Mucous Extravasation Research Articles

Sublingual Epidermoid Cyst Simulating a Plunging Ranula: 2 Rare Case Reports

The incidence ranging of the dermoid and epidermoid cysts on the head and neck, from 1.6 to 7.0%, and they represent less than 0.01% of all oral cavity cysts. Histologically, they can be further classified as epidermoid, dermoid or teratoid. We analyzed two rare cases of large epidermoid cysts of the floor of the mouth, with sublingual as well as submental component resembling plunging ranula. Two female patients (age 15 and 16 y. o.), who’s had sublingual and submental swellings of oral floor with breathing and swallowing difficulties. The suspected clinical diagnosis of the sublingual dermoid or epidermoid cysts were supported by the radiological finding after performing ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI). On the radiological investigation the differentiation between epidermoid cysts, ranulas, cystic tumours, mucous extravasation phenomena and hygromas sometimes indistinguishable, leading in the determination of internal component differentiation and has pathognomonic signs to differentiate. The lesions were surgically excised using an intraoral approach. Microscopic examinations revealed a dermoid cyst of the epidermoid type. Keywords: Sublingual Epidermoid Cyst, Plunging Ranula, Ultrasonography, Computed Tomography, Magnetic Resonance Imaging

Selected presentations of lip enlargement: clinical manifestation and differentiation.

Lip enlargement may be an important symptom of either systemic or local diseases. On the basis of selected age-matched clinical cases we present the possible causes of lip swelling. We describe the most representative symptoms and recommend treatment of these pathologies. We differentiate lip swelling in Miescher syndrome, monosymptomatic form of Melkersson-Rosenthal syndrome, lip swelling in erythema multiforme and Stevens-Johnson syndrome and lip hemangioma and mucous extravasation cyst. We compare different causes of lip edema and indicate the most helpful diagnostic and treatment methods.

Surgical management of plunging ranulas: a 10-year case series in South East Queensland.

Plunging ranulas are rare mucous extravasation pseudocysts that arise in the floor of the mouth and pass into the submandibular space of the neck. The aim of this study was to investigate the diagnosis, surgical management and outcomes of patients with a plunging ranula at our institution in South East Queensland over a 10-year period. A retrospective analysis of adult patients diagnosed with and treated for plunging ranula between 2006 and 2016 at Logan Hospital was conducted. Patient demographics, preoperative investigations, surgical management and post-operative outcomes were collected from medical records. A total of 18 adult patients were treated for plunging ranula. Of the 18 cases, 17 were treated via transoral excision of the sublingual gland. The mean age at presentation was 28.8 years with a 3:1 female to male predominance. Fifty-six percent of patients were of Polynesian descent. The success rate was 94% with only one patient experiencing recurrence and requiring re-excision of remnant sublingual gland tissue. Three patients (17%) developed complications related to post-operative bleeding. There was a slight predominance for right-sided disease (56%) compared with left and one case of bilateral plunging ranulas in this series. This study demonstrates that excision of the sublingual gland is an effective and safe treatment for plunging ranula. The majority of plunging ranulas occur in patients aged <30 years with a higher incidence in patients of Polynesian heritage, which is consistent with previous studies suggesting a possible underlying genetic predisposition for this condition.

Mucus Extravasation cyst as a complication of lingual frenectomy

Mucus Extravasation cyst as a complication of lingual frenectomy

SURGICAL TREATMENT OF ATYPICAL SIZE MUCOCELE IN THE LOWER LIP: A CASE REPORT

The aim of this study is to report a case of an atypical size mucocele on the lower lip region. A 28-year-old female patient, melanoderma, presented with a complaint of swelling in the lower lip for the last 8 months, painless with volumetric variation during this period, related to repetitive trauma caused by accidental biting, with eventual liquid drainage. On clinical examination, there was a floating nodule in the lower lip approximately 6 cm in its largest diameter, normally colored, with the presence of a small ulcerated area. Excisional biopsy was performed and the anatomic specimen was sent for histopathologic analysis. The microscopic diagnosis was mucous extravasation cyst (mucocele). Follow-up after 12 months revealed no recurrence of the lesion.

