Mucous Extravasation Phenomenon Research Articles

Conventional Surgical Excision of Lower Lip Mucocele in Children

Introduction: Mucoceles, as a mucus escape reaction or mucus extravasation phenomenon, are prevalent benign abnormality affecting the salivary glands. Most commonly occur in the lower lip in children and young adults. It emerges in response to trauma and obstruction of salivary gland ducts. Mucoceles are typically painless but can be troublesome for individuals while eating and speaking. Case report: An 8-year-old boy reported a lower lip mucocele due to their habit of lip biting. The lesion has been treated with a conventional surgical excision under local anesthesia and followed up after one week. The results showed that the mucocele lesion healed, no remnant was seen, and there was no complaint from the patient. Discussion: Oral mucoceles in the lower lip occur in children due to mucosa trauma or lip biting. For the patient reported here, conventional surgical excision using a scalpel was the treatment option due to the small size and superficial form of the lesion, so excisions can be done more easily with minimal postoperative wounds. Conclusion: Conventional surgical excision guarantees the removal of a whole small superficial mucocele lesion. Moreover, identifying the underlying cause of oral mucocele is crucial for patient education, enabling them to comprehend their condition and take measures to prevent its recurrence.

Uncommon Histopathological Variants of a Common Lesion: Mucocele

A mucocele is a salivary gland cyst, which contains mucous material. It usually arises from the minor salivary glands and is broadly of two types: mucus retention cysts and mucus extravasation phenomenon. A wide variety of histological features have been documented in the literature such as myxoglobulosis, mucoceles presenting papillary synovial metaplasia-like changes, superficial mucoceles, and clear cell changes. The present case shows histological features of myxoglobulosis and papillary synovial metaplasia like changes (PSM like changes). This paper reports a case of a 17 years old male patient with a chief complaint of a painless swelling on the lower lip since one and half year. Upon a provisional diagnosis of mucocele, surgical excision was carried out. Histopathological examination revealed a mucus extravasation cyst having lumen filled with unique mucinous globular structures, myxoglobulosis and papillary synovial metaplasia like changes.

Papillary synovial metaplasia-like change in oral mucoceles: A retrospective institutional study of 105 cases.

Background:Mucoceles are mucus-filled cavities and are broadly of two types: mucus retention cysts and mucus extravasation phenomenon. A wide variety of histological features have been documented in the literature. The present study was an attempt to study these histological features: papillary synovial metaplasia-like changes (PSM-like changes) in particular.Materials and Methods:One hundred and five tissue samples of mucoceles were retrieved and evaluated for age, gender, type, site, color, etiology, symptoms, dimension of the lesion and presence or absence of PSM-like changes. The results were documented on Microsoft Excel spreadsheet and analyzed by using SPSS.Results:All 105 cases were of mucus extravasation phenomenon with a definitive male preponderance. The mean age of occurrence was 25.82 ± 11.65 years and a predilection for the lower lip. PSM-like changes were seen in 31 cases (Group II), and the remaining 74 cases did not show a definite presence of these features (Group I). The cases in Group II were statistically larger in dimension than Group I cases. No difference was noted in age, gender and laterality.Conclusion:PSM-like changes appear to be an underrecognized histological alteration seen in oral mucoceles and must be recognized to differentiate from other salivary gland entities showing papillary architecture.

Unexpected additional pathologies at the surgical margins of oral squamous cell carcinoma.

