MANAGEMENT OF LIP MUCOCELE – USING MICROSURGERY AND LASER

Abstract

Mucocele of the lip is one of the most common salivary gland pathology, presenting
itself with soft tissue mass, often on the lower lip. The lesion is caused by
extravasation or retention of mucous from the minor salivary gland, which may occur
due to trauma or obstruction of the ducts of the salivary gland. Irrespective of the
pathology, the management of the benign lesion mostly involves surgical removal of
the mass. Due to the high recurrence rate, the involved salivary gland is also removed
to prevent recurrence of the lesion. This case report presents the management of a
mucocele lesion of the lower lip managed with a minimally invasive approach using
microsurgery instruments and laser

Full text

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MANAGEMENT OF LIP MUCOCELE – USING MICROSURGERY AND LASER
1*Dr. Saket Kashyap and 2Dr. Md. Zeeshan Arif
1Periodontist.
2Oral and Maxillofacial Surgeon.
INTRODUCTION
The term mucocele is derived from latin words, mucus
and cocele means cavity. These are mucus-filled cavities,
which may appear in the oral cavity, appendix,
gallbladder, paranasal sinuses, and lacrimal sac.[1] Oral
mucocele is a benign mass present mostly on the lower
lip often as a result trauma or obstruction of the salivary
duct. However, in many cases, history of trauma may not
be present. Though rarely associated with systemic
disorders, mucoceles has been observed in patient
undergoing Anti-Retroviral therapy.[2] Mucocele, also
known as the mucous extravasation cyst is a psedo-cyst,
without defined walls or linings and is formed due to the
accumulation of mucous from an underlying salivary
gland following trauma or injury.[3] The lower lip is the
most commonly affected site, however, it has been
observed at other sites in the oral cavity such as cheek
tongue and palate. When present at the floor of the
mouth, the condition is termed as ranula.[4,5]
The management of mucocele is based on accurate
diagnosis and excision of the lesion. Before planning
surgical procedure it is important that the lesion shall be
differentiated from other similar conditions such as
lipoma, irritation fibroma, oral hemangioma or benign or
malignant neoplasm of the oral cavity.[3] The gold
standard for a definite diagnosis involves a thorough
history taking, clinical examination in conjugation with
histopatholocal analysis. Also, a wide variety of clinical
methods have been tried for the management of the
lesion, which include surgical excision,
mascupialization, use of lasers and electrocautery and
steroid.[6]
This case report presents a case management of a patient
with mucocele of lower lip, which was excised using
laser and micro surgery.
CASE PRESENTATION
A 35 year old male patient reported to our practice with
swelling on the lower lip. The patient reported the
presence of swelling from 2 weeks. The patient also
reported the intermittent nature of the swelling. Pain was
not present; however, patient gave a history of burning
sensation and ulceration at the offended site. On
palpation, the lesion was soft and resilient measuring
approximately 6mm in diameter (Fig 1a,1b). The lesion
was located on the lower lip left of the midline, opposite
to the left mandibular canine. The patient was informed
about the treatment approach and written consent was
taken.
The treatment plan involved a combined approach with
use of microsurgery instruments and laser (Diode laser
Indilase® 980nm) (Fig 2). The microsurgery blades were
used for accurate and minimally invasive tissue
manipulation to ensure a scar free uneventful healing.
Laser assisted in control of haemorrhage as the lip is well
supplied with cappilaries and blood vessels and may
bleed profusely during the procedure.
Patients vital were measured and patient was instructed
to perform a pre procedural mouth rinse with 0.2%
chlorhexidine mouthwash. The patients face and the
surgical site were disinfected with povidone iodine.
Local anaesthesia was administered by local infiltration
of the anaesthetic solution around the lesion. After
achieving profuse local anaesthesia of the surgical site,
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ABSTRACT
Mucocele of the lip is one of the most common salivary gland pathology, presenting
itself with soft tissue mass, often on the lower lip. The lesion is caused by
extravasation or retention of mucous from the minor salivary gland, which may occur
due to trauma or obstruction of the ducts of the salivary gland. Irrespective of the
pathology, the management of the benign lesion mostly involves surgical removal of
the mass. Due to the high recurrence rate, the involved salivary gland is also removed
to prevent recurrence of the lesion. This case report presents the management of a
mucocele lesion of the lower lip managed with a minimally invasive approach using
microsurgery instruments and laser.
KEYWORDS: Mucocele, Aesthetic Dentistry, Minimally Invasive Surgery.
Received on: 24/05/2020
Revised on: 14/06/2020
Accepted on: 04/07/2020
*Corresponding Author
Dr. Saket Kashyap
Periodontist.