HISTOMORPHOMETRIC ANALYSIS OF CHRONIC SCLEROSING SIALOADENITIS

To perform histomorphometric comparison of chronic sclerosing sialoadenitis (CSS) with mucus extravasation cyst (MEC). Both lesions have similar etiology and sometimes may present the same clinical presentation. Two groups of 10 diagnosed cases of each lesion were evaluated. Histomorphometric evaluation comprise the inflammatory infiltration (number, location and intensity of lymphocyte foci adapted from the Sjögren's syndrome classification: FS <1, FS = 1, FS> 1, where 1 = 50 lymphocytes); periductal sclerosis; atrophy of the acinar; adipose tissue; ductal ectasia; ductal dilation. Microscopic sections were photographed under 400X magnitude and registered with Image Java (1.47) software. Data was analyzed through descriptive statistics and Anova test. Differences between the lesions were identified through ANOVA test P<.01. Lymphocyte foci was the major difference with 23 in CSS foci and 4 in M; the highest prevalence was FS <1 with 56.52% in the CSS and 75% in M. In both lesions there was preference for periductal or perivascular lymphocyte infiltrate focal areas. Lymphocyte foci counting adapted from Sjögren's classification may represent an important tool for differential diagnosis of CSS and MEC. The present study suggests an easy way to improve this diagnosis.

Ranula in an adult case series

The ranula is a cyst like mass arising from sublingual gland. It originates from extravasation of mucus from sublingual gland. Ranula can be simple and plunging. The name came from latin word means frog. The ranula can be seen in intraoral and it affects the submandibular space and adjacent structure in the neck. This paper reviews case series of two case of ranula one in floor of mouth and one in the floor and affecting the submandibular space plunging ranula; both case been successfully treated marsupialization were done in first case and excision of the sublingual gland were done in second case. No complication was observed during intraoperative and postoperative period and both patients are in follow up there is no recurrence in 1 year period till now.

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.

Management of Paediatric Oral Ranula: A Systematic Review

Ranula is mucous extravasation cyst that occurs in the floor of the mouth. There are various methods of management of paediatric oral ranula each of which has their own advantage and disadvantage. The aim of this paper was to systematically review the available literature on the management of paediatric oral ranula. A total of 64 articles were retrieved by electronic search. Based on the preset inclusion and exclusion criteria, a total of 21 articles were retrieved for full text analysis. The following characteristics were assessed from the retrieved articles: author, year of publication, study design, sample size, intervention, adverse effects and follow up period. The included studies consisted of the following study design: Seven articles were prospective clinical study, four articles were retrospective review, five articles were case series and five articles were case report. The mode of care varied from surgical excision to drug administration and lasers. The data obtained from the review, display a lack of high quality study, with proper sample size and adequate follow up period. Further, randomized clinical trials are required to help the clinicians devise a best treatment approach for the management of paediatric oral ranula.

Ranula, Surgical Versus Nonsurgical Treatment Alternatives

A review of literature describing performed ranula. The pathological condition called from latin term, derived ran frog, and ula small. It is defined as an extravasation of pseudocystic mucus and is subdivided into simple, where the volume increase occurs only on the floor of mouth and plunging in which an extravasation is given to the neck, accumulating saliva below the mylohyoid muscle. It also investigates about its etiology is unknown although there are certain factors such as obstruction of the excretory duct of the sublingual gland, trauma, surgery and congenital abnormalities have been implicated. Subsequently different types of treatments for ranula described with surgical approach and non-surgical approach. Including: 432 OK, carbon dioxide laser, cryosurgery, botulinum toxin, fenestration and continuous pressure, marsupialization, incision and drainage, surgical removal of the ranula and sublingual gland involved, among others. Sublingual gland removal is considered the most reliable method of treatment, although there are risks such as injury to the lingual nerve and submandibular duct.

