ABSTRACT- Mucocele is a commonly found benign, mucus-containing cystic lesion of the minor salivary gland caused
due to the damage or blocking of the glands. The damaged duct causes the saliva to build up and a cyst like swelling
ensues. Histologically they are of two types: Extravasation cyst and Retention cyst. Clinically they present themselves as
soft, bluish and transparent cyst like swelling especially on the lower lip. This case report presents a case of a 35 year old
male patient reporting with a soft bluish swelling on the inside of the lower lip. The history revealed the patients habit of
biting on the lower lip hence a differential diagnosis of mucocele, oral hemangioma, oral lympangioma, lipoma, and soft
tissue abscess was made. Fine needle aspiration cytology showed increase in amylase and protein content. A final
diagnosis was formulated as mucocele from the history of trauma, clinical features, and investigation (chemical analysis).
Complete excision of the lesion was done and sent for histopathological investigation which revealed a mucin-filled
cyst-like cavity beneath the mucosal surface. The patient was kept under observation for 3 months. The healing was
devoid of any scar formation commonly associated with such surgery’s. There was no recurrence of the cyst after 6
months. Alternative treatment modalities are cryosurgery, intralesional steroid injections.
Key-words- Mucocele, Cyst, Salivary Retention, Salivary glands, Duct
INTRODUCTION-
The movement of saliva from the salivary glands into the
mouth is through tiny tubes (ducts). One of these tubes/
ducts can become damaged or blocked. This most often
happens if the patient repeatedly bites or suck on the lower
lip or cheek. The "head-on collision" during games like
football or basketball may also cause damage or disrupt the
ducts.
Mucus seeps out, pools, becomes walled off from the
damage duct and causes a cyst-like swelling. A similar
build-up happens when the duct has become blocked. This
build up of mucous in a sac is called a mucoceal. A
mucocele is a benign, mucus-containing cystic lesion of the
minor salivary gland.
Oral mucocele (also termed mucous retention cyst, mucous
extravasation cyst, mucous cyst of the oral mucosa, [1] and mucous retention and extravasation phenomena) is a
common lesion of the oral mucosa that results from an
alteration of minor salivary glands due to mucus
accumulation causing limited swelling. [2] It is a clinical
term that refers to two related phenomena:
- Mucus extravasation phenomenon
- Mucus retention cyst
Extravasation mucoceal results from a broken or ruptured
salivary gland duct mostly due to trauma and consequent
spillage into the soft tissue around this gland they are
a swelling of connective tissue consisting of a collection of
fluid called mucin.
Retention mucocele appears due to decrease or absence of
glandular secretion produced by blockage of salivary gland
ducts.
[3-4] The histological difference between extravasation
and retention cyst is that the extravasation type has no
epithelial lining and is formed by a mucus pool surrounded
by granulation tissue and the retention cyst has an epithelial
lining.
[5-6]
Although the term cyst is often used to refer to
these lesions, mucoceles are not strictly speaking true cysts
because there is no epithelial lining.
[3]Rather, it would be
more accurate to classify mucocelesas polyps (i.e. a lump).
[7]
SIGNS AND SYMPTOMS-
The size of oral mucocele varies from 1 mm to several
centimetres and they usually are slightly transparent with a
blue tinge. On palpation, mucoceles may appear fluctuant
but can also be firm. Their duration lasts from days to
years, and may have recurrent swelling with occasional
rupturing of its contents.
Locations-
Mucocele are most commonly found in the inner surface of
the lower lip. They can also be found on the inner side of
the cheek (known as the buccal mucosa), on the anterior
ventral tongue, and the floor of the mouth. When found on
the floor of the mouth or on the frenulum on the tongue
themucoceal is referred to as a ranula. They are rarely
found on the upper lip. As their name suggests they are
basically mucus lined cysts and they can also occur in the
Para nasal sinuses most commonly the frontal sinuses, the
frontoethmoidal region and also in the maxillary sinus.
Sphenoid sinus involvement is extremely rare. When the
lumen of the vermiform appendix gets blocked due to any
factor, again a mucocele can form.
CASE REPORT-
A 35-year-old male patient visited the dental office with a
chief complaint of swelling in the left inner aspect of
thelower lip for the past 9 months. History revealed that he
had a history of trauma to the chin before 9 months and had
mild laceration in that site which healed on its own. Three
months later, He developed a small swelling which
gradually increased in size. He also gave a history of
traumatizing the swelling by often biting the lesion between
the teeth, there was no associated pain. Past medical and
dental history was not contributory. On extra oral
examination, there was mild asymmetry of the left side of
the lower lip [Fig. 1].
Figure 1: Extra Oral View
On intraoral examination, a solitary, well-defined,
dome-shaped swelling was seen on the left side of the inner
surface of the lower lip measuring around 3×2 cm in size,
which was oval in shape, with a smooth surface and a
bluish translucent hue [Fig. 2].
Figure 2: A Solitary, Well-defined, Dome-shaped
swelling on Lower Lip
The swelling was soft in consi stency, non-tender, fluctuant,
compressible, non-reducible, and non-pulsatile, with no
increase in temperature. A differential diagnosis of
mucocele, oral hemangioma, oral lympangioma, lipoma,
and soft tissue abscess was made. Fine needle aspiration
cytology (FNAC) was done, and 1 ml of thick, viscous,
sticky, and blood-mixed mucus secretion was collected and
sent for chemical analysis which showed increase in
amylase and protein content. A final diagnosis was
formulated as mucocele from the history of trauma, clinical
features, and investigation (chemical analysis).
Complete excision [Fig. 3] was done and sent for
histopathological investigation which revealed a
mucin-filled cyst-like cavity beneath the mucosal surface
[Fig 4, 5]. The patient was kept under observation for 3
months with no recurrence.
                         
                       
Figure 3: Total Excision of the Mucocel3
                                                                                     
Figure 4: Ennucleated Mucocele
Figure 5: Post Operative Extra Oral View
DISCUSSION-
Mucoceles are mucus containing cystic lesions of the minor
salivary glands; they are the 15
th common oral mucosal
lesion with a prevalence of 2.4 cases per 1000 people.
Mucoceles occurs in young individuals, with 70% of them
being younger than 20 years. Superficial mucoceles tend to
occur in individuals older than 30 years and ranula occur in
children and young adults. Mucus retention cysts occur in
older individuals; prevalence occurs in persons aged 50–60
years. Lower lip is the most common site of occurrence,
followed by tongue, floor of mouth (ranula), and the buccal
mucosa.
[6-7]
The clinical appearance of a mucus cyst is a distinct,
fluctuant, painless swelling of the mucosa. About 75% of
the lesions are smaller than 1 cm in diameter; however,
rarely, the size can vary from few millimetres to several
centimetres. Superficial lesions take on a bluish to
translucent hue, whereas deep lesions have normal mucosal
coloration and bleeding into the swelling may impart a
bright red and vascular appearance. The patient may relate
a history of recent or past trauma to the mouth or face or
the patient may have a habit of biting the lip. The v
arious differential diagnoses are Blandin and
Nuhnmucocele, oral haemangioma, oral lymphangioma,
lipoma, and soft tissue abscess.
Some authors have suggested cryosurgery
[8], intralesional
steroid injections & CO
2 lasers
[6] as alternative treatment
modalities. The complications noted with surgical removal
are temporary paresthesia, fibrous scar formation &
recurrence of the lesion.
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