There is a scarcity of literature on the presence of additional unexpected pathologies at the surgical margins of oral squamous cell carcinoma (OSCC). It is quite possible that such pathologies might get overlooked because of primary focus on the malignancy at the surgical margins. With this view in mind, a retrospective observational study has been designed to re-visit the surgical margins of OSCC for the possible presence of unexpected pathologies. Haematoxylin and eosin-stained sections of 96 cases (four surgical margins in each case) of OSCC were carefully examined under a compound microscope by two oral pathologists for the presence of any additional pathology. Out of 96 specimens of OSCC, 76 (79.2%) cases showed the presence of accidental pathologies. The surgical margins of 20 (20.8%) cases showed no evidence of any pathology, whereas the margins of 23 (23.95%) cases were associated with more than one pathology. The most commonly observed accidental pathology was oral submucous fibrosis (40.625%), followed by leukoedema (16.675%), retention cysts (10.42%), and calcifications (7.3%). The mucous extravasation phenomenon (6.25%), minor salivary gland (MSG) inflammation (6.25%), and lichen planus (5.21%) were also observed in the surgical margins of OSCC. A significant number of accidental pathologies exist at the surgical margins of OSCC. This effect could be because of over-emphasis on the tumour status at the surgical margins, which leads to over-looking of minor pathologies.

Fibrolipoma em cavidade oral - Relato de caso

Fibrolipoma is a benign neoplasm characterized by the presence of mature adipose cells separated by broad bands of dense fibrous connective tissue. This pathology is a microscopic variant of lipoma and can affect any part of the body. However, its occurrence in the oral cavity is uncommon. It is usually a smooth-surface lesion, asymptomatic, slow-growing, pedicled, asymptomatic, yellowish or pinkish color when deeper, soft on palpation, occurring mainly in the jugal mucosa. Thus, the aim of this paper is to describe the main clinical, histopathological and treatment characteristics of a clinical case of fibrolipoma. A 67-year-old female patient, leukoderma, had a normochromic, asymptomatic, firm palpation nodule, fibrous consistency, and smooth surface, with a time course of approximately two years, located in the left jugal mucosa. The diagnostic hypotheses were lipoma, fibroma, mucus extravasation phenomenon and giant cell fibroma. The patient underwent excisional biopsy and histopathological examination revealed the definitive diagnosis of fibrolipoma. The patient is in preservation, with no sign of relapse. It is concluded that, although fibrolipoma is a benign lesion, its growth can reach large dimensions, reinforcing the need for surgical excision. It should also emphasize the importance of histopathological examination to differentiate histopathological variations of lipoma.

A Multicenter Study of Tongue Lesions from Thailand.

Objective Tongue lesions constitute a considerable proportion of the oral lesions. Previous studies on tongue lesions were based on clinical studies. There has been a scarcity of the studies which are based on histopathological examination. This study aimed to determine the prevalence, demographic, and pathologic features of tongue lesions from Thailand. Materials and Methods Biopsy records of the participating institutions were reviewed for lesions on the tongue diagnosed during 1998 to 2017. Demographic data were collected from the biopsy records. Locations were arbitrarily classified as dorsal, lateral, and ventral surfaces, tip of the tongue, and the combination of sites. Lesions of the tongue were classified as reactive/inflammatory, developmental, immune-mediated, cystic, benign, premalignant, malignant, infectious, and miscellaneous categories. Statistical Analysis Data were analyzed by descriptive statistics using SPSS version 20.0. Results Of the 44,188 accessioned cases, 2,153 cases (4.87%) were diagnosed from the tongue. The age of the patients ranged from 3 to 93 years with the mean ± standard deviation = 45.26 ± 20.48 years. The female-to-male ratio was 1.49:1. The majority of the tongue lesions were encountered at the lateral border of the tongue (47.66%). Most of the tongue lesions in the present study (53.74%) fell into the reactive/inflammatory category. Irritation fibroma was the most prevalent lesion (18.99%) followed by squamous cell carcinoma (16.91%), and mucus extravasation phenomenon (14.26%), respectively. Conclusions This study offers new perspective into the study of tongue lesions apart from the clinically based studies. It also demonstrates the difference between the pediatric and the elderly patients. This study provides invaluable database for clinicians when formulating the clinical diagnosis of tongue lesions.

