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Epidemiological Survey of Mucus Extravasation Phenomenon at an Oral Pathology Referral Center During a 43 Year Period

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Epidemiological Survey of Mucus Extravasation Phenomenon at an Oral Pathology Referral Center During a 43 Year Period Braz J Otorhinolaryngol. 2016;82(5):536---542 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org ORIGINAL ARTICLE Epidemiological survey of mucus extravasation phenomenon at an oral pathology referral center ଝ during a 43 year period a b Thâmara Manoela Marinho Bezerra , Bárbara Vanessa de Brito Monteiro , c d Águida Cristina Gomes Henriques , Marianne de Vasconcelos Carvalho , e f,∗ Cassiano Francisco Weege Nonaka , Márcia Cristina da Costa Miguel a Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil b Universidade Federal de Campina Grande (UFCG), Campina Grande, PB, Brasil c Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil d Universidade de Pernambuco (UPE), Arcoverde, PE, Brazil e Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil f Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil Received 1 June 2015; accepted 11 September 2015 Available online 6 January 2016 KEYWORDS Abstract Introduction: Mucocele; Mucoceles are common benign pseudocystic lesions of the oral cavity; their Ranula; main etiological factors are trauma and ductal obstruction. Tw o histological patterns are Minor salivary glands found: mucus retention phenomenon (MRP) and mucus extravasation phenomenon (MEP). Mucus extravasation phenomenon is the more common histological subtype and it mainly affects the lower lip. The knowledge of its main clinical features and management is important to assist health professionals in clinical practice. Objective: This study aimed to determine the relative frequency and distribution of oral muco- celes in an oral pathology reference center. Methods: Cross-sectional historical study that analyzed all cases pathologically diagnosed as mucus extravasation phenomenon by the department of anatomic pathology of an oral pathology referral center from June of 1970 to May of 2014, considering the clinical characteristics of the lesion and those relating to the patient. SPSS v. 20.0 software for Windows was used for descriptive analysis. Results: During 43 years, 719 cases of mucus extravasation phenomenon (54.7% men and 45.3% women) were registered, with the lower lip as the most commonly affected site (n = 484; 67.3%). ଝ Please cite this article as: Bezerra TM, Monteiro BV, Henriques AC, de Vasconcelos Carvalho M, Nonaka CF, da Costa Miguel MC. Epidemi- ological survey of mucus extravasation phenomenon at an oral pathology referral center during a 43 year period. Braz J Otorhinolaryngol. 2016;82:536---42. ∗ Corresponding author. E-mail: [email protected] (M.C. da Costa Miguel). http://dx.doi.org/10.1016/j.bjorl.2015.09.013 1808-8694/© 2015 Associac¸ao˜ Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.´ Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Epidemiological survey of mucus extravasation phenomenon 537 The average age of patients was 20.8 years (SD ± 14.4) with a peak occurrence in the second decade of life. Most professionals had oral mucocele/ranula (n = 606; 84.3%) as the initial clinical impression. Conclusion: Mucus extravasation phenomenon is a lesion that primarily affects young patients, affecting mainly the lower lip, and is commonly found in oral diagnostic services. © 2015 Associac¸ao˜ Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.´ Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). PALAVRAS-CHAVE Levantamento epidemiológico de fenômeno de extravasamento de muco de um Mucocele; centro de referência em patologia oral por um período de 43 anos Ranula; Resumo Glândulas salivares Introduc¸ão: menores Mucoceles são lesões pseudocísticas benignas comuns da cavidade oral, que possuem como principais fatores etiológicos trauma ou obstruc¸ão ductal. Dois padrões histopatológicos são encontrados: fenômeno de retenc¸ão de muco (FRM) e fenômeno de extravasamento de muco (FEM). O FEM é o subtipo histológico mais comum e tem como principal local de acometimento o lábio inferior. O conhecimento acerca de suas principais característi- cas clínicas e formas de tratamento se faz importante para auxiliar profissionais da saúde na prática clínica. Objetivo: Este trabalho objetivou determinar a frequência relativa e a distribuic¸ão das muco- celes orais em um centro de referência em patologia oral. Método: Estudo transversal de caráter histórico, no qual foram analisados os casos diagnosti- cados histopatologicamente como FEM pelo servic¸o de anatomia patológica de um centro de referência em patologia oral, no período de junho de 1970 a maio de 2014, considerando-se variáveis clínicas da lesão e relativas ao paciente. O