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International Journal of Occupational Safety and Health, Vol 4 No 1 (2014) 38 – 40

Case Report

Surgical Management of Mucocele by Using Diode Laser:

Two Case Reports

Abstract:
Mucoceles are benign, mucus-containing cystic lesions of the minor salivary glands. They are not true Srinivasa T. S., Sana Farista, Parul
Agrawal, Priya Jain, Sushmita
cysts since most of them lack an epithelial lining. These lesion occur most commonly in the lower lip. Deonani, Varsha Goswami
This case report presents two cases of mucocele on the lower and upper lips. This lesion was Department of Periodontology,
Rungta College of Dental Sciences and
diagnosed based on history, clinical finding and histopathological examination. The excision of the Research,
Bhilai, Chhattisgarh, India.
lesion was planed using diode laser. After re-evaluation of both the patients healing was satisfactory.
Corresponding Author:
Key Words: Mucocele; Diode Laser; Mucus Extravasation Cyst; Excision; Recurrence. Dr. Sana Farista
Email: drsanas@yahoo.com
© 2014 IJOSH All rights reserved.

Introduction freezing (cryosurgery), micromarsupialisation and laser

vaporization. There are also some reports suggesting the use of
Mucoceles are defined as mucus-filled cavities that can
corticosteroid injections as an alternative to surgery [3].
appear in the oral cavity, appendix, gallbladder, paranasal
sinuses or lacrimal sac. It is the result of accumulation of mucous Case Presentation
due to the alteration in the minor salivary gland which causes
limited swelling. It is seventeenth most common salivary gland CASE 1: A 38 year old male patient reported to Department of
lesions seen in the oral cavity [1]. Periodontology, Rungta College of Dental Sciences and
Research, Bhilai with chief complaint of swelling in the lower lip
Mucocele are characterized by the accumulation of liquid or
since 1 month. History revealed that the lesion began as a small
mucoid material, giving rise to a rounded, well-circumscribed,
nodular growth in the left commissural region, and gradually
transparent and bluish-colored lesion of variable size. Soft in
continues to grow to the present size. The patient was in a good
consistency and fluctuant in response to palpation. These are
systemic health and his family history, medical history was
painless and tend to relapse. Mucoceles are usually
non-contributory. The dental history revealed that he had a habit
asymptomatic, though in some patients they can cause
of ghutkha chewing 3-4 packets a day since 20 years. He also
discomfort by interfering with speech, chewing or swallowing.
reported habit of lip biting during stress. On intraoral
However, in most cases these lesions rupture spontaneously or
examination, a pink colored, solitary swelling measuring about 2
traumatically a few hours after being formed, with the release of
x 2 cm in size was found. On palpation the swelling was soft,
a characteristic viscous, mucoid fluid. This may give the mistaken
fluctuant and non-tender. On the basis of history and clinical
impression of healing, since the lesion decreases in size or
presentation, a provisional diagnosis of mucocele was made
disappears. However, once the small perforation allowing release
and an excisional biopsy was planned with laser and the same
of the mucocele contents has healed, the secretions accumulate
was explained to the patient and his consent was taken.
again, and the lesion relapses. On the other hand, in the case of
repeated trauma, the lesion may become nodular and firm in Local anesthesia (2% lignocaine HCL with 1:80,000 Adrenaline)
response to palpation, with rupture in this situation being more was administered taking care not to directly infiltrate the lesion
difficult [2]. to avoid compromising the biopsy results. Then the lesion was
marked with the heamatoxlin pencil (Fig 1). The lip was then
Surgical excision of the lesion has been the main treatment
everted with digital pressure to increase the lesion’s
option. However, other options have been reported in the
prominence. Patient and staff used special eye glasses for
literature such as the creation of a pouch (marsupialisation),
Original Article / IJOSH/ ISSN 2091-0878

protection and all the laser safety protocol was followed prior to Figure 4. Pre-operative.
and during the laser procedure. A 940 nm diode laser (Ezlase,
Biolase, USA) was used to excise the lesion. A circular incision

Figure 1. Pre-oprative photograph

CASE 2: A 60 year old male patient visited to the Department

with a chief complains of swelling in the upper lip since 15 days.
was made around the lesion with the capsule intact along with History revealed that the lesion began as a small growth at the
the thin border of healthy adjacent tissue. The enucleated area left commissural region which was gradually growing over the
was further approximated and low level laser therapy was done past 15 days. The patient reported that swelling was interfering
(Fig 2). Then the exciseded tissue (Fig 3) was stored in formaline with the speech and also that he was edentulous since 1 year
and further sent for histopathological examination. and wanted the replacement of the same. On clinical
examination, the swelling was pink measuring 1 x 1 cm in size
Figure 2. Excised mass.
(Fig.5). On palpation the swelling was soft, fluctuant and
non-tender. On the basis of history and clinical presentation, a
provisional diagnosis of mucocele was made and an excisional
biopsy was planned with lasers and the same was explained to
the patient and his consent was taken. The procedure was
performed same as case 1. The patient was recalled after 15
days for postoperative checkup.

Figure 5. Pre-operative .

Figure 3. Post-operative .

The histopathological report revealed normal minor salivary

gland tissue and muscle fibres, thin epithelial lining is seen. A
large portion of mucinophages with inflammatory cells and
extravasted RBC’s was seen.
A postoperative instruction was given to the patient and was
instructed to stop the habit of lip biting. The patient was recalled Considering the history, clinical feature and histopathological
after 15 days for postoperative checkup (Fig 4). Patient is under report, a final diagnosis of ‘Extravasated Mucocele’ was made
observation and so far there is no evidence of recurrence. (6).

39
 International Journal of Occupational Safety and Health, Vol 4. No 1 (2014) 38– 40
Figure 6. Histopathological view References

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The Mucocele is a salivary gland lesion of traumatic origin which 6. Reinhard A. Neumann,Robert M. Knobler. Treatment of oral
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Salivary mucoceles are more common in the lower lip though 2012; 2(2): 115-18.
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the cheek, the palate, retromolar fossa and the dorsal surface of of mucocele of the lower lip with diode laser in pediatric
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There are various different treatment options, including

medication, Gamma-linolenic acid, cryosurgery, intralesional
corticosteroid injection, micromarsupialization, marsupialization
of the mucocele, conventional surgical removal of the lesion [6].

The surgical removal of the lesion sometimes leads to temporary

paresthesia, fibrous scar formation & recurrence of the lesion [8].

Vaporization with argon and Nd: YAG lasers has been described
for the treatment of mucoceles [7]. Both laser procedures
presented satisfactory results with low recurrence rates and were
well-tolerated by the patients [8].

Conclusion

Lasers apply a great technology and are useful for soft tissue
surgery in modern dentistry. In spite of all these advantages of
using lasers in soft tissue incisions Dental lasers provide an easy
and comfortable option of keeping the procedure efficacious as
well as minimally invasive. In our cases, there was no bleeding
during and after the procedure, No post operative swelling or any
discomfort was noted. Uneventful healing after laser therapy
adds to patient satisfaction.

Srinivasa T. S et al. 2014