Distribution of oral and maxillofacial lesions in pediatric patients from a Brazilian southeastern population

ObjectivesOral lesions affecting infants account for approximately 10% of all samples from diagnostic services and studies investigating the distribution of these lesions in pediatrics from different geographic areas are desired to improve the diagnostic knowledge of clinicians. Therefore, the aim of this study is to describe the distribution of oral lesions in a southeastern Brazilian population. MethodsThe oral pathology files of the University of Campinas was retrospectively reviewed for all cases diagnosed from 2000 to 2014 affecting patients 16-years-old and younger. Data on gender and diagnosis were retrieved from patients' oral pathology reports and included in a Microsoft Excel® database. ResultsOut of 34,138 cases, 2539 affected pediatric patients (7.4%) with a higher incidence in those with 13–16 years-old. Salivary gland disease was the most common group of lesions (37.1%), followed by mucosal pathology (13.6%) and odontogenic cysts (11.3%). Mucous extravasation cyst was the most common lesion (36.3%), followed by fibrous hyperplasia (5.6%) and dental follicle (5.2%). Dental lesions were uncommon (7.9%) and malignancies rare (0.4%). ConclusionsOur results were similar to previous studies and the small differences observed were more likely result of methodological variability and characteristics of the service of origin from where samples were collected.

Ranula Decompression Using Stitch and Stab Method: The Aluko Technique.

A ranula is a cystic lesion in the floor of the mouth, formed either as a retention cyst or pseudocyst as a result of extravasation of mucus in the surrounding tissue. It may be treated by micro-marsupialization, marsupialization or excision of lesion with or without the associated salivary gland. Marsupialization is usually achieved by cutting a slit and thereafter stitching the edges such that the epithelium of the exterior becomes continuous with that of the interior of a cyst. A stitch-and-stab technique of achieving patency of the created slit of marsupialized ranula is hereby presented. A stitch and stab technique using four parallel consecutive strokes of the needle with attached polyglactin 910 suture material in alternately opposing directions was employed in treatment of 31 consecutive ranula patients. 100% success was achieved using this technique in 31 ranulas. This stitch-and-stab technique for marsupialization has proven to be very successful. It is recommended for use by the general medical community, as it requires the Clinician to possess only minimal surgical skills. Bartholin's cyst can be so treated.

Ranula: A Rare Cause of Airway Obstruction

Ranulas are mucus-filled cysts that originate from the extravasation of mucus from the sublingual gland. They are typically painless, slow-growing swellings on the floor of the mouth associated with trauma or excretory ductal obstruction. They can, however, form rapidly, leading to airway compromise and respiratory failure. We present a case of a 34-year-old man requiring intensive care unit admission for closer airway monitoring due to rapid progression of a simple ranula. Airway obstruction resolved promptly with steroids and antibiotics.

Evaluation of OK-432 Injection Therapy as Possible Primary Treatment of Intraoral Ranula

A ranula is a pseudocyst caused by mucous extravasation from the sublingual gland. Recently, a sclerosing agent, OK-432 (picibanil), has been reported to be highly effective for treating lymphangioma and cervical cystic lesions. The present study assessed the effectiveness of OK-432 injection therapy for intraoral ranula to clarify whether it can be used as the primary treatment. The present study was a retrospective clinical study of patients with intraoral ranula who received OK-432 injection therapy from 2005 to 2015. The ranula size was measured on computed tomography or magnetic resonance imaging studies. We dissolved 1 Klinische Einheit (KE) unit of OK-432 powder in normal saline equal to the aspiration volume. The primary endpoint was the treatment results. The secondary endpoints were the relation between the treatment results and the lesion length and aspiration volume. A total of 23 patients received OK-432 injection therapy for an intraoral ranula. The mean lesion size was 19.96mm. The mean aspiration volume was 2.14mL. The number of injections was 1 to 4 (mean 1.70). The treatment results were complete regression (CR) in 18 (78.2%), partial regression (PR) in 3 (13.0%), and no response (NR) in 2 (8%) patients after the last injection. The overall efficacy rate was 91.2% (21 of 23). No serious complications were observed. The lesion length and aspiration volume of the CR group was 17.38mm and 1.40mL, respectively. The lesion length and aspiration volume of the PR/NR group was 29.20mm and 4.80mL, respectively. The PR/NR group lesions were significantly larger than the CR group lesions. OK-432 injection therapy for intraoral ranula is safe and effective compared with other surgical therapies. This therapy could potentially become a primary treatment of intraoral ranula.

Management of a mucocoele of the submandibular gland without removal of the gland: a case report

A mucocoele or extravasation of mucus is common in minor salivary glands, but unusual in major ones. Those from the submandibular gland are a diagnostic challenge and conventional management includes excision of the associated gland.We describe a 27-year-old man with a mucocoele of the submandibular gland that presented as a lateral cervical swelling and looked like a plunging ranula. The cystic lesion was completely excised and, to our knowledge, this is the first published case in which the submandibular gland was saved with no recurrence up to two years postoperatively.