Oral ranulas: A 15-year retrospective clinico-surgical evaluation in a major referral hospital in the Southern Province of the Kingdom of Saudi Arabia

Background: A ranula is a mucous extravasation phenomenon involving the sublingual gland. The main objective of the current study was to present a clinic-surgical evaluation of ranula in our center. Materials and Methods: This is a 15-year retrospective analysis of ranulas in the main referral hospital in the Najran Region of the Kingdom of Saudi Arabia. Data collected includes demographics, type of ranula, modality of occurrence, laterality, surgical approach, and type of treatment. Data were stored and analyzed using IBM SPSS Statistics for IOS Version 25(IBM Corp., Armonk, NY, USA). Results were presented as simple frequencies and descriptive statistics. Results: Fifty-five cases of oral ranula were recorded out of a total of 75 ranulas during the study with a prevalence rate of 0.14 cases/1000 persons. There were 27 males and 28 females with a male-to-female ratio of 1:1.03. Their ages ranged from 2 years to 45 years with mean ± standard deviation (22.2 ± 10.7). The age group from 11 to 20 years had the highest frequency with 19 cases, representing 34.5% followed by the age group of 21–30 years with 16 cases, representing 29.1%. Of the total of 55 cases of oral ranula, 53 (96.4%) had the lesions excised together with the sublingual gland through intraoral approach, while only 2 (3.6%) cases were marsupialized. Conclusions: We have reported that oral ranulas represent about 73.3% of the ranulas. Surgical removal of the lesion and the sublingual gland is essential for the prevention of recurrence. Loose intraoral suturing in the floor of the mouth is advised to prevent saliva refilling.

Stromal Changes In Benign and Malignant Salivary Gland Tumors With Picrosirius Red-A Polarizing Microscopic Study

Objectives: To explore the polarizing color profile in connective tissue stroma of Picro-Sirius Red (PSR) stained sections of benign and malignant salivary gland tumors (SGT) and to assess the possible utility of this method as a diagnostic tool. Materials and Methods: A total number of 60 Paraffin blocks of benign (30 cases) and malignant (30 cases) salivary gland tumors were selected from the archives of our institute and regional cancer hospital. 30 cases of Mucous Extravasation Phenomenon (MEP) were selected as control. Salivary gland tumors and control were stained with PSR stain and examined under polarizing microscope. We counted 50 thin and 50 thick collagen fibers in each section of benign and malignant SGT and were categorized as Greenish Yellow (GY) or Yellowish Orange (YO). Statistical analysis was performed by using oneway ANOVA and Paired t-test. Results: We found similar presentation of polarizing color arrangement for thin collagen fibers (80-85% GY and 15-20% YO) in both benign and malignant SGT and MEP. In malignant SGT, thick collagen fibers exhibited different polarizing color (80% GY) than benign SGT and MEP (12-14% GY). Polarizing color profile of collagen in malignant SGT displayed a different presentation as compared to benign SGT and control (MEP) and differences were statistically significant(p<0.05). Conclusion: This study concluded about the difference of stromal collagen fibers in benign and malignant SGT. Malignant SGT suggesting loosely arranged collagen fibers could be involved in further growth and invasion of disease along with other cellular and molecular events. Keywords: Collagen, Mucous Extravasation Phenomenon, Picro-Sirius Red (PSR) Stain, Polarized Microscopy, Salivary Gland Tumor