programa estatístico SPSS 20.0 for Windows foi utilizado para a análise descritiva dos dados. Resultados: Durante 43 anos foram observados 719 casos de FEM (54,7% homens e 45,3% mul- heres), sendo o lábio inferior (n = 484; 67,3%) o local de principal acometimento. A média de idade dos pacientes foi de 20,8 anos (DP ± 14,4), com um pico de ocorrência na segunda década de vida. A maioria dos profissionais teve mucocele oral/rânula (n = 606; 84,3%) como primeira hipótese clínica. Conclusão: O FEM é uma lesão que afeta principalmente pacientes jovens, acometendo pref- erencialmente o lábio inferior, sendo comumente encontrada nos servic¸os de diagnóstico oral. © 2015 Associac¸ao˜ Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.´ Publicado por Elsevier Editora Ltda. Este e´ um artigo Open Access sob uma licenc¸a CC BY (http:// creativecommons.org/licenses/by/4.0/). 1 Introduction mucocele: the mucus retention cyst or sialocyst. Most of these grow from major salivary glands and ducts and have Mucoceles are common benign pseudocystic lesions of the the following etiological factors: sialolithiasis, periductal 5,7 oral cavity that develop secondary to leakage or retention of scarring, or invasive tumors. Histopathologically, MRP are mucous material from salivary glands, principally the minor characterized by epithelium lining coming from the partially 1 4 salivary glands. These lesions account for 70% of cystic and obstructed salivary duct. pseudocystic lesions of the salivary glands, thus they can Clinically, there is no difference between the mucus appear anywhere on the oral mucosa where there is a sali- extravasation and retention phenomena, and both present 1,2 vary gland. with increased volume of cystic appearance, are painless, 2 Etiologic factors involved in mucocele formation include soft to palpation, and show a transparent bluish color. The 3,4 trauma and ductal obstrction, which may lead to forma- most common site of extravasation mucoceles is the lower tion of two histological presentations: the phenomenon of lip, which is also the most susceptible place to injuries. Such 1,5 2,5 mucus retention or extravasation. The mucus extravasa- location is less common in retention mucoceles, which 8 tion phenomena (MEP) are actually pseudocysts, as they are may affect any other site of the oral cavity. Extravasation devoid of epithelial lining. The extravasated mucus induces mucoceles affect young patients (20---30 years) and usually an inflammatory and granular reaction in an attempt to resolve spontaneously, requiring surgical excision in some 4,6 2 contain the extravasation. This type of mucocele is com- cases. Micro-marsupialization, cryosurgery, steroid injec- 7 monly found in minor salivary glands. The mucus retention tions, and CO2 laser have been described as treatments 2,5,8,9 phenomenon (MRP) induces formation of another type of available for these lesions. 538 Bezerra TM et al. The aim of this study was to perform an epidemiological Table 2 Distribution of absolute and relative frequencies survey of oral mucocele cases diagnosed in the Department according to skin color of patients affected by oral mucocele. of Anatomic Pathology of the Oral Pathology Discipline of a university in the period of 1971---2014, as well as to describe Skin color Number (n) Percentage (%) the main clinical characteristics and treatment, in order to Leucoderma 348 48.4 assist health professionals in clinical practice. Melanoderma 135 18.8 Feoderma 133 18.5 Methods No information 103 14.3 Total 719 100 Cross-sectional, retrospective, historical study, approved by the Research Ethics Committee under No. #675,422, that included 719 cases of oral mucoceles selected from 11,589 formation of the lesion (23.6%) and only 7.2% reported at cases recorded in the files of the Pathologic Anatomy Labo- the time of the interview that they noticed the lesion show- ratory between June of 1970 and May of 2014. ing variation in size during the clinical course (Table 3). The collection procedure was based on the information Upon first contact with the lesion, most dentists listed oral in the histopathology reports and medical records of biop- mucocele/ranula (84.3%) as their first clinical impression sies, which were transcribed into a standard file developed (Table 4). Ultimately, excisional biopsy was the treatment specifically for this analysis. The assessed variables related of choice for most lesions (83.3%). to the patient were gender, age, and race. Regarding clinical features of oral mucocele, the following data were col- Discussion lected: lesion location, shape of the main lesion, surface, symptoms, duration, size, history of trauma, size variation, The incidence of mucocele is generally high in the popu- clinical diagnosis, and type of biopsy performed. It is note- 2
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