|Year : 2016 | Volume
| Issue : 4 | Page : 462-464
Mucocele of tongue: A rare case report
Yogita J Khalekar1, Abhijeet R Sande2, Amit Zope3, Ashwinirani Suragimath2
1 Department of Oral Medicine and Radiology, Annasaheb Chudaman Patil Memorial Dental College, Dhule, Maharashtra, India
2 Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
3 Department of Orthodontics, Annasaheb Chudaman Patil Memorial Dental College, Dhule, Maharashtra, India
|Date of Submission||24-Feb-2016|
|Date of Acceptance||30-Jan-2017|
|Date of Web Publication||21-Feb-2017|
Dr. Abhijeet R Sande
Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The mucocele or mucus retention phenomenon is a salivary gland lesion possibly due to a traumatic origin, which is formed when the main duct of a minor salivary gland is torn with subsequent extravasation of the mucus into the fibrous connective tissue such that a cyst like cavity is produced. Mucoceles most commonly occur on the lower lip, followed by the floor of the mouth, with buccal mucosa being the next most frequent site.
Keywords: Cyst, extravasation, mucocele, mucus
|How to cite this article:|
Khalekar YJ, Sande AR, Zope A, Suragimath A. Mucocele of tongue: A rare case report. J Indian Acad Oral Med Radiol 2016;28:462-4
| Introduction|| |
Mucoceles are one of the most common benign soft tissue masses that occur in the oral cavity. Mucoceles (muco – mucus and coele – cavity) by definition are cavities filled with mucus. All cystic lesions of the minor salivary glands, collectively and clinically referred to as mucoceles, are described as either the extravasation type or the retention type. The term mucus extravasation phenomenon (or escape reaction) is used when mucus has been extruded into the connective tissue and is surrounded by a granulation tissue envelope. The term mucus retention cyst is used to describe a cyst with retained mucin, which is lined by ductal epithelium.
Mucoceles are usually formed secondary to rupture of an excretory duct of a salivary gland, which leads to an outpouring of saliva into the surrounding tissues., Because there is no epithelial lining surrounding the mucin, it is categorized as a false cyst or pseudocyst. In contrast, a mucus retention cyst is a true cyst, lined with epithelium. This type of cyst appears to be caused by epithelial proliferation of a partially obstructed salivary duct. On clinical presentation, mucoceles are usually single, although more than one may be present at any given time. Regardless of their location, they present as soft painless swellings, with a normal or bluish color. It is fluctuant and movable because of its mucinous contents. The diameter may range from a few millimetres to a few centimetres. If left without intervention, an episodic decrease and increase in size may be observed, corresponding to rupture and subsequent mucin production.
| Case Report|| |
A 26-year-old female reported with the chief complaint of swelling and pain on the ventral surface of the tongue. The swelling was round-to-oval in shape with a bluish discoloration, measuring approximately 1 × 2 cm in dimension with no history of bleeding or any discharge from the swelling. There was no visible pulsation. On palpation, it was fluctuant and nontender [Figure 1]. Diascopy test was negative. The patient had been aware of the swelling for approximately 2 months but denied any episodic increase or reduction in size. Rest of the medical and dental history was noncontributory. Based on the clinical examination and history, a provisional diagnosis of mucocele was made. Patient was subjected to ultrasonographic examination which revealed a solitary uniformly hypoechoic image without any calcification [Figure 2]. Excisional biopsy was performed and the wound was closed with sutures. The biopsy sample was immediately fixed in 10% formalin and sent for histologic evaluation. The histopathologic report suggested connective tissue stroma with extravasation of mucin with mucinous exudates devoid of demarcation. The pathologic report suggested extravasation type mucocele [Figure 3].
|Figure 1: Intraoral photograph showing mucocele involving ventral surface of the tongue|
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| Discussion|| |
The human tongue contains three distinct sets of minor salivary glands, namely, the glands of Von-Ebner, the glands of Weber, and the glands of Blandin and Nuhn. The glands of Blandin and Nuhn are mixed mucus and serous glands that are embedded within the musculature of the ventral surface of the anterior tongue. They are not lobulated or encapsulated. Each gland is approximately 1–8 mm wide and 12–25 mm deep and consists of several small independent glands. They drain by means of 5–6 small ducts that open near the lingual frenum. These glands extend laterally and posteriorly from the midline, forming a mass resembling a horseshoe with its opening pointing towards the root of the tongue. They have been postulated to be the result of trauma to the ventral surface of tongue that results in rupture of the draining ducts. The solitary, smooth, nodular submucosal lesions of the tongue can be clinically differentiated as schwannoma, neurofibroma, rhabdomyoma, lymphangioma, fibroma, lipoma, leiomyomas, inflammatory lesions such as fibroepithelial polyp, and benign salivary gland tumors and mucocele.
Mucoceles on the tongue are rare and occur almost exclusively on the ventral surface where the glands of Blandin and Nuhn are located. The mucocele is located directly under the mucosa (superficial mucocele), in the upper submucosa (classic mucocele), or in the lower corium (deep mucocele). The clinical presentation of these lesions depends upon their depth within the soft tissue and the degree of keratinization of the overlying mucosa superficial lesions present as raised soft tissue swelling that is translucent and having bluish color, whereas the deeper lesions are more nodular, lack the vesicular appearance, and have a normal mucosal color. Palpation can be helpful for a correct differential diagnosis. Lipomas and tumors of minor salivary glands present no fluctuation whereas cysts, mucoceles, abscess, and hemangiomas do.,
Presence of mucoceles on the dorsal surface of the tongue is not yet reported. Regarding superficial mucoceles, trauma does not always appear to play an important role in pathogenesis. In many cases, mucosal inflammation that involves the minor gland duct results in blockage, dilatation, and rupture of the duct with subepithelial spillage of fluid. Changes in minor salivary gland function and composition of the saliva may contribute to their development.
Histologically, mucoceles are classified as retention and extravasation types. Mucocele involving the glands of Blandin and Nuhn are often histologically diagnosed as being extravasation type. Mucoceles can easily traumatize and become a strong source of irritation and annoyance to the patient. These lesions are often asymptomatic, however, as they grow in size, they can cause discomfort, external swelling, and interfere with speech and mastication. Thus, surgical excision is the treatment of choice. Usually, the surgical excision includes the servicing mucous glands with evacuation of its contents. According to Surgerman et al. and Baurmash, the technique for managing moderate-to-large Blandin and Nuhn mucoceles is to completely unroof the lesion along its entire periphery to visualize and remove all of the glands. Healing without complication or recurrence should follow.,, In small mucocele cases, they are completely excised with primary closure, with rapid and uneventful healing. On the other hand, larger lesions may also be managed by marsupialization, cryosurgery, laser ablation, and micromarsupialization.
The glands of Blandin and Nuhn are not encapsulated and are directly overlapped by the muscle tissues; their manipulation tends to be different from other oral mucoceles; moreover, they cannot be removed in toto like other mucoceles. When only marsupialization is performed, the lesion has every chance of recurrence as soon as the draining site is repaired. To avoid recurrence, which is approximately 14%, we have removed the mucocele up to the muscle plane, including the small glands found in the surgical field. The follow-up was done until 6 months which showed no recurrence.
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[Figure 1], [Figure 2], [Figure 3]