MUCUS EXTRAVASATION PHENOMENON HIDING A MUCOEPIDERMOID CARCINOMA IN THE FLOOR OF MOUTH

Background Mucoepidermoid carcinoma is the most common salivary gland malignancy. Approximately more than half these tumors present in the major salivary glands, the parotid gland being the most frequent location.1 The others occur in the minor salivary glands, primarily in the palate.2 The submandibular gland is rarely involved, about less than 10% of all other major salivary glands.1 This tumor develops over a wide age range—from the second to the seventh decades of life.3 Histologically, mucoepidermoid carcinoma is classified, on the basis of its aggressiveness, into 3 grades: low, intermediate, or high grade.1,2 Clinical and Radiologic Findings A 49-year-old female with a mass on the left side of the floor of the mouth was complaining of neck pain for the last 2 to 3 days and had noticed the mass growing in size and becoming tender to palpation. There was no exacerbation of pain during eating, drinking, or opening of mouth. Clinical examination showed no external signs of infection or inflammation. The patient denied any medical disease or history of surgeries. A multidetector computed tomography (MDCT) scan was made. Definitive Interpretation The radiographic examination revealed a mostly well-defined hypodense area suggestive of mucus extravasation phenomenon (“ranula”), which was corroborated by the clinical findings. The treatment of choice was complete excision of the ranula and the left submandibular salivary gland. The histopathologic examination surprisingly revealed low-grade mucoepidermoid carcinoma. No further treatment was recommended; however, a follow-up was scheduled in 4 months. Discussion/Conclusions This atypical location of mucoepidermoid carcinoma in the floor of the mouth simulated the clinical and radiographic features of a mucus extravasation phenomenon. This case highlights the value and importance of using all the available diagnostic tools and modalities for optimal patient management because histopathologic analysis played an important role in confirming the diagnosis.

Evaluation of pediatric oral and maxillofacial biopsies from a Tertiary Hospital in Sub-Saharan Africa

Introduction: Despite the large number of published studies on indications for biopsy during investigation of adult oral and maxillofacial pathologies, there is a dearth of literature focusing on biopsies for pediatric orofacial pathologies (particularly in sub-Saharan Africa). Objectives: Hence, this study analysed data on maxillofacial pediatric lesions from the surgical pathology archives of the Oral Maxillofacial surgery/Oral pathology unit of Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Method: Data was collected over a ten year period (2007-2016). Result: From a total of 790 biopsies recorded within the study period, only 105 (13.3%) were found to be pediatric cases. Lesions such as ameloblastoma (24%), benign bone pathologies (25%), hyperplastic reactive lesions (22%) and primary oro-facial malignancies (6%), were found within the 105 pediatric cases. Lesions tended to occur more in the mixed dentition to permanent dentition, than primary dentition age groups. A female preponderance in frequency of lesions was also observed in our study. The commonest non-odontogenic tumor was found to be fi brous dysplasia, while pyogenic granuloma was the most prevalent hyperplastic reactive lesions. Lymphangioma and Heck's disease were the commonest soft tissue tumours, and mucous extravasation phenomenon was equally the most frequent salivary gland lesion. Malignancies were found to be rare in pediatric age groups. Overall, we compared our findings to previously published literature on pediatric biopsies. Conclusion: We are hopeful that the knowledge provided in this study, may assist general dental practitioners, oral pathologists, and pediatric dentists in sub-Saharan Africa in making precise diagnostic and management decisions.

Mucous Retention Cyst – Review of Literature and a Case Report

Mucocele is a mucin filled cavity and is one of the most common salivary gland pathology. It arises either due to severance of a duct or due to an obstruction to the salivary flow. In the former case, the more appropriate term is mucous extravasation phenomenon and the latter is called mucous

Epidemiological survey of mucus extravasation phenomenon at an oral pathology referral center during a 43 year period

IntroductionMucoceles are common benign pseudocystic lesions of the oral cavity; their main etiological factors are trauma and ductal obstruction. Two histological patterns are found: mucus retention phenomenon (MRP) and mucus extravasation phenomenon (MEP). Mucus extravasation phenomenon is the more common histological subtype and it mainly affects the lower lip. The knowledge of its main clinical features and management is important to assist health professionals in clinical practice. ObjectiveThis study aimed to determine the relative frequency and distribution of oral mucoceles in an oral pathology reference center. MethodsCross-sectional historical study that analyzed all cases pathologically diagnosed as mucus extravasation phenomenon by the department of anatomic pathology of an oral pathology referral center from June of 1970 to May of 2014, considering the clinical characteristics of the lesion and those relating to the patient. SPSS v. 20.0 software for Windows was used for descriptive analysis. ResultsDuring 43 years, 719 cases of mucus extravasation phenomenon (54.7% men and 45.3% women) were registered, with the lower lip as the most commonly affected site (n=484; 67.3%). The average age of patients was 20.8 years (SD±14.4) with a peak occurrence in the second decade of life. Most professionals had oral mucocele/ranula (n=606; 84.3%) as the initial clinical impression. ConclusionMucus extravasation phenomenon is a lesion that primarily affects young patients, affecting mainly the lower lip, and is commonly found in oral diagnostic services.

