.CO2 laser is indicated for patients unable to soft, mobile and elastic in consistency depending on the tissue tolerate long procedures (15). present over the lesion (7).The diagnosis of superficial mucocele can be done with the help of history and clinical findings. Mucoceles in pediatric patients are treated by micromarsupilization since the technique is simple, rapid and Techniques such as fine needle aspiration biopsy demonstrates (16) (12) has shown less chances of recurrence . the mucus retention, histiocytes and inflammatory cells .A well-defined epithelial wall is present in a retention type of Conventional treatment is commonly surgical extirpation of the mucocele and thus it shows less inflammatory reaction whereas surrounding mucosa and glandular tissue down to the muscle extravasation type is a pseudocyst without epithelial wall .Thus layer. Treatment options include-Cryosurgery, Laser ablation, extravasated mucous is surrounded by a layer of inflammatory intralesional corticosteroid injection, marsupialization and cells and then is well encapsulated by a reactive granulation electrocautery. tissue made up of fibroblasts caused by an immune reaction(2,3,4,11).Chemical analysis shows high amylase and The advantage in laser is that it minimizes the recurrences and protein content. Radiographic techniques such as computed complications and allows rapid, simple mucocele ablation. (García et al 2009). tomography and magnetic resonance imaging help in localization of these lesions. CONCLUSION

Mucocele is the most common benign self-limiting condition mainly affecting the lower . It generally affects the young Differential Diagnosis of Mucocele males and seen in first to third decade of life. Trauma is the main and common etiological factor. Most of the lesions are 36965 | P a g e Dr.Thasneem AA et al., Oral Mucocele- an Enigma diagnosed clinically but sometimes neoplasm and other lesions 9. De Camargo Moraes P, Bönecker M, Furuse C, Thomaz has to be ruled out with the help of biopsies. Among all the LA, Teixeira RG, de Araújo VC. Mucocele of the gland available treatment options, CO2 laser treatment has shown of Blandin-Nuhn: histological and clinical findings. Clin more benefits with less relapse. Oral Investig. 2009 ;13:351-3. 10. Andiran N, Sarikayalar F, Unal OF, Baydar DE, References OzaydinE .Mucocele of the anterior lingual salivary

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How to cite this article:

Dr.Thasneem AA et al.2020, Oral Mucocele- an Enigma. Int J Recent Sci Res. 11(01), pp. 36963-36966. DOI: http://dx.doi.org/10.24327/ijrsr.2020.1101.5033

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