JICDRO is a UGC approved journal (Journal no. 63927)

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Year : 2015  |  Volume : 7  |  Issue : 2  |  Page : 168-170

Laser excision of a mucocele: A case report


Department of Periodontics, Guru Nanak Institute of Dental Science and Research, Kolkata, West Bengal, India

Date of Web Publication3-Sep-2015

Correspondence Address:
Dr. Rajashree Ganguly
TM 5/30 Nishikanan, Teghoria, Kolkata - 700 157, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0754.164405

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   Abstract 

A mucous cyst (mucocele, mucous retention cyst, ranula, and epulis) is usually a painless, thin sac on the inner surface of the lips. It contains clear fluid. It is painless but can be bothersome. The cyst is thought to be caused due to sucking of the lip membranes between the teeth. A mucous cyst is common and harmless. However, if left untreated, it can organize and form a permanent bump on the inner surface of the lip. A mucous cyst is called ranula when it occurs on the floor of the mouth and epulis when it occurs on the gums. The sac may also be formed around the jewellery (piercings) that has been inserted into the lips or the tongue. This article highlights the use of lasers in the treatment of the excision of mucocele.

Keywords: Diode laser, excision, mucocele


How to cite this article:
Ganguly R, Mukherjee M, Pal TK. Laser excision of a mucocele: A case report. J Int Clin Dent Res Organ 2015;7:168-70

How to cite this URL:
Ganguly R, Mukherjee M, Pal TK. Laser excision of a mucocele: A case report. J Int Clin Dent Res Organ [serial online] 2015 [cited 2019 Nov 11];7:168-70. Available from: http://www.jicdro.org/text.asp?2015/7/2/168/164405


   Introduction Top


A mucocele (derived from the Latin terms mucus or mucus and coele or cavity) is defined as a mucus-filled cavity that can appear in the oral cavity, appendix, gall bladder, paranasal sinuses, or lacrimal sac. [1],[2] The term "mucocele" in the oral cavity is used to define the accumulation of mucus secreted from salivary glands and their ducts in the subepithelial tissue. [3] Recurrence may occur and thus, the excision of the adjacent salivary gland [4] as a preventive measure. Clinically, two types of mucoceles are not differentiated. [5]


   Case Report Top


A 34-year-old male patient had come to the outpatient department (OPD) of Guru Nanak Institute of Dental Sciences and Research with complaints of a swelling in the lower lip that was growing in size in the left commissural region for the past 12 days [Figure 1]. On clinical examination, it was revealed that he had a habit of biting his lips. The swelling was fluctuant but painless and sessile [Figure 2]. The swelling was 0.8 × 0.8 cm in size and around 0.8 cm in width [Figure 3] and [Figure 4]. The patient was explained that the lesion had to be excised with the use of lasers that was the latest option available. A diode laser (Doctors Smile Lambda Scientifica Class4 Laser) was used to excise the lesion [Figure 5]. The incision was made on the top of the swelling and the lesion was excised slowly with the capsule intact. The lesion was further sent for histopathological investigation. The histopathological study confirmed the lesion to be a mucocele [Figure 6] and [Figure 7]. The patient was recalled after 1 week and 1 month for postoperative checkups [Figure 8]. The patient had no systemic diseases and had complete dentition with good oral hygiene. The lip was everted with digital pressure to increase the lesion's prominence during surgical excision. All laser safety protocols were followed prior to and during the laser surgical procedure. Enameloplasty was carried out on all the sharp teeth to prevent the same problem in the near future. Postoperative instructions were given to the patient to stop the habit of biting his lips.
Figure 1: Swelling in the lower left lip commissural region


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Figure 2: Sessile lesion


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Figure 3: Per-operative view


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Figure 4: Excised tissue


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Figure 5: Immediate postoperative view


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Figure 6: Optical photomicrograph of the mucocele showing the crypt of the mucocele surrounded by mesenchymal stroma


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Figure 7: Optical photomicrograph showing overlying covering of the epithelium


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Figure 8: 1-month after operation of the healed lesion


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   Discussion Top


Bhaskar et al. [6] suggested obstruction of the salivary gland ducts as the cause of mucoceles. This hypothesis has lost support in favor of a traumatic origin of the lesions. Many studies confirm the traumatic etiology of mucoceles. The incidence of mucoceles in the general population is 0.4%-0.8%, with little differences between males and females. There are different treatment options including medication gamma linolenic acid (GLA), cryosurgery, intralesional corticosteroid injection, micro-marsupialization, marsupialization of the mucocele, conventional surgical removal of the lesion, and laser ablation. [3] GLA is a precursor of prostaglandin E and its use has been associated with limited success in the treatment of mucocele. [5] GLA works by reducing inflammation through competitive inhibition of prostaglandins and leukotrienes. Total elimination is aimed to prevent recurrence. Dental lasers provide an easy and comfortable option of keeping the procedure efficacious as well as minimally invasive. Vaporization with argon and neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12 (Nd:YAG) lasers have been described for the treatment of mucoceles. Both laser procedures presented satisfactory results with low recurrence rates and were well-tolerated by the patients whose main complaint was discomfort. [1],[2] The diode laser (wavelength 800-810 nm), similar to argon and Nd: YAG laser, is intensely absorbed by the gland involved. Appropriate power-set parameters must be considered for this type of procedure to avoid excessive thermal damage to the soft tissues and consequent unfavorable postoperative symptoms. The quicker and uneventful healing after laser therapy adds to patient satisfaction. The tentative diagnosis of a mucocele is made from the clinical history, clinical presentation, and palpation of the lesion and the definitive diagnosis is made by histopathology. The histopathological report confirmed the presurgical diagnosis in this case.

Acknowledgement

I am grateful to Professor (Dr.) Pal. T.K. in guiding and discussing the case. I am thankful to the patient and his family members for their utmost cooperation. I am also grateful to Dr. Mun Mukherjee for her support during the clinical procedure.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Baurmash HD. Mucoceles and ranulas. J Oral Maxillofac Surg 2003;61:369-78.   Back to cited text no. 1
    
2.
Ozturk K, Yaman H, Arbag H, Koroglu D, Toy H. Submandibular gland mucocele: Report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:732-5.  Back to cited text no. 2
    
3.
Asdullah MD, Gupta J, Sachdev AS. Mucocele of lower lip. Guident 2015;8:46-8.  Back to cited text no. 3
    
4.
Seo J, Bruno I, Artico G, Vechio AD, Migliari DA. Oral mucocele of unusual size on the buccal mucosa: Clinical presentation and surgical approach. Open Dent J 2012;6:67-8.  Back to cited text no. 4
    
5.
Chawla K, Lamba AK, Faraz F, Tandon S, Arora S, Gupta M. Treatment of lower lip mucocele with Er,Cr:YSGG Laser - A case report. J Oral Laser Applications 2010;10:181-5.  Back to cited text no. 5
    
6.
Bhaskar SN, Bolden TE, Weinmann JP. Pathogenesis of mucoceles. J Dent Res 1956;35:863-74.  Back to cited text no. 6
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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