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SALIVARY GLANDS - MUCOCELES
Numerous secreting minor salivary glands are scattered throughout the oral cavity. Each gland has its own duct system with the orifice on the immediate overlying mucosa. Because these ducts are subject to oral trauma and consequent laceration, leakage can occur with the secretions escaping into the surrounding submucosal tissue. Pools of mucus collect causing a visible surface swelling - the mucocele.
Infrequently, true minor salivary gland retention cysts with an
epithelial lining can occur. However, since most mucoceles represent
extravasation phenomena, they have no such lining. Rather, the mucocele
has a
The mucocele develops mostly in children and young adults and in any location harboring minor salivary glands. The lower lip and inner aspect of the cheek are most susceptible because they are readily traumatized during oral function. The mucocele typically has a diameter of 1.0-2.0 cm. It is a soft oval fluctuant fluid containing mass that is slow growing and superficially positioned. The overlying vascular congestion and translucent color of the contained secretion serve to give the mucocele a bluish color. Little discomfort, other than some mechanical interference with mastication and speech, is experienced.
Because the mucocele is subject to repeated oral trauma, it tends to rupture easily. Healing of the roofing mucosa rapidly ensues. With unabated leakage from the damaged duct and secretions continuing to accumulate beneath the healed surface, recurrences can be expected.
Although spontaneous remission occasionally occurs, treatment requires surgical intervention. Attempts at blunt dissection are compromised when the thin walled lesion collapses during surgical manipulation and the anatomic borders are lost. Marsupialization (exteriorization) procedures have a high failure rate because the causative agent, the damaged duct, is not eliminated. The Salivary Gland Center (SGC) recommends complete excision of the cystic mass,along with the overlying mucosa and the culpable adjacent minor gland, as the treatment of choice.
Informed consent should include the possibility of recurrence. Furthermore, because the terminal filaments of the mental nerve are anatomically close to lower lip mucoceles, the nerve may incur surgical trauma. Localized areas of anesthesia, usually transient, may develop. The Salivary Gland Center (SGC) was developed because a void existed in the diagnostic and comprehensive care of patients with salivary gland problems and/or secretory dysfunction. Since the diversity of these salivary conditions presents challenges to the clinician, the SGC is available for referrals. Louis Mandel, DDS Director, Salivary Gland Center (212) 305-9982
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wall
of fibrous and inflammatory tissue. Surrounding macrophages take
on an epithelium-like appearance which in the past has been misinterpreted
as a true epithelial lining.