Indian Journal of Dental ResearchIndian Journal of Dental ResearchIndian Journal of Dental Research
HOME | ABOUT US | EDITORIAL BOARD | AHEAD OF PRINT | CURRENT ISSUE | ARCHIVES | INSTRUCTIONS | SUBSCRIBE | ADVERTISE | CONTACT
Indian Journal of Dental Research   Login   |  Users online: 55

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size         

 


 
ORIGINAL RESEARCH Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 3  |  Page : 337-340
Mucocele - A study of 36 cases


1 Department of Oral Pathology, Government Dental College and Hospital, Ahmedabad, Gujarat, India
2 Department of Conservative Dentistry, Government Dental College and Hospital, Ahmedabad, Gujarat, India

Click here for correspondence address and email

Date of Submission03-Jul-2009
Date of Decision08-Sep-2009
Date of Acceptance28-Jan-2010
Date of Web Publication29-Sep-2010
 

   Abstract 

Background: Mucocele is one of the most common benign soft tissue tumor present in the oral cavity. They are of two types - one is extravasation and second one is retention type but the majority are extravasation type.
Aims: The objective is to determine various factors related to mucocele such as role of trauma due to nearby teeth, recurrence, duration, and to find out whether there is any role of psychological stress which initiates trauma like lip or cheek biting.
Materials and Methods: 36 cases of mucocele diagnosed at the Department of the Oral Pathology, Govt. Dental College and Hospital, Ahmedabad, between 2004 and 2008 were reviewed. The clinical data were recorded and histopathologic diagnosis was made.
Statistical Analysis Used: Data analysis tool, Microsoft Office Excel 2007.
Results: A diagnosis of mucocele was established in 36 cases with male-to-female ratio of 1.77:1. Most common type was extravasation in 30 (83.33%) cases. The peak age of occurrence was between 1st and 3rd decade. Lateral side of the lower labial mucosa was the most affected site in 34 (94.44%) cases. The history of trauma appeared the major etiological factor seen in 28 (77.77%) cases.
Conclusion: We conclude that there was male predominance and they were more affected in 2nd and 3rd decade. The lateral side of lower labial mucosa was the commonest site and the trauma due to teeth or lip biting was the major etiological factor for the occurrence of the mucocele. The article highlights role of psychological stress in occurrence of mucocele. The reader should understand the importance of histopathology examination and should try to control the psychological stress in such mucocele patients.

Keywords: Extravasation type, mucocele, psychological stress, retention type, trauma

How to cite this article:
Jani DR, Chawda J, Sundaragiri SK, Parmar G. Mucocele - A study of 36 cases. Indian J Dent Res 2010;21:337-40

How to cite this URL:
Jani DR, Chawda J, Sundaragiri SK, Parmar G. Mucocele - A study of 36 cases. Indian J Dent Res [serial online] 2010 [cited 2014 Oct 24];21:337-40. Available from: http://www.ijdr.in/text.asp?2010/21/3/337/70793
Mucoceles (muco meaning mucous and coele meaning cavity), by definition, are cavities filled with mucus. When it occurs in the oral floor, they are called ranula (rana=frog and ula=little) because the swelling resembles the vocal or air sacs of the frog. [1] Mucus is the exclusive secretory product of the accessory (minor) salivary glands and the more prominent product of the sublingual (major) salivary gland. Mucoceles are of two types based on the histologic features of the cyst wall: a mucous extravasation (extra=outside vasa=vessel) cyst formed by mucous pools surrounded by granulation tissue and a mucous retention cyst with an epithelial lining. [1] The lesions can be located directly under the mucosa (superficial mucocele), in the upper submucosa (classic mucocele), or in the lower corium (deep mucocele). [2]

In this article, we have discussed etiopathology and clinical aspects of 36 cases of mucocele to evaluate the predilection of age, sex, site, and role of psychological stress apart from trauma due to teeth in the occurrence of mucocele. Aim is also to show the importance of histopathological diagnosis in regards to the recurrence of mucocele.


   Materials and Methods Top


All the tissues sent for the histopathological examination to the Department of Oral pathology, Government Dental College and Hospital, Ahmedabad, during 1 st January, 2004 to 31 st December, 2008 were evaluated and specimens diagnosed as mucocele were separated. Re-evaluation of all the mucocele cases was done according to standard diagnostic guidelines by experienced staff members. Information pertaining to age, sex, clinical history, and other findings were recorded from the collected data and all the data were made computerized and subjected to statistical analysis.

The ANOVA test was used for analyzing all the data except size of mucocele (data analysis tool, Microsoft Office Excel 2007). The results were considered statically significant if the P-value was less than 0.05.


