Treatment of painful and recurrent oral mucoceles with a high-potency topical corticosteroid: a case report.

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J Oral Maxillofac Surg
66:1737-1739, 2008
Treatment of Painful and Recurrent Oral
Mucoceles With a High-Potency Topical
Corticosteroid: A Case Report
Ana C. Luiz, DDS,* Karen R.N. Hiraki, DDS,†
Celso A. Lemos, Jr, DDS, DSc,‡ Sílvio K. Hirota, DDS, MS,§ and
Dante A. Migliari, DDS, DSc¶
Single mucoceles are a relatively common disorder of
the oral mucosa, but the occurrence of multiple mu-
coceles is considered an uncommon event. There are
only a few reports in the literature.1-6 Although no
etiologic factor has been associated with multiple
mucoceles, some authors reported on this condition in
patients with oral lichen planus and in association with
graft-versus-host disease.1,6,7 There is a hypothesis that
an inflammatory process may play a role in the patho-
genesis of recurrent mucoceles,6,7 although it was also
argued that changes in minor salivary-gland function
may contribute to the development of these lesions.2
We report on a case of multiple, painful, and recur-
rent mucoceles. Our main focus was on assessing the
effectiveness of a topical high-potency corticosteroid
for the treatment of this clinical condition.
Report of a Case
A 33-year-old female was referred to our clinic for diag-
nosis of a recurrent “bullous” formation, accompanied by
ulcerations, which had been present for about 1 month.
The ulcerations had caused her severe pain and difficulty in
chewing. Several translucent vesicles at multiple sites, dis-
tributed on the lower lip, buccal mucosa (bilaterally), and
floor of the mouth, were observed in association with white
striae and papules (Figs 1A-C). This clinical picture sug-
gested either a combination of mucoceles with reticular
oral lichen planus, or bullous lichen planus. Any other
vesiculobullous diseases were clinically ruled out. Apart
from her oral lesions, the patient was in good health. A
biopsy was taken involving a vesicle together with a sample
of the striae. Microscopic examination showed features
only of a mucocele without any characteristics of lichen
planus (Fig 1D). Thus, the final diagnosis was restricted to
multiple mucoceles.
Management
A high-potency topical corticosteroid (0.05% clobe-
tasol propionate in Orabase; Colgate, New York, NY)
was used mainly for controlling the symptomatology.
The patient was instructed to apply the medication 3
times a day. After 4 weeks of treatment, she reported
that the symptoms and frequency of recurrences had
diminished. In addition, the white areas (striae and
papules) had disappeared completely. Eventually, she
was free of lesions and recurrences, and was taken off
the medication. When the lesions recurred later, the
possibility of an allergy-related mechanism for the
mucoceles was investigated. The patient underwent
skin-patch testing for standard (Brazilian) allergens
and for dental materials (Trolab; Hermal, Reinbeck,
Germany); the results were negative. She was also
asked to avoid the use of toothpaste8 for a while and
to refrain from potentially allergenic foods (eg, milk,
eggs, citrus fruit, wheat, cinnamon, and seafood).
Despite these measures, the mucoceles kept reap-
pearing. Clobetasol propionate was restarted 3 times
a day. As soon as improvement was observed, the
medication was tapered. Three weeks later, she was
again free of lesions, and was then instructed to use
the medication only when she noticed initial symp-
toms of the lesions. For a time, she used the medica-
tion twice a week (on average) to control some flare-
ups. At her latest appointment, after 13 months of
Received from the School of Dentistry, University of São Paulo, São
Paulo, Brazil.
*Research Fellow, Department of Oral Diagnosis.
†Doctoral Student, Department of Oral Pathology.
‡Assistant Professor, Department of Oral Diagnosis.
§Research Fellow, Department of Oral Diagnosis.
¶Assistant Professor, Department of Oral Diagnosis.
Address correspondence and reprint requests to Dr Migliari:
Disciplina de Semiologia, Departamento de Estomatologia, Facul-
dade de Odontologia, Universidade de São Paulo, Av Prof Lineu
Prestes 2227, Cidade Universitária, 05580-900 São Paulo, São Paulo,
Brazil; e-mail: damiglia@usp.br
© 2008 American Association of Oral and Maxillofacial Surgeons
0278-2391/08/6608-0027$34.00/0
doi:10.1016/j.joms.2008.01.050
LUIZ ET AL
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follow-up, she reported feeling well regarding her
present clinical status. The flare-ups have been quite
infrequent, and she rarely needs to use the medica-
tion. A clinical examination showed an oral mucosa
free of any signs of lesions (Fig 2). Her serum cortisol
level was checked 3 times during follow-up, and re-
mained within normal values.
