DIAGNOSIS : Mucocele
DISCUSSION
The lower labial mucosa includes many structures , such as nerves , vasculature , adipose tissue , skeletal muscle , and minor salivary glands . When creating a differential diagnosis , some options may be ruled out clinically , but others need to be differentiated upon histopathologic examination . A mucocele typically presents as a slightly translucent blue or pink papule that undergoes cyclic swelling and possibly rupturing . A fibroma can present as a pink nodule , likely with a history of chronic trauma to the area . Salivary gland malignancies , such as mucoepidermoid carcinoma , can present clinically identical to a mucocele and can only be ruled out with histopathology . Mucoepidermoid carcinoma may also undergo periodic swelling , mimicking a mucocele . Mesenchymal proliferations that should be considered are hemangioma , lipoma , neurofibroma , and traumatic neuroma . 1
Mucoceles are common lesions of the lower labial mucosa and they are , in fact , the most common lesion of minor salivary glands . The most often reported inciting etiology is trauma to a minor salivary gland , interrupting the epithelial lining of the duct , and causing mucin to spill into the adjacent fibrous connective tissue . The typical blue color is due to the collecting mucin , but the coloration can vary based on numerous factors , including the depth and size of the lesion , as well as additional trauma which could cause bleeding into the area . In this patient , a mucocele was suspected because of the location of the lesion and the patient ’ s report that the size of the lesion has increased and decreased . 2 , 3
There are two classifications of mucoceles that may appear in the oral cavity : extravasation and retention types . The extravasation type consists of spilled mucin with a granulation tissue lining . The retention type consists of mucus retained by an epithelial lining , which is also known as a salivary duct cyst . Extravasation mucoceles are more common in young patients , while retention mucoceles / salivary duct cysts are more commonly found in older patients . Both variations have similar clinical presentations , so the type must be differentiated on histological examination . 4
The treatment for a mucocele is the complete surgical excision of the lesion and the associated minor salivary glands and ducts . While this treatment is most commonly curative , it is important to inform the patient that mucoceles may recur . The chance of recurrence is higher if the associated damaged glands are not removed . In cases of repeated recurrences , CO2 or diode laser therapy can be used to eradicate the underlying salivary tissue , although another possible reason for repeated recurrences may be incompletely sampling of a mucoepidermoid carcinoma . 5 Although the clinical presentation in this case favored a mucocele , the patient was informed that a malignancy may have the same presentation , even though this was less likely . At the follow-up visit , the histopathology diagnosis of a mucocele was discussed . The patient reports being much more comfortable , and no recurrence of the lesion was observed at that time .
REFERENCES
1 . Fonseca , R . Cystic Conditions , Minor Salivary Glands . Oral and Maxillofacial Surgery , Volume 1 , Third Edition . 2018 ; pp . 483 . 2 . Baurmash HD . Mucoceles and ranulas . Journal of Oral and Maxillofacial Surgery . 2003 ; 61 ( 3 ): 369-78 . 3 . Chaitanya P , Praveen D , Reddy M . Mucocele on Lower Lip : A Case Series . Indian Dermatol Online J . 2017 ; 8 ( 3 ): 205-207 . 4 . Harrison JD : Salivary mucoceles , Oral Surg Oral Med Oral Pathol . 1975 ; 39 ( 2 ): 268 – 278 . 5 . Paglia M , Crippa R , Ferrante F , Angiero F . Mucocele of the minor salivary glands in an infant : Treatment with diode laser . Eur J Paediatr Dent . 2015 ; 16 ( 2 ): 139-42 .
MAY / JUNE 2023 | PENNSYLVANIA DENTAL JOURNAL 23