Indolent palatal swelling: Catch 22.

We present an interesting but intriguing case of an indolent palatal swelling. The lesion was asymptomatic causing little discomfort to the patient and thus was an incidental clinical finding. Provisional diagnosis was a benign, minor salivary gland tumor. Clinical differential diagnoses included benign lymphoepithelial lesion or mucus extravasation phenomenon. Nevertheless, we also considered malignancies such as mucoepidermoid carcinoma, lymphoma, and neoplasm of the maxillary sinus. However, the histopathology revealed a rare clinicopathologic entity prompting immediate treatment of the lesion.

Congenital Labial Mucocele: Rare Presentation of a Common Disease

Mucoceles are common oral lesions characterized by the accumulation of mucus after rupture of a minor salivary gland duct. Nevertheless, mucoceles in newborn babies (congenital mucoceles [CM]) are an extremely rare condition. White boy, 3 months, was brought by his mother to the Oral Medicine Unit–UFPE with a chief complaint of a labial nodule. According to the mother, the nodule was observed at birth and had undergone several episodes of spontaneous healing and recurrence. Intraoral examination revealed a single pedicled normal-colored nodule with soft consistency and regular surface characteristics located on the right side of the lower lip. It measured 3 × 2 cm. The lesion was removed under local anesthesia, and histopathologic examination showed mucous extravasation phenomenon, confirming the clinical diagnosis of CM. The patient developed no complications after surgery and no clinical sign of recurrence after 12 months.

Salivary gland diseases: infections, sialolithiasis and mucoceles.

The three most frequently diagnosed salivary gland diseases are salivary gland infections, sialolithiasis and mucoceles. Salivary gland infections are usually of bacterial or viral etiology and can be divided into acute and chronic types. Occasionally they can result from obstruction of the salivary duct, an autoimmmune disease or cancer therapy. Infections can occur in all types of salivary glands and are observed at all ages. Sialolithiasis is characterized by the development of calcified structures in the salivary glands, especially in the submandibular gland. Sialoliths are generally attributed to retention of saliva and are usually accompanied by swelling and pain when a salivary stimulus is applied. Mucoceles can be differentiated into mucus extravasation phenomenon or mucus escape reaction, mucus retention cysts and ranulas. They result from extravasation of saliva into the surrounding soft tissues or from retention of saliva within the duct.

A review of 413 salivary gland tumours in the head and neck region

Objectives: Salivary gland tumours (SGTs) are a group of heterogeneous lesions with complex clinico-pathological characteristics and distinct biological behaviours. Previous studies have reported geographic variations in site distribution, incidence and histological types of SGTs. The aim of this study was to describe the demography of SGTs seen at a tertiary health centre and compare findings with previous studies. Study design: Data on SGTs from archives of the Department of Oral Pathology and the Department of Pathology, University College Hospital Ibadan were retrieved. Information about histological types, age, sex and location were analyzed using SPSS for Window (version 20.0; SPSS Inc. Chicago, IL). Reactive and tumor-like lesions such as sialometaplasia, benign lymphoepithelial lesion, lymphoepithelial cyst, mucocele, mucous extravasation phenomenon, ranula, and sialosis were excluded from the study. Results: 413 SGTs consisting of 221 (53.5%) malignant and 192 (46.5%) benign lesions were seen. SGTs occurred more in females (50.6%) than males (49.4%) with a mean age of 43.7 (±16.9) years and peak age in the fifth decade of life. The parotid with 171 (41.4%) cases was the commonest site, followed by palate with 89 (21.5%) cases, while only 7(1.7%) cases were seen in sublingual gland. Pleomorphic adenoma with 169 (40.9%) was the most frequent SGT followed by adenoid cystic carcinoma with 93 (22.5%) cases which also was the most frequent malignant SGT while only 3 (0.7%) cases of Warthin’s tumour were seen. Conclusion: This report is one of few that showed a higher occurrence of malignant SGTs compared to their benign counterparts. The findings were essentially similar to findings in Africa but showed SGTs to be more common in females. The reason(s) for high occurrence of malignant SGTs in minor salivary glands and the rarity of Warthins tumour in this study and other African series compared to those from America needs further investigation. Key words:Salivary gland tumours, parotid gland, pleomorphic adenoma, adenoid cystic carcinoma, warthin’s tumour.

