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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 122-127

Laser versus surgical: Different treatment modalities of mucocele: A case series


1 Department of Pedodontics and Preventive Dentistry, SCB Dental College and Hospital, Utkal University, Cuttack, Odisha, India
2 Department of Periodontics and Implantology, Kalka Dental College, CCSU, Merrut, Uttar Pradesh, India

Date of Submission20-Apr-2021
Date of Acceptance21-Aug-2021
Date of Web Publication11-Feb-2022

Correspondence Address:
Dr. Santoshni Samal
Department of Pedodontics and Preventive Dentistry, SCB Dental College and Hospital, Cuttack, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohs.ijohs_8_21

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  Abstract 


The mucocele is the accumulation of mucous from salivary glands and its ducts into subepithelial tissue. It is the most common, painless, and harmless oral lesions. Etiology could be trauma, lip habits or unknown. Diagnosis is made mainly on the basis of history and clinical examination. Along with conventional surgical treatment now, we have lasers also for excision of mucocele lesions. We reported a case series of mucocele treated with conventional treatment as well as laser.

Keywords: Conventional, laser diode, mucocele, surgical


How to cite this article:
Samal S, Mahakur M, Kumar M, Ray P. Laser versus surgical: Different treatment modalities of mucocele: A case series. Int J Oral Health Sci 2021;11:122-7

How to cite this URL:
Samal S, Mahakur M, Kumar M, Ray P. Laser versus surgical: Different treatment modalities of mucocele: A case series. Int J Oral Health Sci [serial online] 2021 [cited 2022 May 23];11:122-7. Available from: https://www.ijohsjournal.org/text.asp?2021/11/2/122/337504




  Introduction Top


The term “mucocele” is derived from the word “mouco” meaning mucus and “coele” meaning cavity. They are basically mucus filled cavities and usually present in oral cavity, appendix, gall bladder, paranasal sinuses, or lacrimal sac.[1]

The most common variety which is around 92% is mucous extravasation cyst which is formed by mucous pooled into and surrounded by granulation tissue. The other one which is around 8% is epithelial lining retention cyst.[2] Clinically, there is no difference in both.

The prevalence rate of mucoceles in children is unknown, but they occur more frequently in younger individuals than in adults. The most common cause for mucoceles in the lower lip is trauma to the oral cavity or lip biting habits.[3]

The most common recommended treatment for these lesions is surgical excision, but inadequate excision may lead to recurrence which is more frequent.[3] There are other treatment options also available including cryosurgery, micromarsupialization, intralesional corticosteroid injection, marsupialization, and electrocautery and laser.[4]

This article highlights a case series of mucocele on the lower lip treated by surgical excision and diode laser.


  Case Report Top


Case 1

A 9-year-old girl reported to the outpatient department of pediatric and preventive dentistry, with a chief complaint of swelling inside of the lower lip since 4 weeks [Figure 1]. The patient was apparently well before that. There was no significant medical, dental, drug, and family history. It was revealed that the patient had a traumatic bite on lower labial mucosa few months ago.
Figure 1: Clinical picture of mucocele on lower lip

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On extraoral clinical examination, the face was bilateral symmetrical with competent lips. Lymph nodes were not palpable. On intraoral examination, the swelling was well circumscribed 1 cm × 1 cm in size, with normal appearance of mucosa with slightly bluish hue present with respect to 31 and 41. The swelling was fluctuant and sessile. There was no associated pain with this swelling. No increase in the temperature was present on lower labial mucosa with respect to 31 and 41. There was no difficulty in chewing and speaking. No other anomalies were detected.

