International Journal of Science and Healthcare Research Vol.4; Issue: 3; July-Sept. 2019 Website: www.ijshr.com Case Report ISSN: 2455-7587 Surgical Excision of Mucocele in the Lower Lip Region - A Case Report Dr. Saswati Sarmah*, Dr. Roopa D A1*, Dr. Saranik Sarkar*, Dr. Rahul Katiyar* 1Professor and HOD, *Post Graduate Student, Department of Periodontology, Rama Dental College Hospital and Research Centre, Kanpur Corresponding Author: Saswati Sarmah ABSTRACT frequent and are seen particularly in elderly patients. [4] Mucocele is defined as a mucus-filled cyst that On rare occassions, mucoceles are may appear in the oral cavity, appendix, gall seen on the upper lip, retromolar pad and bladder, paranasal sinuses, or lacrimal sac. It palate. Though there is no specific age for results from accumulation of mucus due to mucocele to appear, but they are usually alteration in the minor salivary glands. A 23 yrs [5] old male patient reported with a mucocele on found in 2nd and 3rd decade of life. This the left lower lip area, noticed 3 months back. lesion has no sex predilection and occurs The lesion was excised with scalpel. The patient more frequently in children, adolescents and was reviewed after 3months. No postoperative young adults. Mucoceles appear as discrete, complication or recurrence of the lesion was small, translucent, soft, painless swelling of observed. The diagnosis of the lesion was based the mucosa ranging from normal pink to on the clinical and histological examination. deep blue in color. Tissue cyanosis and vascular congestion associated with Keywords: mucocele, surgical excision, minor stretched overlying tissue and the salivary gland, marsupialisation, histocytes translucency of the accumulated fluid beneath results in the deep blue colour. [6] INTRODUCTION The characteristics features of Mucoceles are the most common mucocele are discrete, small, translucent, disorders of the minor salivary glands soft, painless swelling of the mucosa with a typically presenting as single bluish or color variation of normal pink to deep blue. translucent asymptomatic nodules, [1] Deep blue color is due to tissue cyanosis especially on the lower lip. and vascular congestion, which is a result of On the basis of their microscopic stretching of overlying tissue and the characteristics, these lesions can be translucency of the accumulated fluid. classified as mucous retention or mucous Minor salivary glands are most frequently extravasation cysts, former being associated with mucocele formation. They characterized by the presence of epithelial appear as a fluctuant, bluish, non-tender, tissue while later by a covering with [2] submucosal swelling with a normal granulation tissue. overlying mucosa. Due to higher incidence Mucous extravasation cyst is generally of mechanical trauma in the lower lip regarded as being of traumatic origin, such region, the chance of mucocele formation in as lip biting while the mucous retention cyst this region is very high. [7] results from obstruction of the duct of a [3] minor or accessory salivary gland. CASE REPORT Extravasation mucoceles account for over A 23 years old male visited the 80% of all mucoceles and are more common department of Periodontology, Rama Dental in individuals under 30 years of age. In College Hospital and Research Centre, contrast, retention mucoceles are less International Journal of Science and Healthcare Research (www.ijshr.com) 205 Vol.4; Issue: 3; July-September 2019 Saswati Sarmah et.al. Surgical Excision of Mucocele in the Lower Lip Region - A Case Report Kanpur with the chief complaint of localised After patient’s consent for the swelling in the left lower lip. The patient procedure was obtained, presurgical noticed a small, localized vesicle which has screening was performed. 2ml of anaesthetic reached to the present size within 3 months. solution was infiltrated. Under local No pain was there and patient gave no anesthesia, surgical excision of lesion was history of fever or malaise also. done using scalpel blade and sutures were On clinical examination, the mucosal placed. Specimen was sent for swelling was 7mm in length and 4mm wide. histopathological analysis that confirmed The lesion appeared as vesicular, soft, oval the diagnosis. Patient was recalled at 1day shaped with a sessile base. The surface of and 1 week to check for wound healing. The the lesion had bluish translucent hue. Based patient presented with uneventful healing. on the clinical appearance and history, No post operative oedema or post bleeding provisional diagnosis of mucocele was was reported. made. The lab investigations like HB, TLC The patient was reviewed after 3months. No and DLC were carried out before the postoperative complication or recurrence of excision and the values were found to be the lesion was observed. normal. Fig 1: PRE OPERATIVE Fig 2: DURING PROCEDURE Fig 3: AFTER EXCISION Fig 4: AFTER SUTURING Fig 5: 3 MONTHS POST-OPERATIVE International Journal of Science and Healthcare Research (www.ijshr.com) 206 Vol.4; Issue: 3; July-September 2019 Saswati Sarmah et.al. Surgical Excision of Mucocele in the Lower