Mucocele (Mucous Retention Cyst) - A Case Report

Oral mucoceles are small-size, benign minor salivary gland pathologies. Mucoceles are known to occur most commonly on the lower lip, followed by the floor of mouth and buccal mucosa being the next most frequent sites. They are caused by trauma, orthodontic devices, or biting habits. Two histological types exist–extravasation and retention phenomenon. Mucous retention phenomenon less frequently seen than mucous extravasation phenomenon. The purpose of this article is to describe a case of mucocele (mucous retention cyst) in lower labial mucosa.

Mucous extravasation phenomenon due to heterotopic seromucous glands arising in a thyroglossal duct

Mucous extravasation phenomenon due to heterotopic seromucous glands arising in a thyroglossal duct

Retrospective Survey of Biopsied Oral Lesions in Pediatric Patients

Although the general profile of oral biopsies from Asian children has been reported, it was still worth examining whether there were racial and geographic variations in the categories and incidence of pediatric oral lesions. This retrospective study mainly evaluated the categories and incidence of biopsied oral lesions in Taiwanese pediatric patients. Biopsy records of all oral lesions from pediatric patients, aged 0-14 years, in the files of the Department of Pathology, National Taiwan University Hospital from 1988 to 2007 were evaluated. The patients were divided into three age groups (0-5, 6-10, and 11-14 years), and the oral lesions were classified into four main categories: inflammatory and reactive, cystic, neoplastic, and other lesions. Of a total of 11,986 biopsied oral lesions, 797 (6.6%) were found in pediatric patients. The most common oral lesions were inflammatory and reactive (45.5%), followed by neoplastic (23.5%), cystic (22.2%), and other (8.8%) lesions. The majority of oral biopsies (47.3%) were taken from patients in the 11-14 years age group. Of the 187 oral neoplastic lesions, 178 (95%) were benign and nine (5%) were malignant, including two premalignant lesions. The maxilla (66 cases) and the mandible (61 cases) were the two most common sites for pediatric neoplastic lesions. The top five oral lesions in pediatric patients were mucous extravasation phenomenon (195 cases), dentigerous cyst (84 cases), odontoma (83 cases), radicular cyst (38 cases), and dental follicle (26 cases). The mucous extravasation phenomenon, odontoma, or dentigerous cyst was the most common inflammatory and reactive, neoplastic, or cystic lesion, respectively, in pediatric patients. The relatively high incidence of inflammatory and reactive lesions in pediatric patients implies the importance of stringent oral hygiene in children. Most oral neoplastic lesions in pediatric patients are benign, and malignant oral tumors rarely occur in pediatric patients.

Treatment of ranula using carbon dioxide laser – Case series report

Ranulas are mucus extravasation phenomenon formed after trauma to the sublingual gland or mucus retention from the obstruction of the sublingual ducts. There are various methods for treating ranulas, including marsupialization with or without open packing, excision of ranula with or without removal of sublingual gland, and laser excision and vaporization of ranula. The authors present a case series report on the use of carbon dioxide laser treatment for ranula and a literature review of cases treated using carbon dioxide laser. The authors' experience and reports in the literature indicate that carbon dioxide laser excision of ranula is safe with minimal or no recurrence.