Mucocele Removal

CHAPTER 26 Mucocele Removal



Andy S. Barnett, Stephen K. Toadvine


Oral mucous cysts (mucoceles) form as a result of obstruction or trauma involving the ducts of minor salivary glands. Mucoceles are the most common benign soft tissue mass of the oral cavity. Mucoceles occur most frequently in the mucosa of the lower lip. They appear as soft, nontender, compressible lesions with a pink or bluish tinge. Typical size ranges from a few millimeters up to 1 cm, but can be much larger. Superficial mucoceles may rupture and not recur, but larger lesions usually remain persistent or recurrent unless treated adequately.



Anatomy


Because most labial mucoceles occur as a result of mild trauma, location adjacent to the lower lip incisors is most common. Lesions on the lower lip can occur in any layer of tissue from the upper mucosa to beneath the submucosa and usually involve minor salivary glands without the involvement of significant neurovascular structures.



Indications



• Growth, pain

• Lesions refractory to superficial treatment (e.g., simple puncture or topical cryotherapy)

• Uncertain of clinical nature and biopsy is indicated

• Cosmetic concerns


Contraindications



• Atypical location (e.g., gingival or sublingual)

• Atypical gross appearance when perhaps just a biopsy is indicated

• Pulsating mass (consider an arterial aneurysm) (relative)


Equipment



• Lidocaine 2% with 1 : 100,000 epinephrine

• 1- to 3-mL syringe with a image– to 1-inch, 27- or 30-gauge needle

• Scalpel with no. 11 blade and possibly a no. 15 blade

• Cryocautery or electrocautery unit


Precautions


Depending on location, consider a proximal duct stone or tumor occluding the duct. Be sure to include any unusual or palpable/thickened tissue in the specimen. Lesions that are atypical in appearance or location should be sent for pathologic evaluation to exclude carcinoma.



Preprocedure Patient Preparation


See the sample patient education handout titled “Mucocele Treatment” online at www.expertconsult.com.



Procedure



Small Lesions or Initial Treatment


An injection of lidocaine with epinephrine is given under the mucocele to produce anesthesia and to minimize bleeding by inducing vasoconstriction. The injection will often elevate the lesion, making it easier to see. Injecting in or above the lesion may have just the opposite effect.


With a no. 11 blade, a small stab wound is made in the cyst laterally, and the seromucinous contents are expressed. A freeze of the lesion (see Chapter 14, Cryosurgery) is performed to produce a 2- to 3-mm rim of ice around the lesion. As an alternative to cryotherapy, electrocautery may be used to lightly desiccate the lesion after incision and drainage. The ball cautery tip can be inserted directly into the cavity.



Larger Lesions


Because the tissue is so pliable it is often difficult to stabilize the lip. Consider using a large chalazion clamp, which also effectively controls bleeding.



Option 1


For larger lesions, recurrence is less likely if the roof is shaved off with a no. 15 blade before proceeding to cryotherapy or electrodesiccation (Fig. 26-1). Compress the area firmly between the fingers to reduce bleeding. If cryotherapy is chosen, hemostasis should be obtained before the freeze. A chemical coagulant, such as Monsel’s solution, is useful here. The wound is allowed to heal by secondary intent, which takes 5 to 7 days. Caution the patient not to “bite” on the areas, which is tempting to do.



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Figure 26-1 Mucocele removal. A, Large mucocele on the lip that recurred after previous incision, drainage, and cryosurgery. B, The lip is stabilized for administration of local anesthesia with lidocaine and epinephrine. C, The protruding tip of the mucocele is shaved off with a no. 15 blade. D, Preliminary hemostasis is achieved with Monsel’s solution. E, Liquid nitrogen is sprayed to destroy the underlying lesion. F, Cryospray is continued until a 2-mm halo of normal tissue is frozen around the affected area. G, Electrosurgery is used to achieve final hemostasis after cryosurgery.


(From Usatine RP, Moy RL, Tobinick EL, Siegel DM [eds]: Skin Surgery: A Practical Guide. St. Louis, Mosby, 1998.)

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May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Mucocele Removal

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