Based on the history and clinical findings, provisional diagnosis of mucocele is made. The patient is informed and surgical excision is planned. Blood investigations were within the normal limits. Surgical excision of mucocele was done under local anesthesia (2 ml of lidocaine containing 1:200,000 epinephrine) after obtaining informed consent [Figure 2] and [Figure 3]. Lesion was resected with scalpel from the base with capsule intact within 30–40 min with minimal complications [Figure 4], and the specimen [Figure 5] was sent for histopathological examination which confirmed it is a mucocele [Figure 6]. Intermittent sutures were placed [Figure 7] and postoperative instructions were given with the prescription of analgesia (tablet PARACETAMOL 500 mg SOS). Sutures were removed after 7 days. The clinical outcomes such as healing after 4 weeks were satisfactory with no scar, and there was no sign of recurrence after 12 weeks [Figure 8].
Figure 2: Local anesthesia administration

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Figure 3: Incision with scalpel

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Figure 4: Lesion excised with associated salivary glands

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Figure 5: Silk 3.0 suture placed

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Figure 6: Excised tissue

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Figure 7: Histopathological picture

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Figure 8: Follow up

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Case 2

A 9-year-old boy reported to the outpatient department of pediatric and preventive dentistry, with a chief complaint on swelling on the lower left lip for past few days [Figure 9]. There was no significant family, medical and drug history. The patient had no lip biting habits also he did not remember of any trauma on lower lip.
Figure 9: Clinical picture of mucocele on lower right lip

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On extraoral examination, no significant findings detected. On intraoral examination, the patient was having well circumscribed, painless swelling of 2 cm × 1 cm with respect to 42 and 43. The swelling was slightly bluish in color, sessile, and fluctuant. No other intraoral anomalies were detected.

Based on the history and clinical findings, provisional diagnosis of mucocele is made. Informed consent was taken from the patient and surgical excision is planned. Blood investigations were within normal limits. Surgical excision of mucocele was done under local anesthesia (2 ml of lidocaine containing 1:200,000 epinephrine) within 30–45 min [Figure 10]. After retracting the lower lip with digital pressure, lesion was resected with scalpel from the base with capsule intact [Figure 11] with minimal complications and it was sent for histopathological examination which confirmed it a mucocele [Figure 12]. Intermittent sutures were placed [Figure 13] and analgesic (tablet paracetamol 500 mg SOS) was prescribed to the patient. The patient was recalled after 10 days for suture removal. Healing of the lesion was satisfactory after 4 weeks with no scar and discomfort [Figure 14].
Figure 10: Incision with scalpel

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Figure 11: Lesion excised with associated salivary glands

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Figure 12: Histopathological picture

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Figure 13: Silk 3.0 suture placed

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Figure 14: Follow up picture

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Case 3

A 12-year-old boy reported to the outpatient department of pedodontics and preventive dentistry, with a chief complaint of swelling in the lower left lip region since 3 weeks [Figure 15].
Figure 15: Mucocele on lower left lip

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There was no significant medical, dental and drug and family history. The patient had a habit of lip biting. On extraoral examination, no abnormalities were detected. On intraoral examination, a 1 cm × 1 cm well circumscribed swelling with normal mucosal appearance and same color of adjacent mucosa was present with respect to 32 and 33. The swelling was painless and sessile. No other abnormalities were present.

Based on the history and clinical examination, provisional diagnosis of mucocele is made. Informed consent is obtained from the patient. Laser excision was explained to the patient guardian's and obtained willingness to perform the most recent treatment option of laser. Following minimal infiltration of local anesthesia (0.5 ml of lidocaine containing 1:200,000 epinephrine), the lesion was excised using soft laser (I-Lase diode laser), 840 nm in wavelength, 4 μ diameter tip at 3 watt (low level laser therapy) in continuous mode within 5–7 min with minimal complications [Figure 16] and [Figure 17].
Figure 16: Laser application

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Figure 17: Post operative picture

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The specimen was subjected to histopathological examination which confirmed mucocele [Figure 18] and [Figure 19]. The patient was prescribed analgesic (tablet paracetamol 500 mg SOS) if needed. There was uneventful healing after 3 weeks with minimal patient discomfort and with no scar after 30 days [Figure 20].
Figure 18: Excised tissue

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Figure 19: Histopathological picture

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Figure 20: Follow up

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  Discussion Top


Mucocele is the second most common oral lesion followed by irritational fibroma. The incidence occurs with equal gender distribution in the age group between 10 and 29 years.[5] The most common site of occurrence is lower lip followed by tongue, floor of mouth, and the buccal mucosa.[6] In our cases, also the diagnosis of mucocele was made on the basis of clinical presentation which was later confirmed by histopathological examinations.