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the lower lips were everted and a superficial incision was
made on the surface of the lesion(Fig 3). Under 3.5x
magnification, an incision was made just enough to
provide a purchase point for insertion of curved scissors
for performing blunt dissection. Care has to be taken to
ensure that the incision is not too deep to cause puncture
of the mucus mass, which can make it difficult to
identify and remove the minor salivary glands associated
with the lesion. A blunt dissection was performed to
separate the overlying epithelium from the underlying
mucus mass. After the mucus mass was free from the
overlying tissue, a diode laser was used to detach the
mass from the underlying soft tissue attachment. This
undermining helps in removal of the minor salivary
gland and aid in prevention of recurrence of the lesion.
Tissue tags were excised and the wound margins were
closed with multiple simple interrupted sutures (Fig 4-
6,). The mucus mass was sent stored in formalin solution
and sent for histopathologic evaluation.
HISTOPATHOLOGIC REPORT AND CLINICAL
OUTCOME CLINICAL OUTCOMES
Sutures were removed after 10 days and healing was
observed. Healing of the site was uneventful. Patient did
not report post-operative pain or discomfort. Recurrence
of the lesion was not observed 1 month post operatively
(Fig 7).
Histopathogolical analysis showed normal minor mucous
salivary gland tissue with discontinuous excretory duct
associated with fibrosis. Inflammatory cells, engorged
capillaries and extravasated RBCs were present (Fig 8).
Figure 1 a.
Figure 1 b.

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Figure 2.
Figure 3.

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Figure 4.
Figure 5.

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Figure 6.
Figure 7.

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Figure 8.
DISCUSSION
Mucoceles are pseudocysts formed due to accumulation
of mucus which occurs following trauma or obstruction
of the salivary glands. The lower lip is the most
commonly involved site and the lesion is self-limiting.
Treatment of the lesion is fairly straight forward mostly
involving the surgical removal of the mucus mass and
the associated salivary gland, prevention of reoccurrence
is the challenge more often faced by clinicians.
Elimination of the traumatic etiology such as the use of
thermopasticised has been found to be effective in
prevention of recurrence. .Management of oral habits
such as lip biting and thumb sucking has also been
attributed to the etiology and cause of recurrence of the
lesion.[5,7]
In this case report, a combination of laser and
microsurgery blades were used for the surgical excision
of the lesion. Micro surgery blades were used for making
superficial incisions on the lesion to prevent rupture of
the mucus mass. The diode laser was used in final
excision of the mucus mass from the underlying tissue
for quick excision and haemostatic properties.[8,9]
The convention approach of management of mucocele
involved a simple stab incision to drain out the mucus
content. This approach provided an immediate relief with
minimal healing time. However, removal of the
accessory salivary gland is essential to prevent the lesion
from reoccurring.[10,11]
The successful treatment of mucocele involves complete
removal of the lesion of regular follow-up of the patients.
Evaluation of traumatic local factors and prevention
programs to intercept habits in children and adults can be
beneficial in reducing the incidence of the lesion. Our
patient was followed up for one month to evaluate
recurrence of the lesion, however, a long term evaluation
is essential to support any treatment approach
particularly in lesions such as mucocele which has a high
recurrence rate.
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