Discussion
For single mucoceles, surgical excision is the princi-
pal treatment, and recurrence is rarely reported. The
treatment of recurrent, multiple mucoceles has mostly
focused on control of the recurrences. For this purpose,
some authors have used laser vaporization, corticoste-
roid injection, or gamma-linolenic acid, with recur-
rences reported in 2 of these studies.4,9,10
Considering both the recurrent nature of the mu-
coceles and the considerable pain that would ensue
from surgery and corticosteroid injections, both these
procedures were ruled out for the present case. The
decision was then made to use a high-potency corti-
costeroid (clobetasol propionate) in a mucosal adhe-
sive base, which proved to be very helpful in control-
FIGURE 1. A, Cluster of superficial mucoceles on the labial mucosa. B, Single mucocele surrounded by white patches on the buccal mucosa.
C, Ulcerations resulting from ruptured mucoceles, along with white striae and papules suggesting oral lichen planus, seen on the left side of
the buccal mucosa. A similar pattern was seen on the right side (not shown). D, A pool of mucin surrounded by granulation tissue. Note many
foamy macrophages in the lumen (hematoxylin and eosin stain; original magnification, ?40).
Luiz et al. Topical Corticosteroid for Oral Mucoceles. J Oral Maxillofac Surg 2008.
FIGURE 2. A (patient’s right side) and B (patient’s left side), buccal mucosae free of lesions after 13 months of follow-up.
Luiz et al. Topical Corticosteroid for Oral Mucoceles. J Oral Maxillofac Surg 2008.
1738
TOPICAL CORTICOSTEROID FOR ORAL MUCOCELES

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ling the pain and recurrences. The efficacy of topical
corticotherapy in controlling the recurrences is likely
attributable to the high-potency vasoconstriction and
anti-inflammatory properties of the clobetasol propi-
onate, reducing the inflammatory process involved in
the pathogenesis of the mucoceles.6,7,9
A previous study6 dealing with 3 cases of recur-
rent, superficial mucoceles in patients with graft-
versus-host disease (GVHD) did not report satisfac-
tory results using either systemic (prednisone) or
topical (clobetasol propionate and betamethasone)
corticosteroids in combination with an immunosup-
pressive agent (cyclosporine mouthwash). This lack of
benefit was likely because the coexistence of GVHD
acted as a factor in producing the reappearances of
mucoceles.
Although it must be emphasized that the rarity of this
condition has precluded any controlled study on which
to base any definitive conclusions, the satisfactory result
obtained in the present case suggests that a high-
potency topical corticosteroid may be considered an
option for the treatment of recurrent mucoceles with
multiple-site involvement, especially in the absence of
any immunologically active factor such as GVHD.
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J Oral Maxillofac Surg
66:1739-1743, 2008
Swordfish Bill Injury Involving the
Pterygomaxillary Fossae: Surgical
Management and Case Report
Jose Joaquín Mendonça-Caridad, MD, DMD, PhD,*
Pedro Juiz Lopez, MD,† Luis Francos, MD,‡ and
Mercedes Rodriguez, MD§
Maxillofacial foreign body injuries are relatively com-
mon clinical events. The nature of the causal agent
depends on the particular circumstances to which the
individual has been exposed. Civilian and military
injuries generally differ considerably and thus should
be classified in separate groups.
Civilian penetrating injuries are usually related to
motor vehicle accidents, labor and domestic acci-
dents, violence of all sorts, iatrogenic impaction of
dental/surgical materials and instruments, and certain
types of sports. The capacity of a given material to
penetrate bone depends on its density, its sharpness,
*Consultant Surgeon, Head and Neck Surgery Unit, Polusa Hos-
pital, Lugo, Spain; former Clinical and Research Fellow, Depart-
ment of Oral and Maxillofacial Surgery, UCLA School of Dentistry,
Los Angeles, CA.
†Consultant Surgeon, Head and Neck Surgery Unit, Polusa Hos-
pital, Lugo, Spain.
‡Consulant Surgeon, Vascular Surgery Unit, Polusa Hospital,
Lugo, Spain.
§Consultant Physician, Emergency Section, Ojos Grandes Hospi-
tal, Lugo, Spain.
Address correspondence and reprint requests to Dr Mendonça-
Caridad: Cantón Pequeño, 9-12 Entlo, La Coruña 15003, Spain;
e-mail: josemendonca@terra.es
© 2008 American Association of Oral and Maxillofacial Surgeons
0278-2391/08/6608-0028$34.00/0
doi:10.1016/j.joms.2007.12.016
MENDONÇA-CARIDAD ET AL
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