There are various treatment modalities available for mucocele. The most common treatment modality is excision of the lesion along with the associated minor salivary glands.[7]

Surgical excision does not require expensive equipment, cost effective, and can be performed by most trained dentists and can be done in those patients who cannot afford expensive laser treatment. Great precision and detailed knowledge of its surrounding anatomy are required. Administration of local anesthesia is required, which can be more challenging in children especially uncooperative children. The postoperative bleeding is also greater and a longer healing period is required when compared to other treatment modalities.[8] The excised tissue should be submitted to the pathological investigations to confirm the diagnosis.

Other treatment modalities such as laser ablation, cryosurgery, and electrocautery are approaches that have also been used for treatment of the conventional mucoceles, with variable success.[9]

The main advantages of soft-tissue laser applications are minimal intraoperative bleeding and swelling with less postoperative pain present. Less surgical time is required with scarring, and coagulation. No need of suturing after excision is required because of natural wound dressing due to denatured proteins. Various procedures such as minor and major soft-tissue surgery, bone cutting, and implant exposure with bone removal can be performed in patients with bleeding disorders by using soft-tissue lasers.[10] Diode lasers can be a useful alternative to larger surgical lasers such Er: YAG and CO2 lasers. Their small size and low cost are distinct advantages. They can give a well-defined cutting edge, as well as coagulation and hemostasis during excisions.[11]

In the present cases, diode laser was used for excision of mucocele, which showed minimal patient discomfort, postoperative pain, and edema with no bleeding and recurrence even after long follow-up so it can be one of the successful treatment modalities in uncooperative children.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sebastin JV, Donat FJ, Diago MP, Masanet MA. Clinico-pathological study of oral mucoceles. (394-5). Av Odontoestomatol 1990;6:389-91.  Back to cited text no. 1
    
2.
Yamasoba T, Tayama N, Syoji M, Fukuta M. Clinicostatistical study of lower lip mucoceles. Head Neck 1990;12:316-20.  Back to cited text no. 2
    
3.
Bodner L, Tal H. Salivary gland cysts of the oral cavity: Clinical observation and surgical management. Compendium 1991;12:150-6.  Back to cited text no. 3
    
4.
Tran TA, Parlette HL 3rd. Surgical pearl: Removal of a large labial mucocele. J Am Acad Dermatol 1990;40:760-2.  Back to cited text no. 4
    
5.
Re Cecconi D, Achilli A, Tarozzi M, Lodi G, Demarosi F, Sardella A, et al. Mucoceles of the oral cavity: A large case series (1994-2008) and a literature review. Med Oral Patol Oral Cirug Bucal 2010;15:e551-6.  Back to cited text no. 5
    
6.
Seifert G, Miehlke A, Haubrich J. Diseases of Salivary Glands. New York: Thieme; 1986. p. 91-100.  Back to cited text no. 6
    
7.
López Jornet P. Labial mucocele: A study of eighteen cases. Internet J Dent Sci 2006;3:1-5.  Back to cited text no. 7
    
8.
Cobb CM. Lasers in periodontics: A review of the literature. J Periodontol 2006;77:545-64.  Back to cited text no. 8
    
9.
Anastassov GE, Haiavy J, Solodnik P, Lee H, Lumerman H. Submandibular gland mucocele: Diagnosis and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:159-63.  Back to cited text no. 9
    
10.
Walsh LJ. The current status of laser applications in dentistry. Aust Dent J 2003;48:146-55.  Back to cited text no. 10
    
11.
Azma E, Safavi N. Diode laser application in soft tissue oral surgery. J Lasers Med Sci 2013;4:206-11.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20]



 

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