Notes on Mucocele and Mucous Retention cyst-Etiology,Clinical Features,Differential Diagnosis and Treatment

Salivary glands react to injury or obstruction by undergoing atrophic degeneration and necrosis with replacement of the parenchyma byinflammatory cells and ultimately fibrous scar formation

Mucocele

It is a tissue swelling composed of pooled mucus thatescapes into the connective tissue from several excretory ducts

Mucocele

Whensalivary duct is severed the acinar cells will continue to secrete saliva intothe severed duct.

Atthe site of the cut/severance the secretory product escape into the connectivetissue forming a pool of mucus that distends the surrounding tissue.

Etiology:

Minorglands of the lip are most prone to severance as a result of injury or bitingthe mucosa.

Intraoral minor salivary can also be effected as result of some irritation as well.

Clinicalfeatures

Mostlyencountered in children and young adults.

Twothird of the mucoceles occur in the 3^rd decade of life.

Bothmales and females are effected equally.

Site:mucosal surface of the lower lip

              buccal mucosa

              floor the mouth

              ventral of the tongue and palate

Clinicalappearance of the mococele depends on its location within the submucosa

Moresuperficial zones of mucous extravasations presents a fluctuant mass withbluish translucent appearance.

Patientusually feels the mucocele and the fluctuation in its size

Painis quite rare .

Initiallythe mucocels are well circumscribed but with repeated truma they become nodular,more diffuse and firm on palpation.

Themucoceles have finely vascularized and distended, appearance often referred toas frogs belly that’s why they are also called Ranulas

Whenpart of this ranula is deep seated in to the sumental or submandibular spacethen the term used is the” Plunging Ranula”

Differentialdiagnosis

• Mucoepidermoidcarcinoma
• Cavernoushemangeoma (when there is hemorrhage)
• Blistersseen in some bullous and desqumative disease.

Histopathology:

Underlyingpool of mucin distends the sarface epithelium.

Themucin is walled of by the rim of granulation tissue or in long standing casesby condensed collagen.

Anepithelial lining is lacking

Themucinous material  basophilic oracidophillic and contains  neutrophilsand large oval foam cells the histocytes .

Thebase of the mucocele will reveal feeder duct.

Longstanding mucoceles will show acinar degeneration with fibrosis and minimalinflammation .

Treatment:

Minorsalivary gland mucocele will not resolve on its own it must be surgicallyexcised.

Tominimize the chances of recurrence the feeder gland should also be removed.

Postsurgical parasthesia might occur when the branches of the mental nerve aresevered

Surgical Removal of Mucocele-Video

Mucusretention cyst

Itis a swelling caused by an obstruction of a salivary gland excretory ductresulting in an epithelial lining cavity containing mucus. Mucus retention cystis sometimes also referred as Sialocyst

Themucus retention cyst is lined by epithelium and rarely occur in the majorsalivary gland, when they do occur they are multiple i.e. poly cystic diseaseof the parotid gland

Clinicalfeatures:

Encounteredin adults from 3^rd -5^th decade.

Thelesion is painless and fluctuant and at times bluish in appearance.

Site:parotid cysts are located in the   superficial lobe as fluctuant well defined mass.

    -with in the oral cavity the floor of themouth is the most common place.

    -this is followed by the lip and the buccalmucosa

Histopathology:

Theepithelium of the cyst is stratified cuboidal or columnar duct like epithelium.

Thecytoplasm in the of these cells is either clear or eosinophlic and my show somefeatures mucous differentiation

70%of these cyst are unilocular rest of the 30% have multilocular pattern.

 

Treatment:

Simpleexcision is the treatment of choice with caution of rupturing the cystic sacs.

Recurrenceis rare.

Howeverdamage to the adjacent gland may result in a mucocele formation.