|Year : 2016 | Volume
| Issue : 1 | Page : 44-47
Micromarsupialization combined with intralesional corticosteroids to treat mucocele: A case report
Rajeshwari Javali1, Basavaraj Bhagwati1, Sharanamma Bhagwati2
1 Department of Oral Medicine and Radiology, S.B. Patil Dental College and Hospital, Bidar, Karnataka, India
2 Department of Periodontics, S.B. Patil Dental College and Hospital, Bidar, Karnataka, India
|Date of Web Publication||8-Sep-2016|
Assistant Professor, Department of Oral Medicine and Radiology, S.B. Patil Dental College and Hospital, Naubad, Bidar - 585 401, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Oral mucoceles are the most common benign lesions of the minor salivary gland in the oral mucosa. Various treatment options include marsupialization, surgical excision, dissection, laser ablation, cryosurgery, electrocautery, and intralesional steroid injections. However, most of them are invasive. The objective of this case report is to emphasize a less invasive combination treatment procedure as an alternative for the invasive treatment of mucoceles. This therapy was performed by using intralesional corticosteroid injection along with micromarsupialization to treat the mucocele on the lower labial mucosa. Three intralesional dexamethasone (4 mg) injections followed by standard silk sutures with 1-week interval over a 3-week duration demonstrated complete resolution of the mucocele. A 3-month and 6-month follow-up revealed no signs of recurrence. This combination therapy can be a noninvasive option to treat mucoceles as this treatment modality is well-tolerated by patients owing to its simple execution without any reported complications.
Keywords: Intralesional, micromarsupialization, mucocele, steroids
|How to cite this article:|
Javali R, Bhagwati B, Bhagwati S. Micromarsupialization combined with intralesional corticosteroids to treat mucocele: A case report. J Indian Acad Oral Med Radiol 2016;28:44-7
|How to cite this URL:|
Javali R, Bhagwati B, Bhagwati S. Micromarsupialization combined with intralesional corticosteroids to treat mucocele: A case report. J Indian Acad Oral Med Radiol [serial online] 2016 [cited 2022 Jul 3];28:44-7. Available from: https://www.jiaomr.in/text.asp?2016/28/1/44/189974
| Introduction|| |
Mucocele is a common lesion of the oral mucosa. There are extravasation and retention type of mucoceles. Extravasation mucocele results from broken salivary gland ducts and the consequent spillage into the surrounding soft tissues. Retention mucocele appears due to a decrease or an absence of glandular secretion produced by blockage of the salivary gland ducts. In many cases, local surgical excision is necessary. Several other conservative techniques have been used in the treatment of mucoceles. Micromarsupialization and intralesional corticosteroid injection have been used separately by Delbem  and Luiz, respectively. We present a case treated by a combination of these two techniques.
| Case Report|| |
A 22-year-old female patient reported to the Department of Oral Medicine and Radiology with a chief complaint of a painless swelling on the left lower labial mucosa since 3 weeks [Figure 1]. There was a mild change in the shape of the lower lip, for which the patient was esthetically concerned and visited our Department for its treatment. Past medical and family history was noncontributory. Patient was under orthodontic treatment since 4 months and provided a positive history of lip biting. Upon examination, the lesion appeared as a well-circumscribed, dome-shaped bluish swelling, measuring approximately 2 cm × 1.5 cm in size, smooth surfaced, nontender, and fluctuant with no other abnormality. A diagnosis of mucocele was made. Although a bluish lesion developing after trauma is suggestive of mucocele, a differential diagnosis of vascular malformation, such as lymphangioma, soft tissue neoplasm, such as schwannoma, salivary gland tumors, and cysticercosis was considered. The patient was administered a combination therapy of micromarsupialization and intralesional injection of dexamethasone. The technique was performed as follows: The area was disinfected with 0.1% iodine; a topical anesthetic was applied to cover the entire lesion for approximately 3 minutes, 1 ml of dexamethasone (4 mg/2 ml) was injected into the base of the lesion with an insulin needle [Figure 2]. After injection, micromarsupialization was performed to drain the mucus and reduce the size of lesion. This technique consisted of passing a thick silk suture through the internal part of the lesion along its widest diameter followed by making a surgical knot [Figure 3] and [Figure 4]. After 1 week, the size of the lesion was reduced [Figure 5], and the same procedure was repeated. On the third visit, the size of the lesion further decreased and the patient received the last injection and suture. This process (intralesional injection of dexamethasone combined with micromarsupialization) was repeated 3 times at 1-week intervals. Complete resolution was observed after 3 weeks [Figure 6]. After 3 and 6 months of follow-up, there was no history or sign of recurrence or local discomfort.