   Results Top


During the 2004-2008 period, a total of 36 cases were diagnosed as mucocele of different types. The demographic data pertinent to the 36 cases are consolidated in [Table 1].
Table 1 :The demographic data pertinent to the cases


Click here to view


In the present study, the age range was from 6 years to 66 years with mean age of 23.55 years and duration varied from 7 days to 2 years. There were 23 (63.88%) males and 13 (36.11%) females [Figure 1]. The majority 29 (80.55%) cases were in the 1st to 3 rd decade. In the 1 st decade only, females were affected 5 (13.89%) whereas in 3 rd decade only males were affected 8 (22.22%). In 2 nd decade 16 (44.44%) cases were affected without any gender differentiation [Figure 2].On statistical analysis, there was male predominance (P=0.03<0.05).
Figure 1 :Sex-wise distribution and mucosal appearance of 36 cases of mucocele

Click here to view
Figure 2 :Age distribution of 36 cases of oral mucocele

Click here to view


The lower labial mucosa, lateral to the mid line, was the commonest affected site seen in 34 (94.44%) cases, which was statistically significant (P<0.05), followed by 2 (5.55%) cases of buccal mucosa.

In present study, lesion with normal mucosal appearance was seen in 24 (66.67%) cases rather than the bluish color which was seen in only 12 (33.33%) cases [Figure 1]. In 8 (22.22%) cases, there was no known cause while history of trauma was seen in 28 (77.78%) cases and from them in 20 (71.43%) cases there was history of chronic trauma due to lip or cheek biting and trauma due to adjacent tooth was seen in only 8 (28.57%) cases. An interesting finding was seen in 10 (27.78%) cases which showed recurrences varying from one to multiple recurrences and from them most of the cases were of extravasation type, i.e., 9 (90%) cases. The size of the most of the lesions was less than 1.5 cm as seen in 30 (83.33%) cases, but in only 6 (16.66%) cases the size was larger than 1.5 cm.

On histopathological examination, mainly two types of mucocele were identified.

Here 25 (69.44%) cases showed classical mucocele (extravasation type) which consists of parakeratinized stratified squamous epithelium overlying the condensed fibrous connective tissue in which a cavity containing mucin and inflammatory cells lined by compressed granulation tissue [Figure 3] and the presence of mucous acini beneath it [Figure 4]. And 5 (13.88%) cases showed deep mucocele (extravasation type) which consists of normal salivary gland acini, ducts, and muscle tissue associated with space filled with mucous, but there was no epithelization [Figure 5]. While 6 (16.66%) cases showed retention type of mucocele which consists of mucous-filled spaces lined by epithelium.
Figure 3 :Photomicrograph of classical mucocele (extravasation type) showing mucosal epithelium (E) on the right side and beneath it granulation tissue with collected mucin and inflammatory cells (I) (H and E; original magnification ×100)

Click here to view
Figure 4 :Photomicrograph of classical mucocele (extravasation type) showing mucosal epithelium (E), beneath it granulation tissue (G) with collected mucin and mucous acini (M) (H and E; original magnification ×10)

Click here to view
Figure 5 :Photomicrograph of deep mucocele showing granulation tissue with collected mucin and inflammatory cells (H and E; original magnification ×100)

Click here to view



   Discussion Top


A mucocele or mucous cyst is a common, mucus-containing cystic lesion of the minor salivary glands in the oral cavity. Some authors prefer the term mucocele since most of these lesions are not true cysts due to the absence of epithelial lining. [2] The mechanism of formation of the mucocele is still not totally clear; however, a traumatic etiology rather than an obstructive phenomenon is favored. Chaudhry et al. showed that the escape of mucus into the surrounding tissue after severing the excretory salivary ducts lead to the formation of the mucocele. [3],[4] The most frequent occurrence of the mucocele in the lateral aspect of the lower lip, [5] a trauma-prone site in the present study also supports the role of trauma as an etiologic factor either in the form of sharp tooth cusp or biting habit where the psychological stress appeared as an initiating factor for the biting trauma. Although obstruction may play a role in the etiology of the mucocele. [6] We had noticed that mucocele was most predominant in male and occurred frequently in 1 st to 3 rd decade with majority in 2 nd decade of life which was also reported by Robinson and Hansen. [7] According to our knowledge, males in 2 nd decade have to face many psychological problems and that is why they develop lip biting habit in this age.

In extravasation type, there is leakage of fluid from the ducts or acini in to the surrounding tissue. They are mainly seen at the site of accessory salivary glands and are rarely larger than 1.5 cm. The physical trauma is the initiating factor except in the mucous glands of the mid portion of the posterior hard palate and the adjacent soft palate. [8] These findings were noticed in the present study also. The retention phenomenon occurs as a result of a narrow ductal opening that cannot adequately accommodate the exit of saliva produced and ultimately lead to ductal dilation and surface swelling because of low-grade chronic superficial irritation. [1]

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 having bluish color, while the deeper lesions are more nodular, lack the vesicular appearance, and having normal mucosal color. [9] In the present study in 24 (66.66%) cases, the lesions were deep seated while in 12 (33.33%) cases lesions were superficially located. The extravasation type was seen in 30 (83.33%) cases while only 6 (16.66%) cases showed retention type. All the 6 (16.66%) cases of retention type of mucocele, the overlying mucosa was normal; whereas the extravasation type showed either color, from them 19 (63.33%) cases had normal mucosal color where the lesions were deep seated.

