Mucocele is a benign lesion characterized by an extravasation or retention of mucous in submucosal tissue from minor salivary glands. Mucoceles are known to occur most commonly on the lower lip, followed by the floor of mouth and buccal mucosa being the next most frequent sites. Trauma and lip biting habits are the main cause for these types of lesions. Mucocele is a common oral mucosal lesion but it is rarely observed in the infant. This paper highlights the successful management of a rare case of mucocele in an 11-month-old child. Diagnosis and management of mucocele are challenging. For this reason we felt it would be interesting to review the clinical characteristics, histological features, differential diagnosis, and their treatment and evolution in order to aid decision-making in daily clinical practice.
Oral mucocele represents one of the most common benign lesion of the oral mucosa that means a cavity filled with mucus (muco means mucus and coele means cavity), which is the secretory product of salivary glands. The mechanisms for the development of these lesions are two, mucus extravasation, generally regarded as being of traumatic origin, and mucus retention, resulting from obstruction of the duct of a minor or accessory gland. When located on the floor of the mouth these lesions are called ranulas because the inflammation resembles the cheeks of a frog [
An 11-month-old male patient was referred to our department with the chief complaint of a “little ball” in the lower lip and that he had difficulty in sucking for more than 3 months. The baby was in good general health and no other symptoms were reported. Oral habits or a local trauma was not reported. The clinical examination revealed the presence of a soft tissue nodule on the lower lip mucosa (Figure
Mucocele in the lower lip of baby at 11 months.
Excision of the lesion using electrocautery.
Immediate postoperative view.
H&E stained section reveals stratified squamous epithelium with underlying connective tissue consisting of large central mucin pooled area surrounded by granulation tissue and chronic inflammatory cells.
The baby was reexamined after 15 days and 6 and 12 months. No recurrence was observed after 12 months (Figure
Appearance of the surgical area 12 months after the intervention, no recurrence.
Yamasoba et al. [ trauma, obstruction of salivary gland duct.
Mainly physical trauma causes a spillage of salivary secretion into surrounding submucosal tissue. Later inflammation may become obvious due to stagnant mucous. Habit of lip biting and tongue thrusting are also one of the aggravating factors [
The extravasation type will undergo three evolutionary phases [ In the first phase there will be spillage of mucus from salivary duct into the surrounding tissue in which some leucocytes and histiocytes are seen. In second phase, granulomas will appear due to the presence of histiocytes, macrophages, and giant multinucleated cells associated with foreign body reaction. This second phase is called as resorption phase. Later in the third phase there will be a formation of pseudocapsule without epithelium around the mucosa due to connective cells.
The retention type of mucocele is commonly seen in major salivary glands. It is due to the dilatation of duct due to block caused by a sialolith or dense mucosa [
Clinically they are characterized by single or multiple, spherical, fluctuant nodules, ranging from normal pink to deep blue in color, and are generally asymptomatic. The tissue cyanosis and vascular congestion associated with stretched overlying tissue and the translucency of the accumulated fluid beneath result in the deep blue color. At times it may rupture leaving slightly painful erosions that usually heal within few days. Para functional habits such as lip biting and Lip sucking and trauma explain the lower lip being the most commonly described location of extravasation mucoceles [
The history and clinical findings lead to the diagnosis of a superficial mucocele. The appearance of mucocele is pathognomonic and the following data are crucial: lesion location, history of trauma, rapid appearance, variations in size, bluish color, and the consistency [
Radiographs are the contributing factors in diagnosis of ranulas. Localization of these lesions is done by computed tomography and magnetic resonance imaging. High amylase and protein content can be revealed by the chemical analysis [
Mucocele has clinical resemblance with many other swellings and ulcerative lesions of oral cavity and hence needs to be differentiated carefully. Palpation can be helpful for a correct differential diagnosis. Lipomas and tumors of minor salivary glands present no fluctuation while cysts, mucoceles, abscess, and hemangiomas do. A simple technique known as fine needle aspiration biopsy (FNAB) is very helpful, especially when differential diagnosis of angiomatous lesions is involved [
Differential diagnosis of mucocele occurring on most common site, lower lip.
Lesion | Age | Sex | Site | Clinical appearance | Consistency | Progression |
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Fibroma | Common in 3rd, 4th, and 5th |
M : F = 1 : 2 | Common on labial mucosa | Elevated, smooth surfaced, sessile, or pedunculated nodule of normal pink color. Usually small to rarely several cm in size | Firm | Slowly growing |
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Lipoma | Usually in |
M : F = 1 : 1 | Less common |
Smooth surfaced, yellowish, sessile or pedunculated, asymptomatic, nodular mass. Usually less than 3 cm in size | Soft and freely |
Slowly growing |
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Hemangioma | Infancy | M : F = 1 : 3 | Lip is a common |
Flat or raised, deep red or bluish red, and seldom well circumscribed | Readily |
Rapidly growing for initial 6–10 |
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Varix | Older adults | Lip is a common |
Asymptomatic, nontender, bluish-purple nodule | Firm | ||
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Traumatic neuroma | Middle aged adults | Slightly more |
Lower lip is a |
Smooth surfaced, nonulcerated nodule of normal |
Digital pressure may cause considerable |
Slowly growing |
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Salivary duct cyst | Adults | Lip is a common |
Smooth surfaced, bluish |
Soft and fluctuant | Slowly growing | |
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Epidermoid cyst | 3rd and 4th |
M : F = 2 : 1 | Lip is a fairly common site | Painless, round, flesh colored to yellowish-white nodule present midline | Firm and mobile | Slowly growing |
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Mucoepidermoid |
2nd to 7th |
Slight female |
Lower lip is a |
Low grade tumor appears as a painless mass seldom |
Low grade is usually soft and fluctuant, while high grade |
Low grade tumor slowly enlarging, |
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Amelanotic or blue nevi | Usually in |
Predominant in women | Labial mucosa |
Asymptomatic, round or oval, raised or slightly raised, and sessile growth of normal or blue-black color | Soft to firm | Slowly growing |
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Granular cell tumor | 4th to 6th |
M : F = 1 : 2 | Lip is a less |
Asymptomatic, sessile, pink or yellowish nodular mass | Firm and immovable | |
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Lymphangioma | Usually |
M : F = 1 : 1 | Lip is a less |
Asymptomatic tumor mass of pink or purple color with pebbled surface | Soft | |
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Pyogenic granuloma | Mostly in |
Female |
Lip is a fairly |
Smooth, pedunculated or sessile, pink to red to purple colored, few mms to several cm in size, and painless swelling | Soft | May exhibit rapid growth |
Conventional surgical removal is the most common method used to treat this lesion. Other treatment options include
There is no difference in the treatment of retention and extravasation mucocele. Small sized mucoceles are removed with marginal glandular tissue and in case of large lesions marsupialization will help to avoid damage to vital structures and decrease the risk of damaging the labial branch of mental nerve [
Mucocele is the most common benign self-limiting condition. Since these lesions are painless, it is the dentists, who usually pick up these lesions when the patient comes for a routine oral check or an unrelated dental problem. Management of mucocele becomes challenging because of their high chances of recurrence. However, surgical excision with dissection of surrounding and contributing minor salivary glands proved to be successful with least recurrence.
The authors declare that there is no conflict of interests regarding the publication of this paper.