|Figure 5: Regression in the size of the lesion after the first week of follow-up|
Click here to view
| Discussion|| |
Mucocele is a common lesion and affects the general population. When located on the floor of the mouth, these lesions are called ranulas because the inflammation resembles the belly of a frog. Yamasoba et al. highlight two crucial etiological factors in mucoceles, namely, traumatism and obstruction of salivary gland ducts. A study by Bagán et al. showed that 5% were retention mucoceles whereas the other 95% were extravasation. They proposed that extravasation mucoceles undergo three evolutionary phases. In the first phase, mucous spills diffusely from the excretory duct into conjunctive tissues where some leucocytes and histiocytes are found. Granulomas appear during the resorption phase where histocytes, macrophages, and giant multinucleated cells are associated with a foreign body reaction. In the final phase, connective cells form a pseudocapsule without epithelium around the mucosa. Retention mucoceles are formed by dilation of the duct secondary to its obstruction or are caused by a sialolith or dense mucosa. The majority of retention cysts develop in the ducts of the major salivary glands.
The incidence of mucoceles is generally high, 2.5 lesions per 1000 patients, frequently in the second decade of life,, and rarely among children under 1 year of age. According to several studies, there is no difference between genders ,, and no difference in the clinical presentation of retention and extravasation mucocele. Mucocele presents as bluish, soft, and transparent cystic swelling. The blue color is caused by vascular congestion, cyanosis of the tissue above, and the accumulation of fluid below. Coloration can also vary depending on the size of the lesion, proximity to the surface, and upper tissue elasticity., Lesion duration is not constant, varying from a few days to 3 years. The lower lip is the most frequent site for a mucocele because it is the most probable place for a trauma. The main accepted treatment for mucocele is surgical management. However, Yamasoba et al. showed a 2.8% recurrence in lesions which were removed surgically. Other treatment options are laser ablation, cryosurgery, electrocautery, intralesional steroid injections, OK-432, gamma-linolenic acid, and micromarsupialization. We treated a mucocele by a combination therapy. The proposed mechanism was: Injection of a high-potency corticosteroid to promote the shrinkage of dilated salivary ducts or pools similar to a sclerosing agent. The introduction of a suture which, according to the literature, causes epithelialization around the suture, establishing new excretory ducts between the surface and the underlying salivary gland tissue and leading to the disappearance of the lesion. An important factor observed during the execution of the technique is that only topical anesthesia over the lesion needs to be applied that considerably favors cooperative behavior of the patient. The mucus content of the lesion is the reason why we only need to anesthetize the mucosa that covers the lesion. The immediate extravasation of mucus after the passage of the suture and consequent reduction of the lesion in volume is a fundamental clinical characteristic for the diagnosis of mucus retention phenomena. If the extravasation does not occur, biopsy and histopathologic analysis are recommended.
| Conclusion|| |
The combination of micromarsupialization and intralesional injection of corticosteroid is an alternative to be considered because it is a simple procedure with a good prognosis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Boneu-Bonet F, Vidal-Homs E, Maizcurrana-Tornil A, González-Lagunas J. Submaxillary gland mucocele: Presentation of a case. Med Oral Patol Oral Cir Bucal 2005;10:180-4.
Delbem AC, Cunha RF, Vieira AE, Ribeiro LL. Treatment of mucus retention phenomena in children by the micro-marsupialization technique: Case reports. Pediatr Dent 2000;22:155-8.
Luiz AC, Hiraki KR, Lemos CA Jr, Hirota SK, Migliari DA. Treatment of painful and recurrent oral mucoceles with a high potency topical corticosteroid: A case report. J Oral Maxillofac Surg 2008;66:1737-9.
Ata-Ali J, Carrillo C, Bonet C, Balaguer J, Peñarrocha M. Oral mucocele: Review of the literature. J Clin Exp Dent 2010;2:e18-21.
Yamasoba T, Tayama N, Syoji M, Fukuta M. Clinicostatistical study of lower lip mucoceles. Head Neck 1990;12:316-20.
Bagán Sebastián JV, Silvestre Donat FJ, Peñarrocha Diago M, Milián Masanet MA. Clinico-pathological study of oral mucoceles. Av Odontoestomatol 1990;6:389-91.
Guimarães MS, Hebling J, Filho VA, Santos LL, Vita TM, Costa CA. Extravasation mucocele involving the ventral surface of the tongue (glands of Blandin-Nuhn). Int J Paediatr Dent 2006;16:435-9.
Bentley JM, Barankin B, Guenther LC. A review of common pediatric lip lesions: Herpes simplex/recurrent herpes labialis, impetigo, mucoceles, and hemangiomas. Clin Pediatr 2003;42:475-82.
Tran TA, Parlette HL 3rd
. Surgical pearl: Removal of a large labial mucocele. J Am Acad Dermatol 1999;40:760-2.
Selvig KA, Biagiotti GR, Leknes KN, Wikesjö UM. Oral tissue reactions to suture materials. Int J Periodontics Restorative Dent 1998;18:474-87.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]