Association of pain was seen in only 5 (13.89%) cases which might be due to the active secretion of saliva during mastication from minor salivary glands, causing increased pressure within the cavity. In the present study, 34 (94.44%) cases had lesions on the lower labial mucosa which was the commonest site also reported by Jorne, [2] Robinson and Hansen, [7] and Harrison. [10] An interesting finding was that 8 (22.22%) cases had trauma due to tooth, whereas 20 (55.55%) had biting trauma and most of them were male, i.e., 16 (80%) cases, while remaining 8 (22.22%) cases had no known cause and might indicate that the other factors may play a role in their pathogenesis apart from trauma. Although there is good prognosis of mucocele, in the present study the recurrence rate appears somewhat higher seen in 10 (27.78%) cases; this might be due to partial removal of the lesional tissue or because of the psychological stress, the biting habit may not be discontinued.

From this study we conclude that the mucocele is common in male, mostly in the younger age groups in 1 st to 3 rd decade. We also found that the lower labial mucosa is the commonest site and most of the lesions are of normal mucosal color. Most of the mucoceles can be easily identified through clinical appearance, but in some cases it is very essential to have the histopathological examination because they can be misdiagnosed by clinical appearance alone. The trauma appeared as an etiological factor, but specifically the psychological stresses initiate the biting trauma. This may support the basis for the further study as psychological stresses play a role in the occurrence of mucocele.

 
   References Top

1.Baurmash HD. Mucocele and ranulas. J Oral Maxillofac Surg 2003;61:369-78.  Back to cited text no. 1      
2.Jornet PL. Labial mucocele: a study of eighteen cases. Int J Dent Sci 2006;3:2.  Back to cited text no. 2      
3.Bhaskar SN, Bolden TE, Weinmann JP. Pathogenesis of mucoceles. J Dent Res 1956;35:863-74.   Back to cited text no. 3      
4.Shivapathasundharam B. Physical and chemical injuries of the oral cavity. In: Rajendran R, Shivapathasundharam B, editor. Shafer's Textbook of Oral Pathology, 6 th ed. Noida: Elsevier; 2009. p. 517-69.  Back to cited text no. 4      
5.Shear M. Cysts of the salivary glands. In: Shear M, Speight P, editors. Cysts of The Oral and Maxillofacial Regions, 4 th ed. Oxford: Blackwell Munksgaard; 2007. p. 171-80.  Back to cited text no. 5      
6.Chaudhry AP, Reynolds DH, Lachapelle CF, Vickers RA. A clinical and experimental study of mucocele. J Dent Res 1960;39:1253-62.  Back to cited text no. 6      
7.Robinson L, Hjorting-Hansen E. Pathologic changes associated with mucous retention cysts of minor salivary glands. Oral Surg Oral Med Oral Pathol 1964;18:191-205.   Back to cited text no. 7      
8.Wall VI, Wilson DF. Non-neoplastic disorders of the salivary glands. In: Prabhu SR, Wilson DF, Daftary DK, editors. Oral Diseases in the Tropics, 2nd ed. Oxford: Oxford university press; 1992. p. 665-74.  Back to cited text no. 8      
9.Koudelka BM. Obstructive disorders. In: Ellis GL, Auclair PL, Gnepp DR, editors. Surgical Pathology of the Salivary Glands, 1st ed. Philadelphia, W.B. Saunders Company, 1991. p. 26-39.  Back to cited text no. 9      
10.Harrison JD. Salivary mucoceles. Oral Surg Oral Med Oral Pathol 1975;39:268-78.  Back to cited text no. 10      

Top
Correspondence Address:
Dhaval R Jani
Department of Oral Pathology, Government Dental College and Hospital, Ahmedabad, Gujarat
India
Login to access the Email id


DOI: 10.4103/0970-9290.70793

PMID: 20930340

Get Permissions



    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]

This article has been cited by
1 Clinical and Histological Analysis of Oral Mucocele
Seung-Gu Park,No-Seon Park,Chin-Saeng Cho,Ah-Young Kim,Dong-Sik Chang,Ho-Yun Lee,Hyun-Jin Son,Myoung-Su Choi
Korean Journal of Otorhinolaryngology-Head and Neck Surgery. 2013; 56(6): 359
[Pubmed]
2 Case study of a gingival mucous cyst that developed during distraction of the mandible
Yoshihiro Watanabe,Kasumi Shimizu,Jouji Nomura,Yoshihiko Matsumura,Shinnosuke Nakamura,Kenya Okumura,Chu Sato,Hiroshi Morita,Takashi Takeoka,Toshiro Tagawa
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2012; 24(3): 159
[Pubmed]
3 Case study of a gingival mucous cyst that developed during distraction of the mandible
Watanabe, Y. and Shimizu, K. and Nomura, J. and Matsumura, Y. and Nakamura, S. and Okumura, K. and Sato, C. and Morita, H. and Takeoka, T. and Tagawa, T.
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2012; 24(3): 159-161
[Pubmed]



 

Top
 
 
  Search
 
 
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
    Materials and Me...
    Results
    Discussion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed7050    
    Printed151    
    Emailed9    
    PDF Downloaded278    
    Comments [Add]    
    Cited by others 3    

Recommend this journal