Lip Region - A Case Report HISTOPATHOLOGICAL APPEARANCE report small fluid filled vesicles on the soft palate, the retromolar pad, the posterior buccal mucosa, and, occasionally, the lower labial mucosa. Generally, small and superficial mucoceles do not require treatment because they often heal after spontaneous rupture. However, excision is the treatment of choice in most of the cases. The lesions can be completely excised, Fig 6: Histopathological Appearance including the associated salivary gland tissue as well as any marginal glands, before The mucocele shows an area of spilled primary closure, reducing the incidence of mucin surrounded by a granulation tissue recurrence. Ranulas can be treated by response with numerous foaming histocytes. marsupialization, but there are high chances The adjacent minor salivary gland of recurrence of extravasation type of containing chronic inflammatory cell mucocele. So, in most cases, the lesions are infiltrate and dilated ducts are seen. treated by excision, including the sublingual [10] gland. DISCUSSION Mucoceles are a fairly common oral Mucoceles can appear either as a pathological condition in children. Although fluid filled vesicle or blister in the not associated with significant morbidity. superficial mucosa or as a fluctuant nodule They can be the cause of discomfort. deep within the connective tissue. There is a Although the recurrence rate is reported to [8] high chance of recurrence of mucocele be about 14%, definitive treatment often especially after draining the inspissated involves excision of the minor salivary mucin from the superficial lesions. The glands. surface of long standing lesions may show Differential diagnosis of mucocele fibrosis. [9] are Blandin and Nuhn mucocele, Ranula, Disturbance in the free flow of saliva Oral Hemangioma, Benign or malignant from the secretory apparatus of salivary salivary gland neoplasms, Oral gland is the most common cause of Lymphangioma, Lipoma, Venous varix or developing mucocele. Traumatic ductal venous lake, Soft irritation fibroma, insult, such as crush type injury and the Gingival cyst in adults, Oral rupture of excretory duct of minor salivary lymphoepithelial cyst, Soft tissue abscess, gland causes extravasation of mucus into the Cysticercosis (parasitic infection), Bullous adjacent soft tissue, which leads to the lichen planus and Minor aphthous ulcers. formation of mucocele. Another possible Superficial mucoceles may be confused mechanism is the severance of acinar with Cicatricial pemphigoid. structure by hypertension from ductal The present case report had no obstruction. systemic involvement although the lesion Mucoceles are painless, was grown larger in size in a short duration. asymptomatic swellings with a rapid onset Hence histological examination was of progression and a fluctuation in size. The conducted to rule out the diagnosis. patient may relate a history of recent or past The lower lip mucocele can be trauma to the mouth or face, or the patient treated by a number of approaches. These may have a habit of biting the lip. Tongue include excision by a scalpel, laser ablation thrusting habit increases the severity of (co2, Er.Cr:YSGG), electrosurgery, lesions present on the anterior ventral cryosurgery, medication (gamma – linolenic surface of the tongue. In addition to trauma, acid[GLA]), micro-marsupialization and patients with superficial mucoceles usually watchful watching if the lesion is not International Journal of Science and Healthcare Research (www.ijshr.com) 207 Vol.4; Issue: 3; July-September 2019 Saswati Sarmah et.al. Surgical Excision of Mucocele in the Lower Lip Region - A Case Report problematic for the patient. This last Aparecida de Andrade Moreira Machado. approach can be used for superficial Surgical excision of mucocele with local mucoceles. Generally, small and superficial anesthesia in an 8-month-old baby, Odontol. mucoceles do not require treatment because Clín.-Cient., Recife, 11 (1) 81-83, jan./mar., they often heal after spontaneous rupture. 2012. 2. Delbem AC, Cunha RF, Vieira AE, Ribeiro Excision is the most common choice of LL. Treatment of mucus retention treatment. Complete excision of the lesion phenomena in children by the along with salivary gland tissue and micro‑marsupialization technique: Case marginal glands reduce the chances of reports. Pediatr Dent 2000;22:155‑8 [6] recurrence. 3. Huang IY, Chen CM, Kao YH, Worthington Large lesions may be marsupialized P. Treatment of mucocele of the lower lip to prevent significant loss of tissue or to with carbon dioxide laser. J Oral Maxillofac decrease the risk for significantly Surg 2007;65:855‑8. traumatizing the labial branch of the mental 4. Yague‑Garcia J, Espana‑Tost AJ, nerve. Moderate-sized lesions with thick Berini‑Aytes L, Gay‑Escoda C. Treatment fibrous wall may be treated by dissection. of oral mucocele‑scalpel versus CO2 laser. Adjacent minor salivary glands must be Med Oral Patol Oral Cir Bucal 2009;14: removed during surgery. e469‑74. 5. Baurmash HD. Mucoceles and ranulas. J In this case report we used surgical Oral Maxillofac Surg 2003;61:369–378.