Histopathological review of 667 cases of oral mucoceles with emphasis on uncommon histopathological variations.

Mucoceles can occur in the oral cavity, appendix, bladder, paranasal sinuses, and lacrimal sac. In the oral cavity, mucoceles arise from pathological alterations in the minor salivary gland ducts. In this study, we aimed to histologically reevaluate cases of oral mucoceles to identify possible variants. A total of 667 slides containing tissue sections stained with hematoxylin and eosin diagnosed as a phenomenon of mucus extravasation were analyzed under light microscopy by 4 previously trained examiners. In 128 cases (19.1%), 1 or more histopathological changes were identified. Twenty cases (2.9%) exhibited collagenous globular structures compatible with myxoglobulosis. In 30 cases (4.49%), dissociation of collagen fibers after mucin extravasation was observed. Fifty-four cases (8.09%) exhibited papillary synovial metaplasia-like change, and 32 (4.79%) showed a significant reduction in the lumen of the cavity due to large papillae. Twenty cases (2.9%) were compatible with superficial mucoceles, and in 11 cases (1.64%), the foamy macrophages showed an unusual solid arrangement, known as clear cell change. It is essential to recognize the possible histopathological changes in oral mucoceles to avoid diagnostic pitfalls.

Mucocèle congénitale de la face ventrale de la langue

Congenital cystic lesions of the oral cavity are an extremely rare occurrence. Their prenatal diagnosis is essential since they can impede respiratory and swallowing functions. We describe a case that was detected prenatally and discuss its management. A 21-year-old primigravida patient who was 23 weeks pregnant was referred to our obstetrics and gynecology center after fetal ultrasonography showed a cystic lesion of the oral cavity. She had no family history of any congenital anomalies. Ultrasonography showed a male fetus with an anechoic mass measuring 21×11 mm encompassing the entire oral cavity, evoking either a mucocele or a cystic hygroma. Magnetic resonance imaging (MRI) showed a fetus with a wide-open mouth, due to a well-demarcated protruding cystic mass with no solid component, suggestive of a mucocele. A prenatal sonographically guided percutaneous needle aspiration of mucous fluid was performed at 33 gestational weeks. Although the mucocele decreased significantly in size, it nevertheless continued to expand progressively. After an uncomplicated pregnancy, the patient had spontaneous onset of labor at 39 weeks of gestation. An iterative aspiration was performed in the same manner in utero, resulting in a complete collapse of the mucocele. If needed, intubation could be considered. A 3030-g male was born by vaginal delivery, without respiratory distress. Clinical examination showed the extremely opened mouth and confirmed the presence of a large cystic mass approximately 4 cm in diameter, of sublingual origin and encompassing the entire oral cavity. The continuous protrusion of the tongue was responsible for the infant's inability to close the mouth and be breastfed. After insertion of a feeding tube, the newborn had maxillofacial surgery consisting in marsupialization of the cyst at 2 days of age. The mucocele decreased in size and the postoperative course was uneventful. No recurrence was observed at 6 months' follow-up. Congenital mucoceles of the tongue are very rare benign lesions of the oral cavity, resulting from extravasation or retention of mucus from minor salivary glands. Their prevalence is unknown and, to our knowledge, less than ten cases of prenatal diagnosis have been previously reported. Such cystic lesions can cause respiratory distress and swallowing disorders in newborns. They are usually suspected on ultrasonography. MRI highlights the nature of the lesion and its locoregional connections with muscles and blood vessels. It provides a good analysis of the soft tissues and can distinguish between the muscles of the tongue and the pathologic mass. However, the use of CT has been reported when the diagnosis was made after childbirth or in adulthood. Given the risks of interference of the lesion with respiratory and swallowing functions, intrauterine decompression of the mucocele can be an option to prevent respiratory distress at birth and the need for neonatal intubation. Mucoceles provide somewhat confusing and disturbing ultrasonographic appearances, which can be stressful for the medical team and parents. Prenatal diagnosis and early surgical intervention (marsupialization, complete excision of the cyst or the salivary gland) can prevent risks of breathing distress and breastfeeding problems. Therefore, this strategy is essential to offer fast and satisfactory management of this rare but anxiety-producing congenital situation.

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.